The presence or absence of lymph node metastases is the most powerful predictor of survival following curative resection for gastric cancer. However, the factors which predict survival in node-negative gastric cancer have not been clarified.
In this study, researchers from New York, USA, evaluated the factors predicting survival following curative resection for node-negative gastric adenocarcinoma.
The research team evaluated both histopathology and clinical outcome for all patients undergoing R0 resections for gastric cancer at a tertiary center, between 1985 and 2001.
There were 1256 R0 resections performed. Of these, 507 were node-negative, 465 were T1 to T3, and 317 were adequately staged, as defined by histologic evaluation of at least 15 lymph nodes.
The team found that the patient's median age was 67 years, and that 62% were male.
|5- and 10-year disease-specific survival rates were 79% and 67%, respectively.|
|Annals of Surgery|
They determined that 40% had T1 tumors, 34% T2, and 26% T3. The median tumor size was 3 cm.
In addition, vascular invasion (VI) was present in 17% of tumors and neural invasion (NI) was present in 31%.
The researchers found that extended (D2) lymphadenectomy was performed in 75% of patients.
They established that 5- and 10-year disease-specific survival rates were 79% and 67%, respectively.
The team determined that the factors associated with poorer disease-specific survival were male gender, serosal invasion, presence of VI, presence of NI, and resection other than distal subtotal gastrectomy.
However, multivariate analysis did not identify NI as an independent predictor of survival, as this is correlated with advancing T stage and tumor size.
Dr David Kooby's team concluded, "Serosal invasion and presence of VI are strong predictors of poor survival in this disease".
"NI correlates with T stage and tumor size and may serve as a marker of advanced disease".