Risk factors and prognostic analysis of microscopic positive esophageal margins after radical surgery for proximal gastric cancer.

Background: Proximal gastric cancer has been on the rise worldwide in recent years. A positive surgical margin may result in incomplete tumor and affect the prognosis of patients. This study aims to analyse the risk factors for and prognosis associated with microscopic positive esophageal margins (R1 resection) after radical surgery for proximal gastric cancer patients.

Methods: This was a retrospective analysis of 316 patients with proximal gastric cancer who underwent surgical resection at the Department of Gastrointestinal Surgery of Hengshui People's Hospital from January 2013 to June 2018. Patients were divided into the R1 group (n = 24) and R0 group (n = 292) according to the esophageal margin status. Differences in clinicopathological characteristics and prognosis between the two groups were compared.

Results: Tumor location at the esophagogastric junction, Borrmann type 3/4, Lauren diffuse/mixed type, margin distance < 3 cm, pT4 stage, and vascular invasion were identified as independent risk factors for positive esophageal margins in proximal gastric cancer patients (all P < 0.05). The 5-year overall survival rate was significantly lower in the R1 group than in the R0 group (45.8% vs. 64.2%, P < 0.05). Subgroup analysis revealed that the 5-year overall survival rate was significantly lower in the R1 group in the pT2-3 and pN0 stages (P < 0.05), while there was no significant difference in the pT4 and pN(+) stages (P > 0.05). Multivariate Cox regression analysis revealed that Borrmann type, Lauren type, pT stage, pN stage, and lymphovascular invasion were independent risk factors affecting the prognosis of patients with proximal gastric cancer (all P < 0.05), while esophageal margin status was not an independent risk factor affecting prognosis (P > 0.05).

Conclusion: Positive esophageal margins in proximal gastric cancer are associated with various clinicopathological factors and lead to a worse prognosis in patients with pT2-3 and pN0 stages but do not affect the prognosis of patients with pT4 and pN(+) stages.