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Original article
Prognostic significance of tumour infiltration growth pattern in patients with advanced gastric cancer
  1. Bochao Zhao1,
  2. Jiale Zhang1,
  3. Di Mei1,
  4. Xinyu Huang2,
  5. Shihui Zou1,
  6. Rui Luo1,
  7. Huimian Xu1,
  8. Baojun Huang1
  1. 1 Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
  2. 2 Department of Clinical Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
  1. Correspondence to Dr Baojun Huang, Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China; bjhuang{at}cmu.edu.cn

Abstract

Aims The prognostic significance of infiltration growth pattern (INF) in patients with gastric cancer (GC) remains controversial. In the present study, we evaluated the impact of INF pattern on the prognosis of patients with advanced GC.

Methods A total of 1455 patients with advanced GC who underwent curative gastrectomy in our institution were retrospectively analysed. All patients were histopathologically classified as INFa/b and INFc pattern according to the Japanese Classification of Gastric Cancer. The prognostic difference between two patterns was compared and clinicopathological features were analysed.

Results The prognosis of the patients with INFc pattern was poorer than that of those with INFa/b pattern (5-year disease-free survival, INFa/b: 48.4% vs INFc: 33.5%, p < 0.001), even when they were stratified according to lymph node metastasis and the tumour, node, metastases stage. In addition, the subgroup analysis indicated that INFc pattern was significantly associated with poorer prognosis of T2–T3 stage patients (T2, INFa/b: 72.7% vs INFc: 55.4%; T3, INFa/b: 47.4% vs INFc: 33.5%; p<0.001). However, a similar result was not observed among T4a stage patients (INFa/b: 26.8% vs INFc: 24.8%, p>0.05). The prognosis of T2 stage patients with INFc pattern was similar to that of T3 stage patients with INFa/b pattern (p>0.05). Also, there was no significantly prognostic difference between T3 stage patients with INFc pattern and T4a stage patients (p>0.05). The multivariate analysis indicated that INF pattern was an independent prognostic factor for patients with advanced GC (HR 1.259, 95%CI 1.089 to 1.454).

Conclusion In view of its prognostic significance, histopathological evaluation of INF pattern in surgically resected specimens should be recommended in patients with advanced GC.

  • gastric cancer
  • infiltration growth pattern
  • T stage
  • peritoneal recurrence
  • prognosis

https://doi.org/10.1136/jclinpath-2018-205403

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    Footnotes

    • Handling editor Dhirendra Govender.

    • Contributors BZ contributed to study design, data analysis, data interpretation and drafted this manuscript, JZ and DM contributed to data interpretation and performed statistical analysis, XH contributed to the preparation of this manuscript and critical revision, SZ and RL contributed to acquisition of data and clinicopathological information, HX and BH provided guidance and critically reviewed the manuscript.

    • Funding This work was supported by the National Natural Science Foundation of China (NSFC)(NO.81172408 NO.81272716) and Shenyang Municipal Science and Technology Plan Project (NO.17-231-1-49).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the Ethics Committee of China Medical University, 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; externally peer reviewed.