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Advantages of ypTNM Staging in Post-surgical Prognosis for Initially Unresectable or Stage IV Gastric Cancers

Journal of Gastric Cancer 2020년 20권 3호 p.233 ~ 244
정규성, 이인섭, 박영수, 김범수, 유문원, 육정환, 김병식,
소속 상세정보
정규성 ( Jeong Gyu-Seong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
이인섭 ( Lee In-Seob ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
박영수 ( Park Young-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
김범수 ( Kim Beom-Su ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
유문원 ( Yoo Moon-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
육정환 ( Yook Jeong-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김병식 ( Kim Byung-Sik ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

Abstract


Purpose: For unresectable or initially metastatic gastric cancer, conversion surgery (CVS), after systemic chemotherapy, has received attention as a treatment strategy. This study evaluated the prognostic value of ypTNM stage and the oncologic outcomes in patients receiving CVS.

Materials and Methods: A retrospective review of clinicopathologic findings and oncologic outcomes of 116 patients who underwent CVS with curative intent, after combination chemotherapy, between January 2000 and December 2015, has been reported here.

Results: Twenty-six patients (22.4%) underwent combined resection of another organ and 12 patients received para-aortic lymphadenectomy (10.3%). Pathologic complete remission (CR) was confirmed in 11 cases (9.5%). The median overall survival (OS) and disease-free survival (DFS) times were 35.0 and 21.3 months, respectively. In multivariate analysis, ypTNM stage was the sole independent prognostic factor for DFS (P=0.042). Tumors invading an adjacent organ or involving distant lymph nodes showed better survival than those with peritoneal seeding or solid organ metastasis (P=0.084). Kaplan-Meier curves showed that the 3-year OS rate of patients with pathologic CR and those with CR of the primary tumor but residual node metastasis was 81.8% and 80.0%, respectively. OS was 65.8% for stage 1 patients, 49.8% for those at stage 2, and 36.3% for those at stage 3.

Conclusions: The ypTNM staging is a significant prognostic factor in patients who underwent CVS for localized unresectable or stage IV gastric cancers. Patients with locally advanced but unresectable lesions or with tumors with distant nodal metastasis may be good candidates for CVS.

키워드

Gastric cancer; Conversion surgery; Metastasis; Stage IV; TNM staging

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