ASSESSMENT OF THE ACCURACY OF PREOPERATIVE DETERMINATION OF THE DEPTH OF WALL INVASION IN LOCALLY ADVANCED GASTRIC CANCER

Objective: To evaluate the feasibility of predicting the local extent of the primary tumor in gastric cancer (GC) based on the analysis of preoperative clinical data.

Materials and methods: A retrospective analysis of the results of treatment of 1054 patients who underwent radical surgery for non-metastatic GC was carried out. The relationship between preoperative clinical, morphological and laboratory parameters and the depth of invasion of the gastric wall by the primary tumor (pT) was studied. Comparison of quantitative indicators was carried out using the Kruskal-Wallis test; when examining contingency tables, the chi-square test was used; in case of violation of the assumptions underlying the chi-square test, Fisher’s exact test was used.

Results: The coincidence of cT and pT values occurs only in 58.8 % of cases, while in 23 % of cases defined as cT2-3, the true depth of invasion corresponded to pT1, and 31 % of cases defined as cT2-3 were in subsequently classified as pT4. It has been established that the growth of the primary tumor beyond the mucous-submucosal layer of the stomach wall is more common: with infiltrative tumors in comparison with expansive growth pattern; with non-cohesive adenocarcinoma (high grade) in comparison with cohesive (low grade); with total-subtotal damage to the stomach in comparison with less widespread damage. Evaluation of changes in a number of laboratory parameters (absolute values of platelets, leukocytes, neutrophils, their ratios, as well as fibrinogen levels) confirmed the relationship with the depth of invasion of the gastric wall by the primary tumor previously described in a number of studies.

Conclusion: The presence of a relationship between a number of clinical, morphological and laboratory parameters and the depth of invasion of the gastric wall creates prerequisites for the development and application of prognostic models in order to increase the accuracy of preoperative T-staging.

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