Risk stratification for predicting postoperative recurrence of gastric cancer by grade of venous invasion

BMC Gastroenterology

Research

Yasuo Imai¹  Masanori Ichinose²  Yoshihiro Kurata³ 

[1] Department of Diagnostic Pathology, Ota Memorial Hospital, SUBARU Health Insurance Society, 455-1 Oshima, 373-8585, Ota, Gunma, Japan;Department of Digestive Surgery, Shioya Hospital, International University of Health and Welfare, Tochigi, Japan;Department of Digestive Surgery, Shioya Hospital, International University of Health and Welfare, Tochigi, Japan;Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan;

关键词: Gastric cancer;    Stomach cancer;    Venous invasion;    EVG staining;    Recurrence;    Metastasis;    Adjuvant chemotherapy;    ACTS-GC;    S-1;    Differentiation grade;   

DOI  :  10.1186/s12876-023-02825-0

 received in 2022-11-01, accepted in 2023-05-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundVenous invasion (VI) in pathological examination of surgically resected gastric cancer (GC) may predict postoperative recurrence, but there are no objective criteria for VI grading.Methods157 GC patients (pathological stages I 82, II 34, and III 41) who underwent surgery with curative intent were analyzed. VI was graded in pathological examination by elastica van Gieson staining based on the number of VIs per glass slide as follows: v0, 0; v1, 1−3; v2, 4−6; and v3, ≥ 7. Filling-type invasion in veins with a minor axis of ≥ 1 mm increased the grade by 1. The association of VI grade with prognosis was statistically analyzed.ResultsRecurrence increased with VI grade (v0 1.5%, v1 29.6%, v2 41.7%, v3 78.6%). VI grade as well as pathological (p) tumor, node, metastasis (TNM) stage was a significant recurrence predictor by the multivariate Cox analysis. VI grade was implicated in hematogenous and peritoneal recurrences independent of pTNM stage but not in nodal recurrence. GC was then divided into two tiers, without indication of adjuvant chemotherapy (AC) (pStage I, pT1 and pT3N0) and with AC indication (pStages remaining II/III), based on the ACTS-GC trial, which is common in Japan and East Asia. VI grade was a significant recurrence predictor in both tiers. v2/v3 revealed a significantly worse recurrence-free survival (RFS) than v0/v1 in GC without AC indication. v0/v1 exhibited RFS rate exceeding 95% even after 5 years but that of v2/v3 fell around 70% within one year postoperatively, suggesting that AC may be considered for this tier with v2/v3. GC with AC indication exhibited dismal RFS according to the VI grade. RFS rate fell below 80% within one year postoperatively when VI was positive, while recurrence was not observed in v0, which was, however, rare in this tier (10.9%). Differentiation grade did not significantly affect postoperative prognosis in both tiers.ConclusionsVI grade was a significant predictor of postoperative GC recurrence irrespective of the AC indication based on the ACTS-GC study and this VI grading system could be applied in future studies of adjuvant therapy in GC presently deemed without AC indication in Japan.

【 授权许可】

CC BY   
© The Author(s) 2023

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