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| 1 | Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach显示文摘AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach. | Hong-Mei Wang, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Department of Gastric Surgery, Affiliated Union Hospital of Fujian Medical University, Fuzhou 350001, Fujian Province, China Author contributions: Wang HM and Huang CM conceived of the study, analyzed the data, and drafted the manuscript Zheng CH, Li P and Xie JW helped revise the manuscript critically for important intellectual content Wang JB, Lin JX and Lu J helped collect data and design the study and all authors read and approved the final manuscript. | 2012 | World Journal of Gastroenterology2012，18，38： | 15 |
| 2 | Crisis manage- ment during anaesthesia: bronchospasm 显示文摘 | Westhorpe RN Ludbrook GL Helps SC | 2005 | Qual Saf Health Care2005，14，3： | 1 |
| 3 | Phylogenetic analysis of hemoplasma species:an international study显示文摘 | Tasker S Helps C R Day M J | 2003 | J Clin Microbiol2003，41，8： | 1 |
| 4 | Intracranial pressure changes following traumatic brain injury in rats:lack of significant change in the absence of mass lesions or hypoxia显示文摘 | Gabrielian L Willshire LW Helps SC | | 0，，： | 1 |
| 5 | NIMA related kinase 2 (Nek2), a cell-cycle-regulated protein kinase localized to centrosornes, is eomplexed to protein phosphatase 1显示文摘 | Helps N R Luo X Barker H M | 2000 | Bioehem J2000，349，： | 1 |
| 6 | Alterations in membrane potential in mitochondria isolated from brain subregiuns during focal cerebral ischemia and early reperfusion: evaluation using flow cytometry显示文摘 | Lee DR Helps SC Macardle PJ | 2009 | Neurochem Res2009，34，10： | 1 |
| 7 | Real-time RT-PCR: considerations for efficient and sensitive assay design 显示文摘 | Peters I R Helps C R Hall E J | 2004 | J Immunol Methods2004，286，12： | 1 |
| 8 | Air embolism of the brain in rabbits pretreat with Mechlorethamine显示文摘 | HELPS S C GORMAN D F | 1991 | Stroke1991，22，： | 1 |
| 9 | Default-mode brain dysfunction in mental disorders: A systematic review显示文摘 | Samantha J. Broyd Charmaine Demanuele Stefan Debener Suzannah K. Helps Christopher J. James Edmund J.S. Sonuga-Barke | 2008 | Neuroscience and Biobehavioral Reviews2008，，3： | 1 |
| 10 | General routes for synthesis of Mono,di and tri-N-substituted derivatives of cyclam显示文摘 | Helps IM Parker D Morphy JR | 1989 | Tetrahedron1989，45，1： | 1 |
| 11 | Phylogenetic anal-ysis of hemoplasma species:an international study显示文摘 | TASKER S HELPS C R DAY M J | 2003 | J Clin Microbiol2003，41，8： | 1 |
| 12 | Opportunities and responsibilities in pharmaceutical care 显示文摘 | Help CD Strand LM | 1990 | Am J Hosp Pharm1990，47，： | 1 |
| 13 | A substance P an- tagonist improves outcome when administered 4 h after on- set of ischaemic stroke 显示文摘 | Turner R J Helps SC Thornton E | 2011 | Brain Res2011，1393，： | 1 |
| 14 | Opportunities and responsibilities in pharmaceutical care显示文摘 | Help CD Strand LM | 1990 | Am J Hosp Pharm1990，47，： | 1 |
| 15 | Protection for Sale 显示文摘 | Grossman G and E Help man | 1994 | American Economics Review1994，85，4： | 1 |
| 16 | Most risk fac- tors can be altered with lifestyle changes, medications, awareness 显示文摘 | Assessing your stroke risk may help save your life | 2007 | Heart Advis2007，10，4： | 1 |
| 17 | Opportunities and responsibilities in pharmaceutical care 显示文摘 | Help CD Strand LM | 1990 | Am J Hosp Pharm1990，47，： | 1 |
| 18 | Phylogenetic analysis of hemoplasma species:an international study显示文摘 | Tasker S Helps C R Day M J | 2003 | J Clin Microbiol2003，41，： | 1 |
| 19 | Phylogenetic Analysis of Hemoplasma Species: an International Study显示文摘 | Tasker S Helps CR Day MJ | 2003 | Journal of Clinical Microbiology2003，41，38： | 1 |
| 20 | Phylogenetic analysis of hemoplesma species:an international study显示文摘 | Tasker S Helps C R Day M J | 2003 | Journal of clinical microbiology2003，41，8： | 1 |
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