Document Type : Original Article


1 Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea

2 Department of Pathology, Chonnam National University Medical School, Gwangju, Korea


Background: We evaluated the predictive factors associated with survival for gastric cancer patients with large tumor size (≥10 cm).
Method: In this retrospective study, we investigated 279 gastric cancer patients with large-sized tumors, treated at the Chonnam National University Hospital, Gwangju, Korea. We analyzed the clinicopathological features and predictive factors associated with survival in these gastric cancer patients with large tumors. Survival was calculated using the Kaplan-Meier method and the relative prognostic importance of the parameters was investigated through Cox's proportional hazards model.
Results: The recurrence rates were significantly different between the large and small tumor groups (76.3% and 36.6%, respectively; P < 0.001). Multivariate analysis showed that the presence of serosal invasion, nodal involvement, the extent of lymph node dissection, the presence of peritoneal dissemination, and curability had prognostic effects in gastric cancer patients with large-sized tumors. The 5-year survival rate was lower in patients with tumors ≥10 cm compared with those with smaller tumors (23.6% versus 57.0%, respectively; P < 0.0001). The 5-year survival rate was higher in patients with large tumor size who underwent curative resection (39.1%) than those who did not (10.0%) (P < 0.0001).
Conclusion: The long-term survival of gastric cancer patients with large-sized tumors is related to curative resection. Thus, curative resection is of significance for predicting survival.


How to cite this article:

Kim HG, Gang DY, Lee JH, Kim DY. Prognosis of gastric cancer patients with a large tumor size. Middle East J Cancer. 2022;13(4):657-64. doi: 10.30476/mejc.2022.89113.1506.

1. Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, et al. Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer. 1992;70(5):1030-7. doi: 10.1002/1097-0142(19920901)70:5<1030::aid-cncr2820700504>;2-c.
2. Bozzetti F, Bonfanti G, Morabito A, Bufalino R, Menotti V, Andreola S, et al. A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surg Gynecol Obstet. 1986;162(3):229-34.
3. Yokota T, Ishiyama S, Saito T, Teshima S, Narushima Y, Murata K, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis. Scand J Gastroenterol. 2004;39(4):380-4. doi: 10.1080/003 65520310008629.
4. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101-12. doi: 10.1007/ s10120-011-0041-5.
5. Zhou L, Li W, Cai S, Yang C, Liu Y, Lin Z. Large tumor size is a poor prognostic factor of gastric cancer with signet ring cell: Results from the surveillance, epidemiology, and end results database. Medicine (Baltimore). 2019;98(40):e17367. doi: 10.1097/MD.00 00000000017367.
6. Li C, Oh SJ, Kim S, Hyung WJ, Yan M, Zhu ZG, et al. Risk factors of survival and surgical treatment for advanced gastric cancer with large tumor size. J Gastrointest Surg. 2009;13(5):881-5. doi: 10.1007/s11 605-009-0800-3.
7. Jun KH, Jung H, Baek JM, Chin HM, Park WB. Does tumor size have an impact on gastric cancer? A single institute experience. Langenbecks Arch Surg. 2009;3 94(4):631-5. doi: 10.1007/s00423-008-0417-0.
8. Guo P, Li Y, Zhu Z, Sun Z, Lu C, Wang Z, et al. Prognostic value of tumor size in gastric cancer: an analysis of 2,379 patients. Tumour Biol. 2013;34(2): 1027-35. doi: 10.1007/s13277-012-0642-6.
9. Del Rio P, Viani L, Bertocchi E, Iapichino G, Luzietti E, Dell'Abate P, et al. The prognostic role of tumor size in patients with gastric cancer. Ann Ital Chir. 2017;88:478-84.
10. Yokota T, Ishiyama S, Saito T, Teshima S, Yamada Y, Iwamoto K, et al. Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res. 2002;22(6B): 3673-7.
11. Adachi Y, Oshiro T, Mori M, Maehara Y, Sugimachi K. Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol. 1997;4(2):137-40. doi: 10.1007/BF02303796.
12. Im WJ, Kim MG, Ha TK, Kwon SJ. Tumor size as a prognostic factor in gastric cancer patient. J Gastric Cancer. 2012;12(3):164-72. doi: 10.5230/jgc. 2012.12.3.164.
13. Liu X, Xu Y, Long Z, Zhu H, Wang Y. Prognostic significance of tumor size in T3 gastric cancer. Ann Surg Oncol. 2009;16(7):1875-82. doi: 10.1245/s10434-009-0449-x.
14. Bilici A, Uygun K, Seker M, Ustaalioglu BB, Aliustaoglu M, Temiz S, et al. The effect of tumor size on overall survival in patients with pT3 gastric cancer: experiences from 3 centers. Onkologie. 2010;33(22):676-82. doi: 10.1159/000322215.
15. Liu HG, Liang H, Deng JY, Wang L, Liang YX, Jiao XG. The prognostic analysis of tumor size in T4a stage gastric cancer. Zhonghua Wai Ke Za Zhi. 2013;51(3):230-4.
16. Kim DY, Joo JK, Park YK, Ryu SY, Kim YJ, Kim SK. Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection. Langenbecks Arch Surg. 2007;392(2):131-4. doi: 10.1007/s00423-006-0114-9.
17. Kim HG, Ghu HD, Yun SK, Ryu SY, Kim DY. Clinicopathological features of female gastric carcinoma patients with curative resection: comparison with male patients. Chonnam Med J. 2012;48(2):86-90. doi: 10.4068/cmj.2012.48.2.86.
18. Roviello F, Marrelli D, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, et al. Italian Research Group for Gastric Cancer. Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Br J Surg. 2003;90(9):1113-9. doi: 10.1002/bjs.4164.
19. Kobayashi O, Tsuburaya A, Yoshikawa T, Osaragi T, Murakami H, Yoshida T, et al. The efficacy of gastrectomy for large gastric cancer. Int J Clin Oncol. 2006;11(1):44-50. doi: 10.1007/s10147-005-0535-4.
20. Shiraishi N, Sato K, Yasuda K, Inomata M, Kitano S. Multivariate prognostic study on large gastric cancer. J Surg Oncol. 2007;96(1):14-8. doi: 10.1002/jso.20631.
21. Yasuda K, Shiraishi N, Adachi Y, Inomata M, Sato K, Kitano S. Risk factors for complications following resection of large gastric cancer. Br J Surg. 2001;88(6):873-7. doi: 10.1046/j.0007-1323.2001. 01782.x.