Prognostic factors in T4b gastric cancer after surgery: A more balanced and sequential therapy for patients?

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gastric cancer (GC) remains a significant global health challenge.
• T4b GC, characterized by extensive local invasion, presents unique therapeutic challenges.
• Identifying prognostic factors is crucial for optimizing treatment strategies in advanced GC.

Purpose of the Study:

• To evaluate prognostic factors in T4b gastric cancer (GC).
• To identify clinicopathological factors associated with overall survival (OS) in T4b GC patients.
• To assess the impact of postoperative chemotherapy on survival and inflammatory/nutritional markers.

Main Methods:

• Retrospective analysis of 43 T4b GC patients who underwent surgery.
• Univariate and multivariate analyses to determine independent prognostic factors for OS.
• Assessment of laboratory parameters 4 weeks post-surgery in relation to chemotherapy.

Main Results:

• Distant metastases were present in 44.2% of patients; R0 resection was achieved in 30.2%.
• Multivariate analysis identified distant metastases (poor prognosis), postoperative chemotherapy, and R0 resection (better prognosis) as significant OS predictors.
• Patients not receiving chemotherapy showed elevated inflammatory and reduced nutritional markers post-surgery.

Conclusions:

• Distant metastases are a significant negative prognostic factor in T4b GC.
• Postoperative chemotherapy and R0 resection are associated with improved survival in T4b GC.
• Balancing chemotherapy tolerance and surgical effect is vital for T4b GC management.