INTRODUCTION: Tumor size has prognostic significance in gastric cancer, but its relevance in gastric cardia adenocarcinoma remains incompletely defined. We evaluated associations between pathological tumor size, adverse clinicopathological characteristics, nodal metastatic burden, and overall survival in gastric cardia adenocarcinoma.
METHODS: This retrospective single-center cohort included 100 patients undergoing curative-intent resection between 2014 and 2020. Associations between tumor size and pathological features were evaluated using group comparisons, correlation, and logistic regression. ROC analysis assessed discrimination for pathological nodal metastasis and derived an exploratory tumor-size threshold. Sensitivity analyses were performed according to neoadjuvant treatment status. Overall survival was evaluated using Kaplan–Meier and Cox regression.
RESULTS: The mean pathological tumor size was 4.96 ± 3.24 cm. Larger tumors were associated with advanced postoperative pathological T category, nodal metastasis, lymphovascular invasion, perineural invasion, and serosal involvement. Tumor size correlated with metastatic lymph node number (ρ=0.558) and lymph node ratio (ρ=0.559; both p<0.001). ROC analysis for pathological nodal metastasis yielded an AUC of 0.793 (bootstrap 95% CI, 0.695–0.878) and an exploratory 4.0-cm threshold. Five-year overall survival was 80.0% for tumors ≤ 4 cm and 37.2% for tumors > 4 cm (log-rank p < 0.001). Tumor size remained independently associated with overall survival (adjusted HR 1.13 per 1-cm increase, 95% CI 1.02–1.25; p=0.017).
DISCUSSION AND CONCLUSION: Increasing pathological tumor size was associated with adverse clinicopathological characteristics and poorer overall survival. Tumor size may provide complementary prognostic information; however, the exploratory 4-cm threshold requires external validation before clinical application.

Keywords: gastric cardia adenocarcinoma, tumor size, prognosis, lymph-node metastasis, overall survival, and neoadjuvant chemotherapy