Prognostic influence of sub-stages according to pTNM categories in patients with stage IV gastric cancer.
OBJECTIVE
The prognosis for patients with stage IV gastric cancer is still very poor. The purpose of this study was to evaluate the surgical outcome and prognosis, and to determine the prognostic influence of sub-stages of stage IV gastric cancer.


METHODS
From 1992 to 2002, 287 patients histologically diagnosed with stage IV gastric cancer underwent gastrectomy at the Department of Surgery, Ruijin Hospital, China. Regarding TNM categories, we separated them into T1-3N3M0, T4N1-2M0, T4N3M0, and TanyNanyM1 groups. We compared the clinicopathological characteristics as well as the survival in these groups.


RESULTS
There were largest proportions of patients who underwent extended lymphadenectomy and curative gastrectomy in T1-3N3M0 group followed by T4N1-2M0, T4N3M0, and TanyNanyM1 groups. The survival rate of patients with sub-stage IVa (T1-3N3M0 and T4N1-2M0) tumors was significant higher than that of patients with sub-stage IVb (T4N3M0 and TanyNanyM1) tumors (P = 0.008). Multivariate analysis showed that sub-stage with the highest risk ratio (1.454), and the surgical curability were independent prognostic factors in patients with stage IV gastric cancer.


CONCLUSIONS
Sub-stages IVa (T1-3N3M0 and T4N1-2M0) and IVb (T4N3M0 and TanyNanyM1) may predict patients' prognosis more accurately. Curative resection should be performed whenever possible in patients with stage IV gastric cancer.
Li
Chen
C
Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. leechendoc@yahoo.com.cn
Yan
Min
M
Chen
Jun
J
Xiang
Min
M
Zhu
Zheng Gang
ZG
Lin
Yan Zheng
YZ
D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis