Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach

AIM： To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS： We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic （ROC） curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups： those with large-sized tumors （LSTs） and those with small-sized tumors （SSTs）. The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival （OS） rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox＇s propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS： The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively （AUC=0.795, 95%CI： 0.751-0.839, P=0.000）. Using this cutoff value, 222 patients （51.6%） had LSTs （tumor size ≥ 4.8 cm） and 208 （48.4%） had SSTs （tumor size〈4.8 cm）. Tumor size was significantly correlated with histological type （P=0.039）, Borrmann type （P=0.000）, depth of tumor invasion （P=0.000）, lymph node metastasis （P=0.000）, tumor-nodes metastasis stage （P=0.000）, mean number of metastatic lymph nodes （P=0.000） and metastatic lymph node ratio （P=0.000）. Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs （37.1% vs 63.3%, P=0.000）. Univariate analysis showed that depth of tumor invasion （c 2=69.581, P=0.000）, lymph node metastasis （c 2=138.815, P=0.000）, tumor size （c 2=78.184, P=0.000） and metastatic lymph node ratio （c 2=139.034, P=0.000） were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion （P=0.000）, lymph node metastasis （P=0.019） and tumor size （P=0.000） were independent prognostic factors. Gastric cancers were divided into 12 subg