Relationship between tumor size and aggressive pathological features in gastric adenocarcinoma

Aim Gastric adenocarcinoma shows heterogeneous biological behavior, and its prognosis is influenced by multiple clinicopathological factors. Tumor size is an easily measurable parameter, but its relationship with pathological indicators of aggressiveness remains incompletely defined. This study aimed to evaluate the association between tumor size and aggressive pathological features in patients who underwent surgery for gastric adenocarcinoma. Methods This single-center retrospective study included 58 patients who underwent curative resection for gastric adenocarcinoma at Gaziantep City Hospital between 03/02/2024 and 01/03/2026. Demographic, clinical, surgical, and pathological data were obtained retrospectively. Associations between tumor size and pT stage, pN stage, pathological stage, number of metastatic lymph nodes, lymph node ratio, lymphovascular invasion, perineural invasion, and histological grade were analyzed. Results A total of 58 patients were included. Tumor size showed significant positive correlations with pT stage (rho = 0.263; <em>P</em> = .046), pN stage (rho = 0.298; <em>P</em> = .023), pathological stage (rho = 0.293; <em>P</em> = .026), number of positive lymph nodes (rho = 0.328; <em>P</em> = .012), and lymph node ratio (rho = 0.288; <em>P</em> = .028). In logistic regression, each 1-cm increase in tumor size was associated with perineural invasion (OR = 1.29; <em>P</em> = .036). Patients with tumors >5 cm had higher rates of perineural invasion, distant metastasis, positive lymph node count, and lymph node ratio. Conclusion In gastric adenocarcinoma, tumor size may serve as a practical parameter associated with pathological indicators of aggressiveness. When interpreted together with advanced tumor invasion, increased nodal burden, and invasive histopathological features, it may contribute to a better understanding of tumor biology. These findings should be confirmed in larger multicenter studies.