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Original research
Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer
  1. Bochao Zhao1,2,
  2. Huiwen Lu1,
  3. Shiyang Bao1,
  4. Rui Luo1,
  5. Di Mei1,
  6. Huimian Xu1,
  7. Baojun Huang1
  1. 1 Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
  2. 2 Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
  1. Correspondence to Dr Baojun Huang, Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; bjhuangcmu{at}126.com

Abstract

Aim The aim of this study was to evaluate the risk factors for proximal resection margin involvement and its impact on survival outcome in patients with proximal gastric cancer.

Methods A total of 488 patients who underwent potentially curative resection for proximal gastric cancer were retrospectively reviewed. Clinicopathological characteristics and survival differences between patients with positive and negative resection margins were compared and prognostic factors were determined by Cox multivariate analysis.

Results In this study, 7.6% (37/488) of patients with proximal gastric cancer had a positive proximal resection margin after postoperative histopathological examination. Positive resection margins were significantly associated with advanced tumour stage and more aggressive biological features including larger tumour size, serosal invasion and lymphovascular invasion. Serosal invasion (OR 4.543, 95% CI 2.201 to 9.380, p<0.001) and lymphovascular invasion (OR 2.279, 95% CI 1.129 to 4.600, p<0.05) were independent risk factors for positive proximal resection margins. In terms of survival outcome, positive resection margins had an adverse impact on the prognosis of patients with proximal gastric cancer (median DFS: 20.7 vs 30.2 months, p<0.001). The multivariate analysis indicated that positive resection margins (HR 1.494, 95% CI 1.042 to 2.142, p=0.029), T stage (T3–T4, HR 2.264, 95% CI 1.484 to 3.454, p<0.001) and N stage (N1–N2 stage, HR 1.696, 95% CI 1.279 to 2.248, p<0.001; N3 stage, HR 2.691, 95% CI 1.967 to 3.681, p<0.001) were independent prognostic factors for patients with proximal gastric cancer.

Conclusion Proximal resection margin involvement was an indicator of more aggressive tumours and an independent prognostic factor for patients with proximal gastric cancer. Aggressive efforts should be made to achieve a negative resection margin if gastric cancer was deemed to be potentially resectable.

  • gastric cancer
  • gastric pathology
  • surgical pathology
  • surgery

http://dx.doi.org/10.1136/jclinpath-2019-206305

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    Footnotes

    • Handling editor Runjan Chetty.

    • Contributors All authors of this manuscript have made a significant contribution to this manuscript. BZ contributed to study design, data analysis, data interpretation and drafted this manuscript; HL and SB contributed to data analysis, data interpretation and performed statistical analysis; RL contributed to the acquisition of data and clinicopathological information; DM contributed to the preparation of this manuscript; HX and BH critically reviewed this manuscript and provided important guidance.

    • Funding This work was supported by the Natural Science Foundation of Liaoning Province (No. 20180530026).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Ethics Committee of China Medical University (ethical approval ID: AF-S0P-07-1.0-Ui), and all procedures performed in studies involving human participants were in accordance with the ethical standards published in the 1964 Helsinki Declaration and its later amendments.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data availability statement Data are available on reasonable request.