In some cancers, such as breast and lung, tumor size is included in the classification of disease stage. However, it’s clinical significance remains elusive in gastric cancer.

To investigate the prognostic significance of macroscopic tumor size, we reviewed 1473 gastric cancer patients who underwent curative gastrectomy.

An appropriate threshold of tumor size affecting patient survival was 8 cm. Patients were divided into 2 groups as follows: small size group (SSG = tumor size <8 cm) and large size group (LSG = tumor size ≥8 cm). LSG tumors were frequently observed in patients with undifferentiated types and with lymphatic and venous invasion. Moreover, tumor size was significantly related to depth of invasion and lymph node metastasis. The prognosis of LSG patients was significantly worse than that of SSG patients. Multivariate analysis showed that tumor size was an independent prognostic factor along with depth of invasion, lymph node metastasis, and lymphatic invasion. Recurrence patterns differed between the 2 groups. Peritoneal recurrence was observed in LSG more frequently than SSG patients (P < .001), whereas hematogenous recurrence was observed in SSG more frequently than in LSG patients (P < .05). The survival rates of patient with stages II-, IIIa-, and IIIb-LSG disease were almost the same as those with stages IIIa-, IIIb-, and IV-SSG disease, respectively.

Tumor size serves as a simple predictor of survival in patients with gastric cancer.