Prognosis of pN3 stage gastric cancer.
OBJECTIVE
The aim of this study was to determine the prognosis of pN3 stage gastric cancer patients after they have undergone curative resection, and we also wanted to identify the prognostic factors according to the clinico-pathologic features.


METHODS
Between January 2000 and December 2004, we retrospectively reviewed the medical records of the patients with histologically confirmed pN3 stage gastric cancer. They underwent both gastrectomy and lymphadenectomy with a curative aim. We categorized the pN3 stage patients into 2 groups; one with pN3 only (pN3M0) and the other with pN3 combined with M1 stage (pN3M1) that included peritoneal seeding, hepatic metastasis or para-aortic LN metastasis.


RESULTS
Out of 467 patients with stage IV gastric adenocarcinoma who received surgery, 260 patients underwent curative resection and they were pathologically staged as N3. Among these 260 patients, 78 patients were classified as the pN3/M1 stage. For all the patients, the median follow-up period was 19 months (range: 1~108 months) and the median overall survival time was 16.2 months (95% CI, 14.1~18.3%). The 5-year survival rate of the pN3/M0 group was significantly higher than that of the pN3/M1 group (12.6% vs. 2.6%, respectively, p<0.0001). The identified predictor for a worse prognosis was an advanced T4 stage (HR: 3.38, 95% CI, 1.4~8.3, p=0.008) for the pN3 patients.


CONCLUSIONS
The survival for the pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared to that of the pN3/M1 group. An advanced T stage was a predictor for a poor prognosis for the pN3 patients. Therefore, diverse treatment strategies for these heterogeneous pN3 gastric cancer patients are needed for improving their survival.
Ahn
Jung Ryun
JR
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jung
Minkyu
M
Kim
Chan
C
Hong
Min Hee
MH
Chon
Hong Jae
HJ
Kim
Hye Ryun
HR
Jeung
Hei-Cheul
HC
Hyung
Woo Jin
WJ
Lee
Sung Sook
SS
Chung
Hyun Cheol
HC
Noh
Sung Hoon
SH
Rha
Sun Young
SY
Crit Rev Oncol Hematol. 2009 Aug;71(2):127-64
19230702
J Cancer Res Clin Oncol. 2008 Feb;134(2):187-92
17611776
J Surg Oncol. 2009 May 1;99(6):324-8
19204941
Br J Cancer. 2001 Jan 5;84(1):64-71
11139315
CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
15761078
CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
18287387
Arch Surg. 2009 Jan;144(1):38-45; discussion 45
19153323
Am J Surg. 2004 Apr;187(4):543-6
15041508
J Surg Oncol. 2007 Feb 1;95(2):118-22
17262741
Br J Surg. 2002 Nov;89(11):1438-43
12390389
N Engl J Med. 2007 Nov 1;357(18):1810-20
17978289
World J Surg. 1999 May;23(5):492-7; discussion 497-8
10085399
J Clin Oncol. 2006 May 10;24(14):2137-50
16682732
Ann Surg Oncol. 2001 Apr;8(3):215-21
11314937
Ann Surg Oncol. 2008 Jul;15(7):1959-67
18369676
Cancer Res Treat. 2005 Apr;37(2):87-91
19956485
Ann Surg Oncol. 2007 Sep;14(9):2535-42
17549571
J Gastrointest Surg. 2008 Aug;12(8):1364-9
18516653
Gastric Cancer. 1998 Dec;1(1):10-24
11957040