[Extent and mode of metastatic spread to lymph nodes in patients with adenocarcinoma of the gastric cardia: a multivariate analysis using COX proportion hazard model].
OBJECTIVE
To investigate lymph node metastases (LNM) and assess LNM level accurately after standard resection.


METHODS
An analysis was done in 736 patients with resected gastric cardia cancer whose postoperative survival time was longer than three months, through comparison of prognosis, frequency of LNM and ratio of the number of invaded to removed lymph nodes (I/R), using COX multivariate analysis model.


RESULTS
(1) The most important prognostic variables were I/R, left gastric artery LNM, lesser curvature LNM, and paracardia LNM. (2) The patients without LNM had better survival (P < 0.001). (3) There were a relatively regular way of LNM and significant difference between LNM of single site and that of multiple sites on the frequency of LNM and I/R, respectively (P < 0.05). (4) There was significantly different I/R among group 1 (single paracardia LNM and single lesser curvature LNM), group 2 (single left gastric artery LNM and paracardia plus lesser curvature LNM) and group 3 (multiple sites in association with left gastric artery LNM) (P < 0.05).


CONCLUSIONS
The dissemination of LNM seems to be as follows: from paracardia lymph nodes to distant lymph nodes, and from a single lymph node of one site to multiple sites with many lymph notes involved. It is suggested that group 1 LNM belongs to station 1, group 2 LNM to station 2 and group 3 LNM to station 3 according to their I/R.
Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing.
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Li
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Zhang
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Zhang
D000230:Adenocarcinoma / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000473:pathology*