Metastatic lymph node in gastric cancer; is it a real distant metastasis?
BACKGROUND
Currently, the TNM staging system is a widely accepted method for assessing the prognosis of the disease and planning therapeutic strategies for cancer. Of the TNM system, the extent of lymph node involvement is the most important independent prognostic factor for gastric cancer. The aim of our study is to evaluate the survival and prognosis of gastric cancer patients with LN#12 or #13 involvement only and to assess the impact of anatomic regions of primary gastric tumor on survival in this particular subset of patients.


METHODS
Among data of 1,008 stage IV gastric cancer patients who received curative R0 gastrectomy, a total of 79 patients with LN#12 (n = 68) and/or #13 (n = 11) were identified. All patients performed gastrectomy with D2 or D3 lymph node dissection.


RESULTS
In 79 patients with LN#12/13 involvement, the estimated one-, three- and five-year survival rate was 77.2%, 41.8% and 26.6% respectively. When we compared the patients with LN#12/13 involvement to those without involvement, there was no significant difference in OS (21.0 months vs. 25.0 months, respectively; P = 0.140). However, OS was significantly longer in patients with LN#12/13 involvement only than in those with M1 lymph node involvement (14.3 months; P = 0.001). There was a significant difference in survival according to anatomic locations of the primary tumor (lower to mid-body vs. high body or whole stomach): 26.5 vs. 9.2 months (P = 0.009). In Cox proportional hazard analysis, only N stage (p = 0.002) had significance to predict poor survival.


CONCLUSIONS
In this study we found that curatively resected gastric cancer patients with pathologic involvement of LN #12 and/or LN #13 had favorable survival outcome, especially those with primary tumor location of mid-body to antrum. Prospective analysis of survival in gastric cancer patients with L N#12 or #13 metastasis is warranted especially with regards to primary tumor location.
Lim
Do Hyoung
DH
Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. psy27hmo@skku.edu
Kim
Hyeong Su
HS
Park
Young Suk
YS
Lee
Jeeyun
J
Park
Se Hoon
SH
Lim
Ho Yeong
HY
Ji
Sang Hoon
SH
Park
Min Jae
MJ
Yi
Seong Yoon
SY
An
Ji Yeong
JY
Sohn
Tae Sung
TS
Noh
Jae Hyoung
JH
Bae
Jae Moon
JM
Kim
Sung
S
Park
Cheol Keun
CK
Kang
Won Ki
WK
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D045744:Cell Line, Tumor; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000473:pathology*; D016896:Treatment Outcome