Prognostic factors and recurrence pattern in node-negative advanced gastric cancer
Introduction
Nodal metastasis is the most important prognostic factor for survival after curative resection in gastric adenocarcinoma.1, 2 Importantly, many patients have node-negative disease on their pathologic examination. Although node-negative advanced gastric cancer (AGC) shows a better overall survival than node-positive AGC, a significant number of patients still develop recurrence. Patients without node metastasis are theoretically free of locoregional micrometastasis and can potentially benefit from adjuvant therapy.
Several reports demonstrate that the depth of invasion is an independent prognostic indicator in node-negative gastric cancer including early gastric cancer (EGC).3, 4, 5 However, there is still controversy on the prognostic significance of other factors, including patient age, tumor size, histology, differentiation, and the presence of lymphovascular invasion. Moreover, most studies include a significant proportion of patients with EGC, which has a very low risk of recurrence,3, 4, 5, 6, 7 as well as patients with understaged disease due to limited lymphadenectomy and the subsequent small number of retrieved lymph nodes on pathology.4, 5, 8, 9
In this study, by only investigating patients with node-negative AGC, we aimed to evaluate the prognostic factors and their relation to survival. In addition, we analyzed the pattern and indicators of recurrence.
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Patient population
Patients who underwent curative gastrectomy with extended lymphadenectomy (R0) for node-negative AGC at the Asan Medical Centre from 2003 to 2005 were identified. Among them, patients with pathologically confirmed tumor involvement of adjacent organs (T4b), recurred gastric cancer, tumor in the remnant stomach, <15 harvested lymph nodes, and those who received neoadjuvant chemotherapy were excluded.
Data collection
The medical records of the resulting 424 patients were retrospectively analyzed to determine
Clinicopathologic characteristics
The median age at operation was 58 and the ratio of men to women was 2. The median tumor size and number of harvested lymph nodes were 5 cm and 27, respectively. Most patients had malignant lesions on the lower third of the stomach and received distal gastrectomy. In addition, most tumors were Borrmann type 3 on gross appearance, had undifferentiated histology, and involved the proper muscle or subserosal layer (Table 1).
Recurrence and survival
At the time of analysis, 40 patients had recurrence, of which 25 had
Importance of the study
Previously, several studies investigated the prognostic factors for node-negative gastric adenocarcinoma with R0 resection. In contrast to previous studies, we excluded patients with node-negative EGC to lessen their confounding effect and patients with less than 15 harvested lymph nodes to eliminate possible understaging. In addition, to the best of our knowledge, our study is the largest scaled one assessing prognostic factors in node-negative AGC.
In other studies, the 5-year survival rate in
Conclusion
In conclusion, serosal invasion and undifferentiated histology are two predictors of poor prognosis in node-negative AGC patients. Moreover, Lauren's type and depth of invasion may be helpful to predict the recurrence pattern of node-negative AGC. Such parameters should be considered to stratify patients for adjuvant treatment. Further studies are needed to confirm that adjuvant therapy can improve survival in such patients.
Conflict of interest statement
The authors have no conflicts of interest or financial support to declare.
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