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[Tumor volume in advanced gastric cancer as a prognostic factor correlating with lymph node involvement]
Dragan Radovanović1, Nebojsa Mitrović, Dejan Stevanović
1Klinika za hirurgiju, Klinicko-bolnicki centar "Dr Dragisa Misović", Beograd. mitra@yubc.net
Introduction:
It has been established that measurement of tumor volume, rather than its diameter, is a better indicator of the depth of tumor invasion and lymph node involvement. The present study evaluates the significance of tumor volume as a prognostic factor in gastric cancer.
Material And Methods:
This prospective clinical trail included 87 patients with gastric cacncer admitted to Surgery Clinic "Dr. Dragisa Misović" in Belgrade from 1998 to 2003. All patients were evaluated by standard diagnostic procedures, and after that underwent radical surgical treatment. Oncologic-surgical principles recommended by Japanese Research Society for Gastric Cancer were respected. Tumor volume was determined by measurement of specimens that had been obtained during surgery and by histopathological analysis. These criteria were analyzed and correlated with the lymph node status and clinicopathological factors.
Results:
Single-factor analysis showed that lymph node metastases correlated with larger tumor diameter, larger tumor volume, depth of tumor invasion, diffuse and low-grade differentiation of the intestinal type of gastric carcinoma. Using a linear correlation coefficient, it was found that there was a highly significant correlation of tumor volume and number of metastatic nodes in groups between lymph nodes r = 0.567; p < 0.0001 in drainage group 1, r = 0.511; p < 0.0001 in drainage group II, r = 0.579; p < 0.0001 in drainage group III. Also, there was highly significant correlation with the total number of metastatic nodes (r = 0.577; p < 0.0001) and significant correlation with the depth of tumor invasion and tumor diameter (p < 0.05). With 97% sensitivity and 88% specificity, "cut off" point was established by determining the tumor volume above which there were metastases into lymph nodes. In this study that volume was 2750 cmm.
Conclusion:
Tumor volume can be used as a valuable prognostic factor for advanced gastric cancer, and hopefully it will be calculated preoperatively by 3D-EUS volumetric analysis.