European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Comparative survival in gastric cancer: Mucosa-confined with extensive nodal metastases versus serosal invasion without nodal spread.
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Li Jie, Liu Lu, Wu Di, Wang Haoya, Xue Fengyuan, Zhao Binghe, Gu Mingyu, Dai Baishu, Wen Minghai, Wang Xinxin
Аннотация
BACKGROUND: The TNM staging system classifies both pT1N3aM0 and pT4aN0M0 gastric cancers as stage ⅡB, despite their distinct profiles of local invasion versus lymphatic spread. This study compares their survival outcomes to assess the differential prognostic impact of these two patterns.
METHODS: A total of 235 patients with pT1N3aM0 or pT4aN0M0 gastric cancer diagnosed between October 2005 and July 2022 were included. Propensity score matching (PSM) was applied to balance baseline characteristics between the groups. Survival outcomes were analyzed using the Kaplan-Meier method, with 3- and 5-year disease-free survival (DFS) and overall survival (OS) rates compared. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors.
RESULTS: This study enrolled 197 gastric cancer patients: 31 with pT1N3aM0 and 166 with pT4aN0M0. Significant differences were observed between groups in gender and tumor location. After PSM (1:3), pathological analysis revealed higher neural invasion in T4aN0 group (26.9% vs. 3.2%, p = 0.005) compared to T1N3a group, which showed more frequent lymphatic invasion (41.9% vs. 16.1%, p = 0.003). The T1N3a group predominantly exhibited signet ring cell carcinoma (SRCC, 64.5%), with the highest lymph node metastasis rate at No. 3 (77.4%). Survival analysis indicated worse OS in the T1N3a group (3-year OS: HR = 2.495, 95% CI: 0.99,6.24, p = 0.0115; 5-year OS: HR = 1.993, 95% CI: 0.85, 4.68, p = 0.0384). Subgroup analysis showed that in patients with SRCC, the T1N3a subgroup had poorer 3-year OS (HR = 2.761, 95% CI: 0.95,8.06, p = 0.0424). While N stage was an independent prognostic factor for 3-year OS (HR = 3.1, 95% CI: 1.4,6.7, p = 0.004), this association did not persist at 5 years. Notably, an Eastern Cooperative Oncology Group (ECOG) score of 2 consistently predicted higher mortality at both 3 and 5 years (3-year HR = 4.8, p = 0.013; 5-year HR = 4.1, p = 0.008).
CONCLUSION: Patients with pT1N3aM0 gastric cancer have a poorer prognosis than those with pT4aN0M0. Among SRCC patients, the T1N3a subgroup exhibits histology-driven intrastage heterogeneity. Future risk stratification models should account for the interaction between histological subtype and anatomical stage, with more intensive follow-up and adjuvant therapy for these high-risk patients.
METHODS: A total of 235 patients with pT1N3aM0 or pT4aN0M0 gastric cancer diagnosed between October 2005 and July 2022 were included. Propensity score matching (PSM) was applied to balance baseline characteristics between the groups. Survival outcomes were analyzed using the Kaplan-Meier method, with 3- and 5-year disease-free survival (DFS) and overall survival (OS) rates compared. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors.
RESULTS: This study enrolled 197 gastric cancer patients: 31 with pT1N3aM0 and 166 with pT4aN0M0. Significant differences were observed between groups in gender and tumor location. After PSM (1:3), pathological analysis revealed higher neural invasion in T4aN0 group (26.9% vs. 3.2%, p = 0.005) compared to T1N3a group, which showed more frequent lymphatic invasion (41.9% vs. 16.1%, p = 0.003). The T1N3a group predominantly exhibited signet ring cell carcinoma (SRCC, 64.5%), with the highest lymph node metastasis rate at No. 3 (77.4%). Survival analysis indicated worse OS in the T1N3a group (3-year OS: HR = 2.495, 95% CI: 0.99,6.24, p = 0.0115; 5-year OS: HR = 1.993, 95% CI: 0.85, 4.68, p = 0.0384). Subgroup analysis showed that in patients with SRCC, the T1N3a subgroup had poorer 3-year OS (HR = 2.761, 95% CI: 0.95,8.06, p = 0.0424). While N stage was an independent prognostic factor for 3-year OS (HR = 3.1, 95% CI: 1.4,6.7, p = 0.004), this association did not persist at 5 years. Notably, an Eastern Cooperative Oncology Group (ECOG) score of 2 consistently predicted higher mortality at both 3 and 5 years (3-year HR = 4.8, p = 0.013; 5-year HR = 4.1, p = 0.008).
CONCLUSION: Patients with pT1N3aM0 gastric cancer have a poorer prognosis than those with pT4aN0M0. Among SRCC patients, the T1N3a subgroup exhibits histology-driven intrastage heterogeneity. Future risk stratification models should account for the interaction between histological subtype and anatomical stage, with more intensive follow-up and adjuvant therapy for these high-risk patients.