title: Predictors of long-term survival in pN3 gastric cancer patients.
abstract: OBJECTIVE
  Patients with pN3 gastric cancer are classified as having a stage IV disease just by virtue of having more than 15 metastatic lymph nodes according to the 5th UICC cancer staging criteria. We tried to verify whether the pN3 gastric cancer patients truly constitute a homogeneous group with the same poor prognosis by looking for predictors of long-term survival within the group.
  
  
  METHODS
  Medical records of 347 patients who had gastrectomy with D2/D3 lymph node dissection for gastric cancer and diagnosed with pN3 disease by pathology, between January 1987 and December 1997 were reviewed. Clinicopathologic prognostic variables were evaluated as predictors of long-term survival by univariate and multivariate analysis.
  
  
  RESULTS
  The overall 5-year survival rate was 13.0% (95% CI, 9.3-16.6%). The extent of gastric resection and metastatic lymph node ratio were significant independent predictors of long-term survival on multivariate analysis. The 5-year survival rates for the subtotal and total gastrectomy groups were 18.2 and 8.8%, respectively. The 5-year survival rate according to the metastatic lymph node ratio was 20.2, 8.9, and 1.9% when the ratio was <0.33, 0.33-0.67, and > 0.67, respectively.
  
  
  CONCLUSIONS
  Patients with pN3 gastric cancer appear to be a heterogeneous group with clinicopathologic predictors that identify subgroups with significantly different long-term prognoses. The metastatic lymph node ratio may serve as a valuable tool to predict the long-term prognosis of these patients.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea.
authors.forename: Junuk
authors.initials: J
authors.lastname: Kim
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Cheong
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Jianguo
authors.initials: J
authors.lastname: Shen
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis