title: Gastric cancer: establishing predictors of biologic behavior with use of population-based data.
abstract: BACKGROUND
  Tumor thickness and nodal status are important predictors of survival following curative resection for gastric cancer. Lymphovascular invasion (LVI) is a potential predictor of biological behavior. The relationship between LVI and tumor thickness (T status) has not been established in population-based studies.
  
  
  METHODS
  Clinicopathological and survival data of 577 patients at nine centers, from between 1991 and 1997, was collected from patient records and a Provincial Cancer Registry. The primary endpoint of the study was death. A secondary analysis of a node-negative subgroup examined the significance of LVI with respect to T status.
  
  
  RESULTS
  The population disease-specific survival was 28%. In a multivariate analysis, T, N, M, esophageal margin, tumor morphology, and residual tumor category were independent predictors of survival. LVI was documented in 58% of resected tumors. LVI correlated with advancing T and N status but was not significant in a multivariate population model. Subgroup analysis of node-negative gastric cancer found T status and LVI to be independent predictors of survival. LVI was associated with a 5-year survival of 8%, versus 43% among patients in whom it was absent (P <.001).
  
  
  CONCLUSIONS
  T status and N status were the most important independent predictors of survival in a population-based study of gastric cancer. LVI correlated with advancing N and T status. Multivariate analysis of node-negative patients showed LVI and T status are independent predictors of survival.
authors.affiliation: 2D2 Walter C. Mackenzie Health Sciences Center, 8440-112 St. University of Alberta Hospital, Edmonton, Alberta, Canada T6G 2B7.
authors.forename: B J
authors.initials: BJ
authors.lastname: Dicken
authors.forename: L D
authors.initials: LD
authors.lastname: Saunders
authors.forename: G S
authors.initials: GS
authors.lastname: Jhangri
authors.forename: C
authors.initials: C
authors.lastname: de Gara
authors.forename: C
authors.initials: C
authors.lastname: Cass
authors.forename: S
authors.initials: S
authors.lastname: Andrews
authors.forename: S M
authors.initials: SM
authors.lastname: Hamilton
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate