Macroscopic appearance of Type IV and giant Type III is a high risk for a poor prognosis in pathological stage II/III advanced gastric cancer with postoperative adjuvant chemotherapy.

Aim: To evaluate whether a high risk macroscopic appearance (Type IV and giant Type III) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage II/III (pStage II/III) gastric cancer.

Methods: One hundred and seventy-two advanced gastric cancer (defined as pT2 or beyond) patients with pStage II/III who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined.

Results: Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival (RFS) (35.7%) and overall survival (OS) (34%) than an average risk appearance ( = 0.0003 and < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13 Japanese Gastric Cancer Association (JGCA) pT ( = 0.01), but not with the 13 JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13 JGCA pStage ( < 0.0001) and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified high-risk macroscopic appearance ( = 0.036, HR = 2.29 for RFS and = 0.021, HR = 2.74 for OS) as an independent prognostic indicator.

Conclusion: A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13 JGCA stage in pStage II/III advanced gastric cancer.