Ulcer Size as a Novel Indicator Marker Is Correlated with Prognosis of Ulcerative Gastric Cancer

Abstract

Aims: The objective of this study was to assess the significance of ulcer size for the survival of gastric cancer patients. Methods: A total of 260 patients with ulcerative gastric cancer who had undergone curative resection were reviewed. The diameter of the malignant ulcer was measured. Patients were divided into group U1 (≤3 cm) and group U2 (>3 cm) according to the diameter of the ulcer. The prognostic significance of ulcer size was assessed by uni- and multivariate analyses. Results: Patient survival was correlated with age, gender, tumor location, tumor size, ulcer size, serosal invasion, node involvement and synchronism distant metastasis. The 5-year overall survival rate in U1 patients was 84.3% as compared with 67.5% in U2 patients (p < 0.001), and the 5-year recurrence-free survival rates were 82.9% for group U1 and 62.5% for group U2 (p = 0.001). Multivariate analysis revealed that ulcer size is an independently significant predictive factor for survival rates (overall: hazard ratio 1.222, p = 0.003; recurrence-free: hazard ratio 1.205, p = 0.006). Conclusion: Ulcer size might be a potential indicator for advanced disease and the use of minimal local treatments must be considered carefully in larger ulcer size patients.

Frequência e fatores preditivos relacionados a metástase linfática em câncer gástrico precoce

“…In a previous study of Gotoda et al 6 , with a significant number of patients, the presence of ulceration was an independent factor associated with lymph node metastases. Recent studies indicate not only the presence of ulceration as a biomarker for lymph node metastases, but also the diameter of ulceration 35,36 .…”

The Influence of Antral Ulcers on Intramural Gastric Nerve Projections Supplying the Pyloric Sphincter in the Pig (Sus scrofa domestica)—Neuronal Tracing Studies

“…The ulcers induced in the present study were large in diameter and deeply penetrated into the muscular layer. According to some authors, the large size of gastric ulcer was closely related with difficulties in its treatment [ 3 ], the likelihood of ulcer malignancy [ 6 , 46 , 4 ] and lymph node metastasis [ 5 , 47 ]. Extensive, deeply penetrating ulcers destroy deeper tissues of the gastric wall, including nerve pathways.…”

“…The ulcers may vary in size of diameter, depth of penetration and localization within the gastrointestinal tract. Large ulcer diameter seems to be correlated with hindered healing process [ 3 ] and the risk of gastric cancer development [ 4 – 6 ]. Ulcers localized in the close proximity to the pyloric sphincter have been clinically associated with a characteristic “pyloric syndrome” complex [ 7 ], which clinical signs differed significantly from symptoms associated with other ulcer locations [ 8 ].…”

Impact of Intraoperative Macroscopic Diagnosis of Serosal Invasion in Pathological Subserosal (pT3) Gastric Cancer

“…Although some authors insist that tumor size is an independent prognostic factor in survival analysis, 11 , 12 it is not generally accepted as a prognostic factor in patients with gastric cancer. However, tumor size is very important in overestimating serosal invasion.…”