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Prognostic impact of microscopic positive margin in gastric cancer patients
Tomoyuki Nagata1, Daisuke Ichikawa, Shuhei Komatsu
1Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
Background:
Complete resection with negative surgical margins has been a long-held surgical philosophy based on the concept that even minimal remaining cancer cells will develop recurrences.
Objectives:
This study investigated the clinical significance of microscopic positive margin on the outcome of patients with gastric cancers.
Methods:
The relationships between the margin status and other clinicopathologic factors were examined in gastric cancer patients undergoing gastrectomy, and then the prognostic impact of the margin status was evaluated by univariate and multivariate analysis.
Results:
The microscopic positive margin was identified in 23 patients (2.8%) by standard H&E staining. The positive margin showed a strong correlation significantly with tumor size (P < 0.05). Microscopic positive margin was found to be a significant prognostic factor on univariate analysis (5-year survival rate 51.9% vs. 82.2%, P < 0.0001), as well as multivariate analysis (risk ratio 3.24, 95% CI: 1.24-6.50, P < 0.01). Detailed analysis of margin status demonstrated that patients with positive margin in a deep site and/or in multiple layers showed poor survival.
Conclusions:
Microscopic positive margin was found to be an independent prognostic factor in gastric cancer patients. The status of the surgical margin might provide useful information for selecting additional treatments and performing intensive follow-up.
