Background/Objectives: Gastrectomy is among the most effective treatments for gastric adenocarcinoma. Margin status can be categorized into three types: proximal, distal, and radial margins. While the relationship between proximal and distal margin involvement in specimens and prognosis has been extensively studied, the impact of a radial margin has not been thoroughly investigated. This study was conducted to determine whether a positive radial margin could affect the prognosis of patients with gastric adenocarcinoma undergoing gastrectomy.Methods: This is a retrospective cohort study of patients with stage II/III gastric adenocarcinoma who received gastrectomy from January 2009 to December 2019 at Taichung Veterans General Hospital, Taiwan. The clinicopathologic features and outcomes were compared between groups.Results: Among the 431 patients who underwent gastrectomy, 94 patients (21.8%) had a positive margin. Radial margin positivity accounted for 16.2%. Factors associated with a positive margin included perineural invasion and advanced cancer stage. The factors related to poor overall survival (OS) and disease-free survival (DFS) included advanced Borrmann type, positive nodal disease, higher nodal burden (≥5), and margin status. In the subgroup analysis, radial margin positivity could negatively impact OS and DFS in the advanced T stage subgroup and nodal-positive subgroup.Conclusions: Aggressive tumor biology may result in a positive margin following gastrectomy. A positive radial margin was correlated with poorer OS and DFS. Future investigations should focus on developing tailored treatment plans for patients with a positive radial margin.
背景/目的：胃切除术是治疗胃腺癌最有效的方法之一。切缘状态可分为三种类型：近端切缘、远端切缘和环周切缘。虽然标本中近端和远端切缘受累与预后的关系已得到广泛研究，但环周切缘的影响尚未得到充分探讨。本研究旨在确定环周切缘阳性是否会影响接受胃切除术的胃腺癌患者的预后。 方法：这是一项回顾性队列研究，对象为2009年1月至2019年12月期间在台湾台中荣民总医院接受胃切除术的II/III期胃腺癌患者。比较了各组间的临床病理特征和预后结果。 结果：在接受胃切除术的431例患者中，94例（21.8%）存在切缘阳性。其中环周切缘阳性占16.2%。与切缘阳性相关的因素包括神经侵犯和晚期癌症分期。与总生存期（OS）和无病生存期（DFS）较差相关的因素包括进展期Borrmann分型、淋巴结阳性、较高的淋巴结负荷（≥5个）以及切缘状态。在亚组分析中，环周切缘阳性对晚期T分期亚组和淋巴结阳性亚组的OS和DFS有负面影响。 结论：侵袭性肿瘤生物学特性可能导致胃切除术后切缘阳性。环周切缘阳性与较差的OS和DFS相关。未来的研究应侧重于为环周切缘阳性患者制定个体化治疗方案。
肿瘤(癌症)患者之家