Potential of clinical staging for long-term prognosis prediction in pathological stage III gastric cancer

In gastric cancer (GC), discrepancies are often observed between the clinical stage (cStage) and pathological stage (pStage). Nevertheless, cStage diagnosis may contribute to outcome predictions even within the same pStage. Therefore, the present study examined the prognostic significance of cStage in patients with pStage III GC who underwent curative gastrectomy. A multicenter retrospective study was conducted on 162 patients with pStage III GC who underwent curative resection at three institutions in Kyoto between April 2010 and May 2020. Patients were stratified into two groups according to cStage (I/II vs. III/IVA), and the clinicopathological features and survival outcomes were compared. Of the 162 patients, 72 (44.4%) were classified as cStage I/II and 90 (55.6%) as cStage III/IVA. The 5-year overall survival rate was significantly lower in the cStage III/IVA group than that in the cStage I/II group (50.0% vs. 63.9%, P=0.030), as was the 5-year recurrence-free survival rate (36.7% vs. 51.4%, P=0.023). A multivariate analysis identified cStage III/IVA (P<0.05, hazard ratio=1.912) as an independent poor prognostic factor for overall survival. I2n conclusion, preoperative cStage may serve as a complementary prognostic indicator reflecting tumor biological aggressiveness and could assist in postoperative treatment decision-making.