Surgical outcomes of patients with gastric carcinoma: the importance of primary tumor location and microvessel invasion.
BACKGROUND
This study was done to identify clinicopathologic predictors of disease-free survival (DFS) and overall survival (OS) among patients undergoing potentially curative resections for gastric carcinoma.


METHODS
We reviewed 110 patients surgically treated between 1987 and 2001. There were 74 men and 36 women with a mean age of 65.2 years (range 27 to 87 years). Log-rank tests and Kaplan-Meier survival curves were generated to determine clinicopathologic factors influencing DFS and OS. Significant factors were then determined with Cox multivariate analysis.


RESULTS
Median survival for all patients was 38.2 months and the estimated 5-year OS was 42.3%. There were no significant differences in DFS or OS for female sex, black race, or age>65. Symptoms associated with lower DFS were weight loss and palpable abdominal mass (P<.05), although none were predictive for OS. Median survival was markedly worse in patients undergoing esophagogastrectomy versus gastrectomy (26.8 vs 52.3 months; P<.05), although there were no significant differences between patients undergoing total gastrectomy versus subtotal gastrectomy. As expected, OS was inversely proportional to the American Joint Committee on Cancer's tumor stage. When compared with patients with partial-thickness tumors (T(1-2)), full-thickness (T(3-4)) tumors had a decreased median survival (63.8 vs 27.9 months; P<.01). Although N(2) stage was associated with decreased survival (20.6 months), patient outcomes were similar for N(0) and N(1) stages (52.5 and 48.8 months). Lymphatic and capillary invasion (21.4 vs 45.3 months; P<.02) and proximal location of primary tumors (28.5 vs 58.6 months; P<.02) were the only other factors adversely affecting survival. Lauren classification and histologic grade were not significant predictors of patient outcomes.


CONCLUSIONS
In addition to the American Joint Committee on Cancer stage, microvessel involvement and tumor location are important predictors of DFS and OS in gastric cancer and should be included in risk stratification and selection criteria for patients entering novel adjuvant or neoadjuvant clinical trials.
Talamonti
Mark S
MS
Department of Surgery, Feinberg School of Medicine, Northwestern University, 201 E. Huron, Galter 10-105, Chicago, IL 60611, USA.
Kim
Simon P
SP
Yao
Katherine A
KA
Wayne
Jeffrey D
JD
Feinglass
Joseph
J
Bennett
Charles L
CL
Rao
Sambasiva
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000473:pathology; D002277:Carcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome