Proposal for a clinicopathological prognostic score for resected gastric cancer patients
Cristina Díaz del Arco1, Lourdes Estrada Muñoz2, Elena Molina Roldán3, Luis Ortega Medina1, Soledad García Gómez de las Heras4, Ángela Chávez5, Ma Jesús Fernández Aceñero6
1 Department of Surgery and Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid; Department of Pathology, Hospital Clínico San Carlos, Madrid, Spain
2 Department of Pathology, Hospital Rey Juan Carlos; Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Madrid, Spain
3 Department of Pathology, Hospital Clínico San Carlos, Madrid, Spain
4 Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Madrid, Spain
5 Department of Surgery, School of Medicine, Autónoma University of Madrid, Madrid, Spain
6 Department of Surgery and Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid; Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Cristina Díaz del Arco,
Department of Surgical Pathology, Hospital Clinico San Carlos. C/Profesor Martin Lagos s/n, 28040, Madrid
Source of Support: None, Conflict of Interest: None
Background: Factors other than pTNM stage have been associated with gastric cancer (GC) prognosis, and several alternative prognostic scores have been constructed. Our aims are to identify prognostic factors in western GC patients and to build clinicopathological prognostic models for overall survival (OS) and disease-free survival (DFS).
Methods: A Retrospective study of 204 cases of GC resected during the years 2000 to 2014 was conducted in our hospital. Clinicopathological features were assessed, univariate and multivariate analysis were performed and prognostic scores were constructed.
Results: Most patients were diagnosed at pTNM stages II and III (36.9% and 48.1%, respectively). According to Laurén classification, tumors were intestinal (55.8%), diffuse (35.2%) and mixed (9%). During follow-up, 43.5% of patients had tumor recurrence, and 28.6% died due to tumor. Univariate analysis showed that patient age, Laurén subtype, signet-ring cell morphology, pTNM stage, tumor grade, perineural invasion, growth pattern, intratumoral inflammation, adjuvant therapy, and desmoplasia were significantly related to tumor progression or death. Multivariate analysis showed that Laurén subtype, pT stage, and lymph node ratio (LNR) were significantly and independently associated with GC recurrence. Laurén subtype and LNR were significantly related to patient survival. Prognostic scores for tumor progression and death were developed and patients were classified into four prognostic groups which showed good prognostic performance.
Conclusion: A prognostic model comprising histological features such as Laurén subtype can be easily applied in clinical practice, and provides more prognostic information than pTNM stage alone. These models can further stratify resected GC patients and have the potential to aid in the individualization of patient management.