title: Prognosis of pN3 stage gastric cancer.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung Ryun
authors.initials: JR
authors.lastname: Ahn
authors.forename: Minkyu
authors.initials: M
authors.lastname: Jung
authors.forename: Chan
authors.initials: C
authors.lastname: Kim
authors.forename: Min Hee
authors.initials: MH
authors.lastname: Hong
authors.forename: Hong Jae
authors.initials: HJ
authors.lastname: Chon
authors.forename: Hye Ryun
authors.initials: HR
authors.lastname: Kim
authors.forename: Hei-Cheul
authors.initials: HC
authors.lastname: Jeung
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Sung Sook
authors.initials: SS
authors.lastname: Lee
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Chung
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
references.citation: Crit Rev Oncol Hematol. 2009 Aug;71(2):127-64
references.pmid: 19230702
references.citation: J Cancer Res Clin Oncol. 2008 Feb;134(2):187-92
references.pmid: 17611776
references.citation: J Surg Oncol. 2009 May 1;99(6):324-8
references.pmid: 19204941
references.citation: Br J Cancer. 2001 Jan 5;84(1):64-71
references.pmid: 11139315
references.citation: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references.pmid: 15761078
references.citation: CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
references.pmid: 18287387
references.citation: Arch Surg. 2009 Jan;144(1):38-45; discussion 45
references.pmid: 19153323
references.citation: Am J Surg. 2004 Apr;187(4):543-6
references.pmid: 15041508
references.citation: J Surg Oncol. 2007 Feb 1;95(2):118-22
references.pmid: 17262741
references.citation: Br J Surg. 2002 Nov;89(11):1438-43
references.pmid: 12390389
references.citation: N Engl J Med. 2007 Nov 1;357(18):1810-20
references.pmid: 17978289
references.citation: World J Surg. 1999 May;23(5):492-7; discussion 497-8
references.pmid: 10085399
references.citation: J Clin Oncol. 2006 May 10;24(14):2137-50
references.pmid: 16682732
references.citation: Ann Surg Oncol. 2001 Apr;8(3):215-21
references.pmid: 11314937
references.citation: Ann Surg Oncol. 2008 Jul;15(7):1959-67
references.pmid: 18369676
references.citation: Cancer Res Treat. 2005 Apr;37(2):87-91
references.pmid: 19956485
references.citation: Ann Surg Oncol. 2007 Sep;14(9):2535-42
references.pmid: 17549571
references.citation: J Gastrointest Surg. 2008 Aug;12(8):1364-9
references.pmid: 18516653
references.citation: Gastric Cancer. 1998 Dec;1(1):10-24
references.pmid: 11957040