Clinical Significance of the Pre-albumin Level in Gastric Cancer Patients who Receive Curative Treatment

Clinical Significance of the Pre-albumin Level in Gastric Cancer Patients who Receive Curative Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Significance of the Pre-albumin Level in Gastric Cancer Patients who Receive Curative Treatment toru aoyama, Masato Nakazono, Kenki Segami, Shinsuke Nagasawa, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1009371/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background We investigated the clinical influence of the prealbumin level on the gastric cancer survival and recurrence after curative treatment. Methods This study included 447 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. Results A prealbumin level of 20 mg/dl was regarded as the optimal point of classification, considering the 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 80.7% and 65.0% in the low-prealbumin group, respectively, and 93.1% and 87.9% in the high-prealbumin group, respectively, a statistically significant difference (p<0.001). The RFS rates at 3 and 5 years after surgery were 71.7% and 68.0% in the low-prealbumin group, respectively, and 90.1% and 84.7% in the high-prealbumin group, respectively, a statistically significant difference (p=0.031). A multivariate analysis demonstrated that the prealbumin level was a significant independent risk factor for the OS and RFS. In addition, the rate of introduction of adjuvant chemotherapy was significantly lower and the frequency of peritoneal recurrence and lymph node recurrence significantly higher in the low-prealbumin group than in the high-prealbumin group. Conclusion Prealbumin is a risk factor for the survival in patients who undergo curative treatment for gastric cancer. It is necessary to develop an effective plan of perioperative care and surgical strategy according to the prealbumin level. Gastrointestinal Surgery Oncology prealbumin group survival level recurrence gastric Figures Figure 1 Figure 2 Introduction Gastric cancer is the third-most common cancer and the second leading cause of cancer-related death in the world. Every year, 1 million new cases of gastric cancer occur, with 800,000 gastric cancer deaths noted worldwide [1, 2]. Gastrectomy with D2 lymphadenectomy with or without pre- and/or postoperative adjuvant treatment is a global standard treatment for resectable gastric cancer. However, even when patients receive curative treatment, more than half develop recurrence [3-6]. Once recurrence manifests after curative treatment, the prognosis is limited. Thus, to further improve patients’ chances of a survival, it necessary to establish new approaches for treatment. Recently, the preoperative nutritional status was shown to affect the occurrence of postoperative surgical complications, toxicity of adjuvant treatment, and patient’s survival in various malignancies [7-10]. Although several scoring system and serum biomarker have been tested, optimal nutritional biomarkers have not yet been established. If physicians could assess optimal serum nutritional biomarker, they might be able to make or change treatment strategies according to those biomarkers. Pre-albumin, a negative acute-phase protein synthesized in the liver, recently became the focus of research as a serum biomarker for assessing the nutritional status [11]. In addition, prealbumin may serve as a more sensitive marker than albumin due to its shorter half-life (about 1.9 days) [12]. Several studies have also reported that prealbumin might be a prognostic factor in patients with lung cancer, esophageal cancer, and renal cell carcinoma [13-15]. However, few studies have assessed the prognostic value of prealbumin in gastric cancer patients who have received curative treatment [16-17]. In addition, the mechanism underlying the effect of prealbumin on the oncological outcomes in gastric cancer remains unclear. Therefore, we investigated whether or not the overall survival (OS) and recurrence-free survival (RFS) were affected by the prealbumin level and clarified the clinical course according to the prealbumin level in gastric cancer patients who underwent curative treatment. Patients And Methods Patients Patients were selected based on the medical records of consecutive patients who underwent curative resection for gastric cancer at Kanagawa Cancer Center from 2013 to 2017. The inclusion criteria were as follows: (1) histologically proven adenocarcinoma, (2) clinical stage I to III disease as evaluated using according the 15th edition of the general rules for gastric cancer published by the Japanese Gastric Cancer Association [18], and (3) complete (R0) resection of gastric cancer with radical lymph node dissection. Surgical procedure and adjuvant treatment All of the patients received distal or total gastrectomy with lymphadenectomy. D1+nodal dissection was performed for clinical stage IA disease, while D2 dissection was performed for clinical stage ≥IB. Patients diagnosed with pathological II or III disease received adjuvant chemotherapy for one year. In principle, patients with pathological stage II disease received S-1 monotherapy, while those with pathological stage III disease received S-1 plus docetaxel or capecitabine+oxaliplatin therapy. Follow‑up Hematological tests and physical examinations were performed at least every three months for five years. The carcinoembryonic antigen and CA19‑9 tumor marker levels were checked at least every three months for five years. Patients underwent computed tomography (CT) every 6-12 months until 5 years after surgery. Evaluations and statistical analyses The significance of differences between the prealbumin levels and clinic pathological parameters was determined using the χ 2 test. The Kaplan-Meier method was used to calculate the OS and RFS curves. Univariate and multivariate survival analyses were performed using a Cox proportional hazards model. P values of <0.05 were considered to indicate statistical significance. The SPSS software program (v27.0 J Win; SPSS, Chicago, IL, USA) was used for all statistical analyses. This study was approved by the IRB of Kanagawa Cancer Center. Results Patients We evaluated 447 patients in the present study. The median age was 68 (range: 32-90) years old, and 296 patients were male, while 151 were female. Based on the 3- and 5-year OS rate and previous studies, we set the cut-off value for prealbumin at 20 mg/dl in the preset study. When comparing the background characteristics between patients with prealbumin <20 mg/dl (low-prealbumin group) and prealbumin ≥20 mg/dl (high-prealbumin group), there were significant differences in the gender and clinical T and N status. The incidence rates of female patients and aggressive tumors were much higher in the low-prealbumin group than in the high-prealbumin group. Survival analyses and recurrence patterns Each clinicopathological factor was categorized as shown in Table 2 and analyzed for its prognostic significance. Univariate analyses for the OS showed that the pathological T factor, pathological N factor, histological type, lymphatic invasion, vascular invasion and prealbumin level were significant prognostic factors. The prealbumin level was therefore selected for the final multivariate analysis model. The OS rates at 3 and 5 years after surgery were 80.7% and 65.0% in the low-prealbumin group, respectively, and 93.1% and 87.9% in the high-prealbumin group, respectively, a statistically significant difference (p<0.001). The OS curves are shown in Figure 1 . Univariate analyses for the RFS showed that the prealbumin level was a significant prognostic factor. It was thus selected as a significant prognostic factor for the final multivariate analysis model ( Table 3 ). The RFS rates at 3 and 5 years after surgery were 71.7% and 68.0% in the low-prealbumin group, respectively, and 90.1% and 84.7% in the high-prealbumin group, respectively, a statistically significant difference (p=0.031). The RFS curves are shown in Figure 2 . Postoperative adjuvant chemotherapy course and recurrence patterns in the high- and low-prealbumin groups When comparing the postoperative course between the high- and low-prealbumin groups, there were some differences in the postoperative adjuvant chemotherapy course. In the present study, 28.0% (125/447) of patients needed postoperative adjuvant chemotherapy. Among them, 48.7% (38/78) needed postoperative adjuvant chemotherapy in the low-prealbumin group, while 23.6% (87/369) needed postoperative adjuvant chemotherapy in the high-prealbumin group, a significant difference (p<0.001). The introduction rate of postoperative adjuvant chemotherapy differed between the two groups. Among the patients who required postoperative adjuvant chemotherapy, only 71.1% (27/38) received it in the low-prealbumin group, while 86.2% (75/87) received it in the high-prealbumin group, a significant difference (p<0.001). The site of first relapse differed significantly between the high- and low-prealbumin groups ( Table 4 ). The incidence of peritoneal recurrence was significantly higher and lymph node metastasis marginally significantly higher in the low-prealbumin group than in the high-prealbumin group. Discussion We evaluated whether or not the preoperative prealbumin level has any clinical significance with regard to the oncological outcomes of gastric cancer patients who receive curative treatment. We found that the patients with a prealbumin level <20 mg/dl (low-prealbumin group) had significantly poorer outcomes than those with higher prealbumin levels (high-prealbumin group). In addition, the incidence of the introduction of postoperative adjuvant chemotherapy was significantly lower in the low-prealbumin group than in the high-prealbumin group. Therefore, our results suggest that the preoperative prealbumin level is a promising clinical prognostic marker for gastric cancer patients who receive multimodal treatment, and patients with a low prealbumin level require close attention in their postoperative clinical course, especially with regard to adjuvant chemotherapy. We found that the preoperative prealbumin level was a viable prognostic factor for gastric cancer patients. The hazard ratio (HR) for the OS was 2.375 (95% confidence interval [CI]: 1.362-4.144), and that for RFS the was 1.724 (95% CI: 1.052-2.832). Similar HRs were observed in previous studies. Han et al. evaluated the prognostic impact of preoperative prealbumin in 101 adenocarcinoma of esophagogastric junction (AEG) patients [16]. They set the cut-off value of prealbumin at 200 g/L and found that the prealbumin level was indeed a prognostic factor, with a high prealbumin level (≥200 g/L) associated the a longer OS in AEG patients than a low level. The HR for the OS (prealbumin 200 g/L) was 0.494 (95% CI: 0.271-0.901, p=0.021). In addition, Shen et al. evaluated the clinical significance of preoperative prealbumin in 731 stage II and III gastric cancer patients [17] with a cut-off value of 180 mg/l. They found that the preoperative prealbumin level was also a prognostic factor in their study. The median OS was 62 months in the high-prealbumin group and 46 months in the low-prealbumin group (HR: 1.362, 95% CI: 1.094-1.695), and the median RFS was 61 months in the high-prealbumin group and 37 months in the low-prealbumin group (HR: 1.369, 95% CI: 1.099-1.706). In both the present and previous studies, a high level of prealbumin demonstrated a positive association with the survival in gastric cancer patients. However, there remain some concerns associated with the use of the preoperative prealbumin level as a prognostic factor for gastric cancer. First, the optimal cut-off value and method of evaluating the prealbumin level are unclear. In the present study, we set the cut-off value according to the 3- and 5-year survival rates. Han et al. and Shen et al. set their cut-off values using a receiver operating characteristic (ROC) curve analysis based on the most prominent points on the ROC curves [16, 17]. While the cut-off values have been similar, standard evaluation methods need to be established. Second, the evaluation point of prealbumin is also important. In the present study, we measured the prealbumin level within three to four days before surgery, while the other two studies measured the level within seven days before surgery. The half-life of prealbumin is about 1.9 days [11, 12]. Thus, the timing of the evaluation of prealbumin might affect the cut-off value. A further analysis is needed to confirm the utility of prealbumin as a prognostic factor in daily clinical practice. We also found that the prealbumin level influenced the introduction of postoperative adjuvant chemotherapy and recurrence pattern. In the low-prealbumin group, almost half of the patients needed postoperative adjuvant chemotherapy, with 70% of them actually receiving adjuvant chemotherapy. In contrast, in the high-prealbumin group, only 20% of the patients needed postoperative adjuvant chemotherapy, with nearly 90% of them actually receiving adjuvant chemotherapy. Therefore, the merits of adjuvant chemotherapy were limited in the low-prealbumin group. In addition, the difference in the rate of the introduction of adjuvant chemotherapy affected the recurrence pattern. Peritoneal recurrence was significantly more frequent and lymph node metastasis marginally more frequent in the low-prealbumin group than in the high-prealbumin group. Several previous pivotal studies showed similar results. For example, the ACTS-GC trial, which assessed the usefulness and efficacy of S-1 adjuvant chemotherapy for locally advanced gastric cancer, demonstrated that effective adjuvant chemotherapy significantly suppressed and reduced peritoneal and lymph node recurrence [19]. The recurrence rates at the peritoneum and lymph node were 11.2% and 5.1%, respectively, in the adjuvant treatment group and 15.8% and 8.7%, respectively, in the surgery alone group in the ACTS-GC trial (p=0.009 and p=0.01, respectively). Given these previous findings, the prealbumin level was considered to have affected the rate of introduction of adjuvant chemotherapy, and this decreased rate of chemotherapy introduction affected the pattern of recurrence and resulted in a poor prognosis. Several limitations associated with the present study warrant mention. First, the present study was retrospective in nature and conducted at a single center, and the sample size was relatively small. Second, there was some degree of selection bias. In our institution, the surgical indication was determined by seven physicians, including an anesthesiologist, who took into consideration the activities of daily living, performance status, medical history, physical examination findings, and organ function, as is done in general community hospitals. However, there is a possibility that only patients with a good status were selected, as our hospital is a regional cancer center that treats only cancer patients. Elderly patients with co-morbidities who visit general hospitals often undergo surgery at the hospital at which they were diagnosed with gastric cancer. Indeed, the ASA physical status, incidence of co-morbidities, and pre-operative laboratory values were lower than in general hospital patients. Therefore, the gastric cancer patients in the present study were well selected and fit for surgery. Considering these limitations, the findings of our study should be validated in another cohort. In conclusion, prealbumin was determined to be a useful risk factor for the survival in patients who undergo curative treatment for gastric cancer. It is necessary to develop an effective plan of perioperative care and perioperative treatment strategy according to the prealbumin level. Declarations Authors’ Contributions TA and MN made substantial contributions to the concept and design. TA, MN, KS, SN, HS, KK, TY, IH, HW, MN, HT, TO, NY, TO and YR made substantial contributions to the acquisition of data and the analysis and interpretation of data. TA, HW, MN, HT, TO, NY and YR were involved in drafting the article or revising it critically for important intellectual content. TA, NM, KK and TO gave their final approval of the version to be published. Acknowledgment This work was supported by JSPS KAKENHI Grant Number 21K08688. 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Gastric Cancer. 14:101-12, 2011. PMID: 21573743. doi: 10.1007/s10120-011-0041-5. 19. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K; ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 357:1810-20, 2007. Doi: 10.1056/NEJMoa072252. Tables Table I. Patient characteristics Characteristics No. of patients (n=447, %) Low pre-albumin group (n=78) High pre-albumin group (n=369) p Value Age (years) 0.075 65 312 (69.8%) 61 (88.2%) 251 (68.0%) Gender <0.001 Man 296 (66.2%) 29 (37.2%) 267 (72.4%) Woman 151 (33.8%) 49 (62.8%) 102 (27.6%) Pathological type 0.656 Intestinal 228 (51.0%) 38 (48.7%) 190 (51.5%) Diffuse 219 (49.0%) 40 (51.3%) 179 (48.5%) UICC T status <0.001 T1 276 (61.7%) 33 (42.3%) 190 (51.5%) T2 to T4 171 (38.3%) 45 (57.7%) 126 (48.5%) Lymph node metastasis <0.001 Negative 319 (71.4%) 43 (55.1%) 276 (74.8%) Positive 128 (28.6%) 35 (44.9%) 93 (25.2%) Lymphatic invasion 0.024 Negative 141 (31.5%) 33 (42.3%) 108 (29.3%) Positive 306 (68.5%) 45 (57.7%) 261 (70.7%) Vascular invasion 0.009 Negative 193 (43.2%) 44 (56.4%) 149 (40.4%) Positive 254 (56.8%) 34 (43.6%) 220 (59.6%) Postoperative complications 0.221 Yes 66 (14.8%) 15 (19.2%) 51 (13.8%) No 381 (85.2%) 63 (80.8%) 318 (86.2%) UICC: Union for International Cancer Control. Table II. Uni and Multivariate Cox proportional hazards analysis of clinicopathological factors for overall survival. Factors No Univariate analysis Multivariate analysis OR 95%CI p Value OR 95%CI p Value Age (years) 0.129 -< 65 135 1.000 65≦- 312 1.561 0.879-2.774 Gender 0.209 0.098 Woman 151 1.000 1.000 Man 296 1.414 0.824-2.427 1.643 0.913-2.955 Pathological type 0.049 Intestinal 228 1.000 Diffuse 219 1.635 1.003-2.666 UICC T status <0.001 0.073 T1 228 1.000 1.000 T2-T4 219 4.518 2.675-7.632 1.816 0.946-3.487 Lymph node metastasis <0.001 <0.001 Negative 319 1.000 1.000 Positive 128 5.203 3.166-8.550 2.939 1.618-5.337 Pre-albumin level <0.001 0.002 20 <‐ 369 1.000 1.000 ‐< 20 78 3.045 1.839-5.041 2.375 1.362-4.144 Lymphatic invasion <0.001 Negative 141 1.000 Positive 306 3.072 1.896-4.978 Vascular invasion <0.001 0.083 Negative 193 1.000 1.000 Positive 254 4.197 2.443-7.210 1.736 0.930-3.238 Postoperative complications 0.843 Yes 66 1.000 No 381 1.074 0.532-2.167 UICC: Union for International Cancer Control. Table III. Uni and Multivariate Cox proportional hazards analysis of clinicopathological factors for recurrence free survival. Factors No Univariate analysis Multivariate analysis OR 95%CI p Value OR 95%CI p Value Age (years) 0.140 -< 65 135 1.000 65≦- 312 1.487 0.878-2.518 Gender 0.366 Woman 151 1.000 Man 296 1.252 0.769-2.036 Pathological type 0.077 Intestinal 228 1.000 Diffuse 219 1.500 0.957-2.351 UICC T status <0.001 0.010 T1 228 1.000 1.000 T2-T4 219 3.930 2.433-6.348 2.096 1.198-3.668 Lymph node metastasis <0.001 <0.001 Negative 319 1.000 1.000 Positive 128 4.612 2.933-7.252 3.087 1.806-5.278 Pre-albumin level <0.001 0.031 20 <‐ 369 1.000 1.000 ‐< 20 78 2.488 1.553-4.036 1.724 1.050-2.832 Lymphatic invasion <0.001 Negative 141 1.000 Positive 306 3.007 1.925-4.697 Vascular invasion <0.001 Negative 193 1.000 Positive 254 3.470 2.144-5.617 Postoperative complications 0.992 Yes 66 1.000 No 381 1.003 0.530-1.899 Table IV. Patterns of recurrence between the patients with pre-albumin level -< 20 and those with pre-albumin level 20 < ‐. Pre-albumin level All cases (n=447) ‐< 20 (n=78) 20 < - (n=369) Recurrence site Number % Number % Number % p Value Peritoneal 22 4.9% 8 10.3% 14 3.8% 0.017 Hematological 15 3.4% 4 5.1% 11 3.0% 0.339 Lymph node 10 2.2% 4 5.1% 6 1.6% 0.057 Local site 8 1.8% 3 3.8% 5 1.4% 0.132 Total 45 19 26 . Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Minor revision 27 Oct, 2021 Reviews received at journal 26 Oct, 2021 Reviewers invited by journal 26 Oct, 2021 Editor assigned by journal 25 Oct, 2021 First submitted to journal 22 Oct, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Shiritsu Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Keisuke","middleName":"","lastName":"Komori","suffix":""},{"id":59160807,"identity":"e7288b70-0bf1-4fbf-9d3a-d9dd68428334","order_by":11,"name":"Hiroshi Tamagawa","email":"","orcid":"","institution":"Yokohama City University: Yokohama Shiritsu Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hiroshi","middleName":"","lastName":"Tamagawa","suffix":""},{"id":59160808,"identity":"31b1df29-5624-44e0-8bc8-a65017a84f17","order_by":12,"name":"Norio Yukawa","email":"","orcid":"","institution":"Yokohama City University: Yokohama Shiritsu Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Norio","middleName":"","lastName":"Yukawa","suffix":""},{"id":59160809,"identity":"0e4a1536-91e9-4d12-a529-b1ea1be1d8ef","order_by":13,"name":"Yasushi Rino","email":"","orcid":"","institution":"Yokohama City University: Yokohama Shiritsu Daigaku","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yasushi","middleName":"","lastName":"Rino","suffix":""},{"id":59160810,"identity":"2192acc4-c9a7-4d73-8fef-47bd5085f258","order_by":14,"name":"Takashi Ogata","email":"","orcid":"","institution":"Kanagawa Cancer Center: Kanagawa Kenritsu Gan Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Ogata","suffix":""},{"id":59160811,"identity":"6094b20f-f1c2-466e-8f2f-a3c9db05ca3d","order_by":15,"name":"Takashi Oshima","email":"","orcid":"","institution":"Kanagawa Cancer Center: Kanagawa Kenritsu Gan Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Oshima","suffix":""}],"badges":[],"createdAt":"2021-10-22 23:56:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1009371/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1009371/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":14993547,"identity":"8412a457-6af4-4ff2-aa7e-a7f498d5be1f","added_by":"auto","created_at":"2021-10-28 15:29:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43062,"visible":true,"origin":"","legend":"A comparison of the overall survival in the patients with a prealbumin level of ≥20 versus \u003c20 mg/dl.","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-1009371/v1/6fcb9e3e974cb9849bcb6320.png"},{"id":14993546,"identity":"eb6e97d4-028d-4f44-a851-aa555c279914","added_by":"auto","created_at":"2021-10-28 15:29:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43045,"visible":true,"origin":"","legend":"A comparison of the recurrence-free survival in the patients with a prealbumin level of ≥20 versus \u003c20 mg/dl.","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-1009371/v1/d27f14411c44f85386c7ac17.png"},{"id":14993587,"identity":"0b65fa4f-9c12-46f7-8f74-8fdc3b89dfd5","added_by":"auto","created_at":"2021-10-28 15:29:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":328146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1009371/v1/4ef8ce3b-cd29-47ec-853b-359506107dbf.pdf"}],"financialInterests":"","formattedTitle":"Clinical Significance of the Pre-albumin Level in Gastric Cancer Patients who Receive Curative Treatment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGastric cancer is the third-most common cancer and the second leading cause of cancer-related death in the world. Every year, 1 million new cases of gastric cancer occur, with 800,000 gastric cancer deaths noted worldwide [1, 2]. Gastrectomy with D2 lymphadenectomy with or without pre- and/or postoperative adjuvant treatment is a global standard treatment for resectable gastric cancer. However, even when patients receive curative treatment, more than half develop recurrence [3-6]. Once recurrence manifests after curative treatment, the prognosis is limited. Thus, to further improve patients\u0026rsquo; chances of a survival, it necessary to establish new approaches for treatment.\u003c/p\u003e\n\u003cp\u003eRecently, the preoperative nutritional status was shown to affect the occurrence of postoperative surgical complications, toxicity of adjuvant treatment, and patient\u0026rsquo;s survival in various malignancies [7-10]. Although several scoring system and serum biomarker have been tested, optimal nutritional biomarkers have not yet been established. If physicians could assess optimal serum nutritional biomarker, they might be able to make or change treatment strategies according to those biomarkers.\u003c/p\u003e\n\u003cp\u003ePre-albumin, a negative acute-phase protein synthesized in the liver, recently became the focus of research as a serum biomarker for assessing the nutritional status [11]. In addition, prealbumin may serve as a more sensitive marker than albumin due to its shorter half-life (about 1.9 days) [12]. Several studies have also reported that prealbumin might be a prognostic factor in patients with lung cancer, esophageal cancer, and renal cell carcinoma [13-15]. However, few studies have assessed the prognostic value of prealbumin in gastric cancer patients who have received curative treatment [16-17]. In addition, the mechanism underlying the effect of prealbumin on the oncological outcomes in gastric cancer remains unclear.\u003c/p\u003e\n\u003cp\u003eTherefore, we investigated whether or not the overall survival (OS) and recurrence-free survival (RFS) were affected by the prealbumin level and clarified the clinical course according to the prealbumin level in gastric cancer patients who underwent curative treatment.\u003c/p\u003e"},{"header":"Patients And Methods","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients were selected based on the medical records of consecutive patients who underwent curative resection for gastric cancer at Kanagawa Cancer Center from 2013 to 2017. The inclusion criteria were as follows: (1) histologically proven adenocarcinoma, (2) clinical stage I to III disease as evaluated using according the 15th edition of the general rules for gastric cancer published by the Japanese Gastric Cancer Association [18], and (3) complete (R0) resection of gastric cancer with radical lymph node dissection.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurgical procedure and adjuvant treatment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll of the patients received distal or total gastrectomy with lymphadenectomy. D1+nodal dissection was performed for clinical stage IA disease, while D2 dissection was performed for clinical stage \u0026ge;IB. Patients diagnosed with pathological II or III disease received adjuvant chemotherapy for one year. In principle, patients with pathological stage II disease received S-1 monotherapy, while those with pathological stage III disease received S-1 plus docetaxel or capecitabine+oxaliplatin therapy.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFollow‑up\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHematological tests and physical examinations were performed at least every three months for five years. The carcinoembryonic antigen and CA19‑9 tumor marker levels were checked at least every three months for five years. Patients underwent computed tomography (CT) every 6-12 months until 5 years after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEvaluations and statistical analyses\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe significance of differences between the prealbumin levels and clinic pathological parameters was determined using the \u0026chi;\u003csup\u003e2\u003c/sup\u003e test. The Kaplan-Meier method was used to calculate the OS and RFS curves. Univariate and multivariate survival analyses were performed using a Cox proportional hazards model. P values of \u0026lt;0.05 were considered to indicate statistical significance. The SPSS software program (v27.0 J Win; SPSS, Chicago, IL, USA) was used for all statistical analyses. This study was approved by the IRB of Kanagawa Cancer Center.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe evaluated 447 patients in the present study. The median age was 68 (range: 32-90) years old, and 296 patients were male, while 151 were female. Based on the 3- and 5-year OS rate and previous studies, we set the cut-off value for prealbumin at 20 mg/dl in the preset study. When comparing the background characteristics between patients with prealbumin \u0026lt;20 mg/dl (low-prealbumin group) and prealbumin \u0026ge;20 mg/dl (high-prealbumin group), there were significant differences in the gender and clinical T and N status. The incidence rates of female patients and aggressive tumors were much higher in the low-prealbumin group than in the high-prealbumin group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurvival analyses and recurrence patterns\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach clinicopathological factor was categorized as shown in \u003cstrong\u003eTable 2\u003c/strong\u003e and analyzed for its prognostic significance. Univariate analyses for the OS showed that the pathological T factor, pathological N factor, histological type, lymphatic invasion, vascular invasion and prealbumin level were significant prognostic factors. The prealbumin level was therefore selected for the final multivariate analysis model. The OS rates at 3 and 5 years after surgery were 80.7% and 65.0% in the low-prealbumin group, respectively, and 93.1% and 87.9% in the high-prealbumin group, respectively, a statistically significant difference (p\u0026lt;0.001). The OS curves are shown in \u003cstrong\u003eFigure 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eUnivariate analyses for the RFS showed that the prealbumin level was a significant prognostic factor. It was thus selected as a significant prognostic factor for the final multivariate analysis model (\u003cstrong\u003eTable 3\u003c/strong\u003e). The RFS rates at 3 and 5 years after surgery were 71.7% and 68.0% in the low-prealbumin group, respectively, and 90.1% and 84.7% in the high-prealbumin group, respectively, a statistically significant difference (p=0.031). The RFS curves are shown in \u003cstrong\u003eFigure 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostoperative adjuvant chemotherapy course and recurrence patterns in the high- and low-prealbumin groups\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhen comparing the postoperative course between the high- and low-prealbumin groups, there were some differences in the postoperative adjuvant chemotherapy course. In the present study, 28.0% (125/447) of patients needed postoperative adjuvant chemotherapy. Among them, 48.7% (38/78) needed postoperative adjuvant chemotherapy in the low-prealbumin group, while 23.6% (87/369) needed postoperative adjuvant chemotherapy in the high-prealbumin group, a significant difference (p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe introduction rate of postoperative adjuvant chemotherapy differed between the two groups. Among the patients who required postoperative adjuvant chemotherapy, only 71.1% (27/38) received it in the low-prealbumin group, while 86.2% (75/87) received it in the high-prealbumin group, a significant difference (p\u0026lt;0.001).\u0026nbsp;The site of first relapse differed significantly between the high- and low-prealbumin groups (\u003cstrong\u003eTable 4\u003c/strong\u003e). The incidence of peritoneal recurrence was significantly higher and lymph node metastasis marginally significantly higher in the low-prealbumin group than in the high-prealbumin group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe evaluated whether or not the preoperative prealbumin level has any clinical significance with regard to the oncological outcomes of gastric cancer patients who receive curative treatment. We found that the patients with a prealbumin level \u0026lt;20 mg/dl (low-prealbumin group) had significantly poorer outcomes than those with higher prealbumin levels (high-prealbumin group). In addition, the incidence of the introduction of postoperative adjuvant chemotherapy was significantly lower in the low-prealbumin group than in the high-prealbumin group. Therefore, our results suggest that the preoperative prealbumin level is a promising clinical prognostic marker for gastric cancer patients who receive multimodal treatment, and patients with a low prealbumin level require close attention in their postoperative clinical course, especially with regard to adjuvant chemotherapy.\u003c/p\u003e\n\u003cp\u003eWe found that the preoperative prealbumin level was a viable prognostic factor for gastric cancer patients. The hazard ratio (HR) for the OS was 2.375 (95% confidence interval [CI]: 1.362-4.144), and that for RFS the was 1.724 (95% CI: 1.052-2.832). Similar HRs were observed in previous studies. Han et al. evaluated the prognostic impact of preoperative prealbumin in 101 adenocarcinoma of esophagogastric junction (AEG) patients [16]. They set the cut-off value of prealbumin at 200 g/L and found that the prealbumin level was indeed a prognostic factor, with a high prealbumin level (\u0026ge;200 g/L) associated the a longer OS in AEG patients than a low level. The HR for the OS (prealbumin \u0026lt;200 g/L for prealbumin \u0026gt;200 g/L) was 0.494 (95% CI: 0.271-0.901, p=0.021). In addition, Shen et al. evaluated the clinical significance of preoperative prealbumin in 731 stage II and III gastric cancer patients [17] with a cut-off value of 180 mg/l. They found that the preoperative prealbumin level was also a prognostic factor in their study. The median OS was 62 months in the high-prealbumin group and 46 months in the low-prealbumin group (HR: 1.362, 95% CI: 1.094-1.695), and the median RFS was 61 months in the high-prealbumin group and 37 months in the low-prealbumin group (HR: 1.369, 95% CI: 1.099-1.706). In both the present and previous studies, a high level of prealbumin demonstrated a positive association with the survival in gastric cancer patients.\u003c/p\u003e\n\u003cp\u003eHowever, there remain some concerns associated with the use of the preoperative prealbumin level as a prognostic factor for gastric cancer. First, the optimal cut-off value and method of evaluating the prealbumin level are unclear. In the present study, we set the cut-off value according to the 3- and 5-year survival rates. Han et al. and Shen et al. set their cut-off values using a receiver operating characteristic (ROC) curve analysis based on the most prominent points on the ROC curves [16, 17]. While the cut-off values have been similar, standard evaluation methods need to be established. Second, the evaluation point of prealbumin is also important. In the present study, we measured the prealbumin level within three to four days before surgery, while the other two studies measured the level within seven days before surgery. The half-life of prealbumin is about 1.9 days [11, 12]. Thus, the timing of the evaluation of prealbumin might affect the cut-off value. A further analysis is needed to confirm the utility of prealbumin as a prognostic factor in daily clinical practice.\u003c/p\u003e\n\u003cp\u003eWe also found that the prealbumin level influenced the introduction of postoperative adjuvant chemotherapy and recurrence pattern. In the low-prealbumin group, almost half of the patients needed postoperative adjuvant chemotherapy, with 70% of them actually receiving adjuvant chemotherapy. In contrast, in the high-prealbumin group, only 20% of the patients needed postoperative adjuvant chemotherapy, with nearly 90% of them actually receiving adjuvant chemotherapy. Therefore, the merits of adjuvant chemotherapy were limited in the low-prealbumin group. In addition, the difference in the rate of the introduction of adjuvant chemotherapy affected the recurrence pattern. Peritoneal recurrence was significantly more frequent and lymph node metastasis marginally more frequent in the low-prealbumin group than in the high-prealbumin group. Several previous pivotal studies showed similar results. For example, the ACTS-GC trial, which assessed the usefulness and efficacy of S-1 adjuvant chemotherapy for locally advanced gastric cancer, demonstrated that effective adjuvant chemotherapy significantly suppressed and reduced peritoneal and lymph node recurrence [19]. The recurrence rates at the peritoneum and lymph node were 11.2% and 5.1%, respectively, in the adjuvant treatment group and 15.8% and 8.7%, respectively, in the surgery alone group in the ACTS-GC trial (p=0.009 and p=0.01, respectively). Given these previous findings, the prealbumin level was considered to have affected the rate of introduction of adjuvant chemotherapy, and this decreased rate of chemotherapy introduction affected the pattern of recurrence and resulted in a poor prognosis.\u003c/p\u003e\n\u003cp\u003eSeveral limitations associated with the present study warrant mention. First, the present study was retrospective in nature and conducted at a single center, and the sample size was relatively small. Second, there was some degree of selection bias. In our institution, the surgical indication was determined by seven physicians, including an anesthesiologist, who took into consideration the activities of daily living, performance status, medical history, physical examination findings, and organ function, as is done in general community hospitals. However, there is a possibility that only patients with a good status were selected, as our hospital is a regional cancer center that treats only cancer patients. Elderly patients with co-morbidities who visit general hospitals often undergo surgery at the hospital at which they were diagnosed with gastric cancer. Indeed, the ASA physical status, incidence of co-morbidities, and pre-operative laboratory values were lower than in general hospital patients. Therefore, the gastric cancer patients in the present study were well selected and fit for surgery. Considering these limitations, the findings of our study should be validated in another cohort.\u003c/p\u003e\n\u003cp\u003eIn conclusion, prealbumin was determined to be a useful risk factor for the survival in patients who undergo curative treatment for gastric cancer. It is necessary to develop an effective plan of perioperative care and perioperative treatment strategy according to the prealbumin level.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTA and MN made substantial contributions to the concept and design. TA, MN, KS, SN, HS, KK, TY, IH, HW, MN, HT, TO, NY, TO and YR made substantial contributions to the acquisition of data and the analysis and interpretation of data. TA, HW, MN, HT, TO, NY and YR were involved in drafting the article or revising it critically for important intellectual content. TA, NM, KK and TO gave their final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by JSPS KAKENHI Grant Number 21K08688.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest in association with the present study.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68: 394-424, 2018. PMID: 30207593. DOI: 10.3322/caac.21492\u003c/p\u003e\n\u003cp\u003e2. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 396:635-648, 2020. PMID: 32861308. 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Muro K, Van Cutsem E, Narita Y, Pentheroudakis G, Baba E, Li J, Ryu MH, Zamaniah WIW, Yong WP, Yeh KH, Kato K, Lu Z, Cho BC, Nor IM, Ng M, Chen LT, Nakajima TE, Shitara K, Kawakami H, Tsushima T, Yoshino T, Lordick F, Martinelli E, Smyth EC, Arnold D, Minami H, Tabernero J, Douillard JY. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with metastatic gastric cancer: a JSMO-ESMO initiative endorsed by CSCO, KSMO, MOS, SSO and TOS. Ann Oncol. 30:19-33, 2019. PMID: 30475956. Doi: 10.1093/annonc/mdy502.\u003c/p\u003e\n\u003cp\u003e7. Shimoda Y, Fujikawa H, Komori K, Watanabe H, Kano K, Yamada T, Shiozawa M, Morinaga S, Katsumata K, Tsuchida A, Ogata T, Oshima T. Preoperative utility of the Glasgow Prognostic Score on outcomes of patients with locally advanced gastric cancer. J Gastrointest Cancer. 2021. PMID: 33460001. Doi: 10.1007/s12029-021-00584-3.\u003c/p\u003e\n\u003cp\u003e8. Wang N, Xi W, Lu S, Jiang J, Wang C, Zhu Z, Yan C, Liu J, Zhang J. A novel inflammatory-nutritional prognostic scoring system for stage III gastric cancer patients with radical gastrectomy followed by adjuvant chemotherapy. Front Oncol.11:650562, 2021. PMID: 34195071. Doi: 10.3389/fonc.2021.650562.\u003c/p\u003e\n\u003cp\u003e9. Inoue H, Kosuga T, Kubota T, Konishi H, Shiozaki A, Okamoto K, Fujiwara H, Otsuji E. Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer. World J Surg Oncol. 19:173, 2021. PMID: 34118953. Doi: 10.1186/s12957-021-02286-3.\u003c/p\u003e\n\u003cp\u003e10. Zhang X, Fang H, Zeng Z, Zhang K, Lin Z, Deng G, Deng W, Guan L, Wei X, Li X, Jiang L, Xu L. Preoperative Prognostic Nutrition Index as a Prognostic Indicator of Survival in Elderly Patients Undergoing Gastric Cancer Surgery. Cancer Manag Res. 13:5263-5273, 2021. PMID: 34239325. Doi: 10.2147/CMAR.S316437.\u003c/p\u003e\n\u003cp\u003e11. Keller U. Nutritional Laboratory Markers in Malnutrition. J Clin Med. 31;8:775, 2019. PMID: 31159248. Doi: 10.3390/jcm8060775.\u003c/p\u003e\n\u003cp\u003e12. Raiten DJ, Sakr Ashour FA, Ross AC, Meydani SN, Dawson HD, Stephensen CB, Brabin BJ, Suchdev PS, van Ommen B; INSPIRE Consultative Group. Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE). 145:1039S-1108S, 2015. Epub 2015 Apr 1. PMID: 25833893. Doi: 10.3945/jn.114.194571.\u003c/p\u003e\n\u003cp\u003e13. Kawai H, Ota H. Low perioperative serum prealbumin predicts early recurrence after curative pulmonary resection for non-small-cell lung cancer. World J Surg. 36:2853-7, 2012. PMID: 22948197. Doi: 10.1007/s00268-012-1766-y.\u003c/p\u003e\n\u003cp\u003e14. Kelly P, Paulin F, Lamont D, Baker L, Clearly S, Exon D, Thompson A. Pre-treatment plasma proteomic markers associated with survival in oesophageal cancer. Br J Cancer. 106(5):955-61, 2012. PMID: 22294182. Doi: 10.1038/bjc.2012.15.\u003c/p\u003e\n\u003cp\u003e15. Cai W, Kong W, Dong B, Zhang J, Chen Y, Xue W, Huang Y, Zhou L, Huang J. Pretreatment Serum Prealbumin as an Independent Prognostic Indicator in Patients With Metastatic Renal Cell Carcinoma Using Tyrosine Kinase Inhibitors as First-Line Target Therapy. Clin Genitourin Cancer. 15:e437-e446, 2017. PMID: 28188047. doi: 10.1016/j.clgc.2017.01.008.\u003c/p\u003e\n\u003cp\u003e16. Han WX, Chen ZM, Wei ZJ, Xu AM. Preoperative pre-albumin predicts prognosis of patients after gastrectomy for adenocarcinoma of esophagogastric junction. World J Surg Oncol.14:279, 2016. PMID: 27809860. Doi: 10.1186/s12957-016-1035-x.\u003c/p\u003e\n\u003cp\u003e17. Shen Q, Liu W, Quan H, Pan S, Li S, Zhou T, Ouyang Y, Xiao H. Prealbumin and lymphocyte-based prognostic score, a new tool for predicting long-term survival after curative resection of stage II/III gastric cancer. Br J Nutr. 120:1359-1369, 2018. PMID: 30370885. Doi: 10.1017/S0007114518002854.\u003c/p\u003e\n\u003cp\u003e18. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 14:101-12, 2011. PMID: 21573743. doi: 10.1007/s10120-011-0041-5.\u003c/p\u003e\n\u003cp\u003e19. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K; ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 357:1810-20, 2007. Doi: 10.1056/NEJMoa072252.\u0026nbsp;\u003c/p\u003e"},{"header":"Tables","content":"\u003cp\u003eTable I. Patient characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003eNo. of patients (n=447, %)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003eLow pre-albumin group (n=78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003eHigh pre-albumin group (n=369)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt; 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e135 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e17 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e118 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cu\u003e\u0026gt;\u003c/u\u003e 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e312 (69.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e61 (88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e251 (68.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e296 (66.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e29 (37.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e267 (72.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e151 (33.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e49 (62.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e102 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Intestinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e228 (51.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e38 (48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e190 (51.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Diffuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e219 (49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e40 (51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e179 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"42.10526315789474%\"\u003e\n \u003cp\u003eUICC T status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.720893141945773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.647527910685806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e276 (61.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e33 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e190 (51.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;T2 to T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e171 (38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e45 (57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e126 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"42.10526315789474%\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.720893141945773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.647527910685806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e319 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e43 (55.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e276 (74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e128 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e35 (44.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e93 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"42.10526315789474%\"\u003e\n \u003cp\u003eLymphatic invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.720893141945773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.647527910685806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e141 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e33 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e108 (29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e306 (68.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e45 (57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e261 (70.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"42.10526315789474%\"\u003e\n \u003cp\u003eVascular invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.720893141945773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.647527910685806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e193 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e44 (56.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e149 (40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e254 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e34 (43.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e220 (59.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"42.10526315789474%\"\u003e\n \u003cp\u003ePostoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.720893141945773%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.647527910685806%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e66 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e15 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e51 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"24.121405750798722%\"\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.891373801916934%\"\u003e\n \u003cp\u003e381 (85.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"24.76038338658147%\"\u003e\n \u003cp\u003e63 (80.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.68370607028754%\"\u003e\n \u003cp\u003e318 (86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.543130990415335%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUICC: Union for International Cancer Control.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable II. Uni and Multivariate Cox proportional hazards analysis of clinicopathological factors for overall survival.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.933977455716587%\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"7.568438003220612%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"36.553945249597426%\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"34.94363929146538%\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"14.831460674157304%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.348314606741575%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.831460674157304%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.808988764044944%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.348314606741575%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.831460674157304%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;-\u0026lt; 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;65≦-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.879-2.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Man\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.824-2.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.913-2.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Intestinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Diffuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e1.003-2.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003eUICC T status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;T2-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e4.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e2.675-7.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.816\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.946-3.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e5.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e3.166-8.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e2.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e1.618-5.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003ePre-albumin level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;20 \u0026lt;‐\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp; ‐\u0026lt; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e3.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e1.839-5.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e2.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e1.362-4.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003eLymphatic invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e3.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e1.896-4.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"28.456591639871384%\"\u003e\n \u003cp\u003eVascular invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e4.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e2.443-7.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e0.930-3.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003ePostoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.532-2.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUICC: Union for International Cancer Control.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable III. Uni and Multivariate Cox proportional hazards analysis of clinicopathological factors for recurrence free survival.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.933977455716587%\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"7.568438003220612%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"36.553945249597426%\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"34.94363929146538%\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"14.831460674157304%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.348314606741575%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.831460674157304%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.808988764044944%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.348314606741575%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.831460674157304%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;-\u0026lt; 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;65≦-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.878-2.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Man\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.769-2.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Intestinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Diffuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.957-2.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003eUICC T status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;T2-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e3.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e2.433-6.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e2.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e1.198-3.668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e4.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e2.933-7.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e3.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e1.806-5.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003ePre-albumin level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;20 \u0026lt;‐\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp; ‐\u0026lt; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e2.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e1.553-4.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e1.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e1.050-2.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003eLymphatic invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e3.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e1.925-4.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"28.456591639871384%\"\u003e\n \u003cp\u003eVascular invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e3.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e2.144-5.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"25.884244372990352%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"39.067524115755624%\"\u003e\n \u003cp\u003ePostoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.90032154340836%\"\u003e\n \u003cp\u003e\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.556270096463023%\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e0.530-1.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.163987138263666%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.27331189710611%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.610932475884244%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable IV. Patterns of recurrence between the patients with pre-albumin level -\u0026lt; 20 and those with pre-albumin level 20 \u003cu\u003e\u0026lt;\u003c/u\u003e‐.\u003c/p\u003e\n\u003ctable align=\"left\" border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" width=\"48.40499306518724%\"\u003e\n \u003cp\u003ePre-albumin level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.72222222222222%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"20.97222222222222%\"\u003e\n \u003cp\u003eAll cases\u003c/p\u003e\n \u003cp\u003e(n=447)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"24.86111111111111%\"\u003e\n \u003cp\u003e‐\u0026lt; 20\u003c/p\u003e\n \u003cp\u003e(n=78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"23.61111111111111%\"\u003e\n \u003cp\u003e20 \u003cu\u003e\u0026lt;\u003c/u\u003e-\u003c/p\u003e\n \u003cp\u003e(n=369)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.833333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003eRecurrence site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.0374479889043%\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003ePeritoneal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e4.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.0374479889043%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e10.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e3.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003eHematological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.0374479889043%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e3.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003eLymph node\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.0374479889043%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003eLocal site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.0374479889043%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e3.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e1.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"19.694868238557557%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.540915395284328%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.0374479889043%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.789181692094314%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.818307905686547%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"prealbumin, group, survival, level, recurrence, gastric","lastPublishedDoi":"10.21203/rs.3.rs-1009371/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1009371/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground We investigated the clinical influence of the prealbumin level on the gastric cancer survival and recurrence after curative treatment.\u003c/p\u003e\u003cp\u003eMethods This study included 447 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. \u003c/p\u003e\u003cp\u003eResults A prealbumin level of 20 mg/dl was regarded as the optimal point of classification, considering the 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 80.7% and 65.0% in the low-prealbumin group, respectively, and 93.1% and 87.9% in the high-prealbumin group, respectively, a statistically significant difference (p\u0026lt;0.001). The RFS rates at 3 and 5 years after surgery were 71.7% and 68.0% in the low-prealbumin group, respectively, and 90.1% and 84.7% in the high-prealbumin group, respectively, a statistically significant difference (p=0.031). A multivariate analysis demonstrated that the prealbumin level was a significant independent risk factor for the OS and RFS. In addition, the rate of introduction of adjuvant chemotherapy was significantly lower and the frequency of peritoneal recurrence and lymph node recurrence significantly higher in the low-prealbumin group than in the high-prealbumin group. \u003c/p\u003e\u003cp\u003eConclusion Prealbumin is a risk factor for the survival in patients who undergo curative treatment for gastric cancer. It is necessary to develop an effective plan of perioperative care and surgical strategy according to the prealbumin level.\u003c/p\u003e","manuscriptTitle":"Clinical Significance of the Pre-albumin Level in Gastric Cancer Patients who Receive Curative Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-10-28 15:29:47","doi":"10.21203/rs.3.rs-1009371/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2021-10-28T02:33:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-10-26T21:25:56+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-10-26T08:35:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-10-26T02:48:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Gastrointestinal Cancer","date":"2021-10-22T19:56:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dbd0793a-6633-4556-a275-60ccae2cb7f3","owner":[],"postedDate":"October 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":8145724,"name":"Gastrointestinal Surgery"},{"id":8145725,"name":"Oncology"}],"tags":[],"updatedAt":"2021-10-31T22:47:18+00:00","versionOfRecord":[],"versionCreatedAt":"2021-10-28 15:29:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1009371","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1009371","identity":"rs-1009371","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}