Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Prognostic Factors for Node-Negative Advanced Gastric Cancer after Curative Gastrectomy

  • Lee, Eun Woo (Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Woo Yong (Department of Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine) ;
  • Koo, Ho-Seok (Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine)
  • Received : 2016.06.17
  • Accepted : 2016.08.29
  • Published : 2016.09.30
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Abstract

Purpose: Lymph node (LN) metastasis is the best prognostic indicator in non-distant metastatic advanced gastric cancer. This study aimed to assess the prognostic value of various clinicopathologic factors in node-negative advanced gastric cancer. Materials and Methods: We retrospectively analyzed the clinical records of 254 patients with primary node-negative stage T2~4 gastric cancer. These patients were selected from a pool of 1,890 patients who underwent radical resection at Memorial Jin-Pok Kim Korea Gastric Cancer Center, Inje University Seoul Paik Hospital between 1998 and 2008. Results: Of the 254 patients, 128 patients (50.4%), 88 patients (34.6%), 37 patients (14.6%), and 1 patient (0.4%) had T2, T3, T4a, and T4b tumors, respectively. In a univariate analysis, operation type, T-stage, venous invasion, tumor size, and less than 15 LNs significantly correlated with tumor recurrence and cumulative overall survival. In a multivariate logistic regression analysis, tumor size, venous invasion, and less than 15 LNs significantly and independently correlated with recurrence. In a multivariate Cox proportional hazards analysis, tumor size (hazard ratio [HR]: 2.926; 95% confidence interval [CI]: 1.173~7.300; P=0.021), venous invasion (HR: 3.985; 95% CI: 1.401~11.338; P=0.010), and less than 15 LNs (HR: 0.092; 95% CI: 0.029~0.290; P<0.001) significantly correlated with overall survival. Conclusions: Node-negative gastric cancers recurred in 8.3% of the patients in our study. Tumor size, venous invasion, and less than 15 LNs reliably predicted recurrence as well as survival. Aggressive postoperative treatments and timely follow-ups should be considered in cases with these characteristics.

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References

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29. https://doi.org/10.3322/caac.21208
  2. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252-271. https://doi.org/10.3322/caac.21235
  3. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 2015;47:127-141. https://doi.org/10.4143/crt.2015.060
  4. Cuschieri SA, Hanna GB. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma: let us move on to another era. Ann Surg 2014;259:e90. https://doi.org/10.1097/SLA.0000000000000418
  5. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg 2011;253:900-911. https://doi.org/10.1097/SLA.0b013e318212bff6
  6. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 2nd English edition. Gastric Cancer 1998;1:10-24. https://doi.org/10.1007/PL00011681
  7. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077-3079. https://doi.org/10.1245/s10434-010-1362-z
  8. Kim SS, Choi BY, Seo SI, Jung MY, Choi HS, Ahn SM, et al. The comparison between 6th and 7th International Union against Cancer/American Joint Committee on Cancer classification for survival prognosis of gastric cancer. Korean J Gastroenterol 2011;58:258-263. https://doi.org/10.4166/kjg.2011.58.5.258
  9. Kim JH, Kim CW, Choi NK, Kwak JH, Choi KM, Jang HJ, et al. The comparison between 6th and 7th UICC/AJCC N Stage for prognostic significance in gastric cancer. J Korean Surg Soc 2010;79:202-206. https://doi.org/10.4174/jkss.2010.79.3.202
  10. Imamura T, Komatsu S, Ichikawa D, Kubota T, Okamoto K, Konishi H, et al. Poor prognostic subgroup in T3N0 stage IIA gastric cancer, suggesting an indication for adjuvant chemotherapy. J Surg Oncol 2015;111:221-225. https://doi.org/10.1002/jso.23796
  11. Adachi Y, Oshiro T, Mori M, Maehara Y, Sugimachi K. Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol 1997;4:137-140. https://doi.org/10.1007/BF02303796
  12. Kim DY, Seo KW, Joo JK, Park YK, Ryu SY, Kim HR, et al. Prognostic factors in patients with node-negative gastric carcinoma: a comparison with node-positive gastric carcinoma. World J Gastroenterol 2006;12:1182-1186. https://doi.org/10.3748/wjg.v12.i8.1182
  13. Yokota T, Ishiyama S, Saito T, Teshima S, Yamada Y, Iwamoto K, et al. Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res 2002;22:3673-3677.
  14. Zhang BY, Yuan J, Cui ZS, Li ZW, Li XH, Lu YY. Evaluation of the prognostic value of the metastatic lymph node ratio for gastric cancer. Am J Surg 2014;207:555-565. https://doi.org/10.1016/j.amjsurg.2013.05.004
  15. He H, Shen Z, Wang X, Qin J, Sun Y, Qin X. Survival benefit of greater number of lymph nodes dissection for advanced nodenegative gastric cancer patients following radical gastrectomy. Jpn J Clin Oncol 2016;46:63-70. https://doi.org/10.1093/jjco/hyv159
  16. Rausei S, Dionigi G, Ruspi L, Proserpio I, Galli F, Tirotta F, et al. Lymph node staging in gastric cancer: new criteria, old problems. Int J Surg 2013;11 Suppl 1:S90-S94. https://doi.org/10.1016/S1743-9191(13)60025-4
  17. Dicken BJ, Graham K, Hamilton SM, Andrews S, Lai R, Listgarten J, et al. Lymphovascular invasion is associated with poor survival in gastric cancer: an application of gene-expression and tissue array techniques. Ann Surg 2006;243:64-73. https://doi.org/10.1097/01.sla.0000194087.96582.3e
  18. Lee JH, Kim MG, Jung MS, Kwon SJ. Prognostic significance of lymphovascular invasion in node-negative gastric cancer. World J Surg 2015;39:732-739. https://doi.org/10.1007/s00268-014-2846-y

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