The Prognostic Impact of Macroscopic Serosal Change on Resectable Advanced Gastric Cancer

Abstract Background: Advanced gastric cancer sometimes causes macroscopic serosal change (MSC) due to direct invasion or inflammation. However, the prognostic significance of MSC remains unclear.Methods: We retrospectively reviewed the clinical records of 1410 patients who had been diagnosed with deeper-than-pathological-T2 gastric cancer and undergone R0 gastrectomy with lymph node dissection between January 2000 and December 2012 at the National Cancer Center Hospital, Japan. Results: MSC was not found in 108 of the 506 patients with pathological T4a (21.3%), whereas it was detected in 250 of the 904 patients with pathological T2-T3 (27.7%). The sensitivity, specificity and accuracy for diagnosing pathological serosa exposed (SE) by MSC were 78.7%, 72.3% and 74.6%, respectively. The MSC-positive cases had a worse 5-year overall survival (OS) than the MSC-negative cases in pT3 (72.9% vs. 84.3%, p=0.001), pT4a (56.2% vs. 73.4%, p=0.001), pStageIIB (76.0% vs. 88.4%, p=0.005), pStageIIIA (63.4% vs. 75.6%, p=0.019), pStageIIIB (53.6% vs. 69.2%, p=0.029) and pStage IIIC (27.6% vs. 50.0%, p=0.062). A multivariate analysis showed that MSC was a significant independent predictor for the OS (hazard ratio [HR], 1.587) along with the tumor depth (HR, 7.742), nodal status (HR, 5.783) and age (HR, 2.382). Peritoneal recurrence rates were higher in the MSC-positive cases than in the MSC-negative cases at each pT stage.Conclusions: MSC was an important prognostic factor in patients with resectable locally advanced gastric cancer. MSC should be considered when predicting the patient prognosis.