# Assessment of the Relationship Between Positive Radial Margin and Prognosis in Patients with Gastric Adenocarcinoma

## TL;DR

This study finds that a positive radial margin after surgery for gastric cancer is linked to worse survival outcomes, suggesting a need for personalized treatment.

## Contribution

This study is the first to thoroughly investigate the impact of a positive radial margin on prognosis in gastric adenocarcinoma patients.

## Key findings

- Positive radial margins were associated with worse overall and disease-free survival in gastric cancer patients.
- Radial margin positivity was more common in patients with advanced cancer stages and perineural invasion.
- Tailored treatment approaches are needed for patients with a positive radial margin due to aggressive tumor biology.

## Abstract

This study assesses the influence of a positive radial margin on the outcomes of gastric adenocarcinoma patients post-gastrectomy. A cohort of 431 stage II/III patients operated on from 2009 to 2019 was retrospectively examined. Of these, 94 patients (21.8%) presented with a positive margin, with radial margin positivity at 16.2%. Positive margins were correlated with perineural invasion and advanced cancer stages. Advanced Borrmann type, positive nodal involvement, higher nodal burden (≥5), and margin status were associated with decreased overall survival (OS) and disease-free survival (DFS). Subgroup analysis indicated that radial margin positivity notably impacted OS and DFS in patients with advanced T stage and nodal involvement. These results imply that aggressive tumor biology may lead to margin positivity, underscoring the necessity for personalized treatment approaches for patients exhibiting a positive radial margin.

Background/Objectives: Gastrectomy is among the most effective treatments for gastric adenocarcinoma. Margin status can be categorized into three types: proximal, distal, and radial margins. While the relationship between proximal and distal margin involvement in specimens and prognosis has been extensively studied, the impact of a radial margin has not been thoroughly investigated. This study was conducted to determine whether a positive radial margin could affect the prognosis of patients with gastric adenocarcinoma undergoing gastrectomy. Methods: This is a retrospective cohort study of patients with stage II/III gastric adenocarcinoma who received gastrectomy from January 2009 to December 2019 at Taichung Veterans General Hospital, Taiwan. The clinicopathologic features and outcomes were compared between groups. Results: Among the 431 patients who underwent gastrectomy, 94 patients (21.8%) had a positive margin. Radial margin positivity accounted for 16.2%. Factors associated with a positive margin included perineural invasion and advanced cancer stage. The factors related to poor overall survival (OS) and disease-free survival (DFS) included advanced Borrmann type, positive nodal disease, higher nodal burden (≥5), and margin status. In the subgroup analysis, radial margin positivity could negatively impact OS and DFS in the advanced T stage subgroup and nodal-positive subgroup. Conclusions: Aggressive tumor biology may result in a positive margin following gastrectomy. A positive radial margin was correlated with poorer OS and DFS. Future investigations should focus on developing tailored treatment plans for patients with a positive radial margin.