A multicentric Western analysis of prognostic factors in advanced, node-negative gastric cancer patients.
BACKGROUND
The presence of lymph node metastasis is one of the most important prognostic factors in patients with gastric carcinoma. Node-negative patients have a better outcome, nevertheless a subgroup of them experience disease recurrence.


OBJECTIVE
To analyze the clinicopathological characteristics of lymph node-negative advanced gastric carcinoma patients submitted to gastrectomy and D2 lymphadenectomy with a retrieved number of nodes greater than 15, after an actual follow-up of almost 5 years, and to evaluate outcome indicators.


METHODS
The records of 301 patients who underwent curative gastrectomy for gastric carcinoma and were adequately staged as N0 between 1992 and 2002 were retrospectively analyzed from the prospectively collected database of 7 centers participating to the Italian Research Group for Gastric Cancer.


RESULTS
Disease-specific and disease-free survival after 3, 5, and 10 years were 90.4%, 86.1%, 75.9%, and 72.1%, 57.3%, 57.3%, respectively. Mortality was 1.7%. The factors associated with a better disease-free survival at univariate analysis were age <60, T2 tumors, distal location, intestinal histotype, and number of retrieved nodes >25; depth of infiltration and histotype were the only 2 independent predictors of 5-year recurrence-free survival at multivariate analysis.


CONCLUSIONS
These parameters must be considered to stratify node-negative gastric cancer patients for an adjuvant treatment and follow-up scheduling. Survival was similar to that previously reported by Eastern Centers. Lymphadenectomy is suggested to be effective, and retrieval of more than 25 nodes may be warranted.
Baiocchi
Gian Luca
GL
Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, Brescia, Italy. baiocchi@med.unibs.it
Tiberio
Guido A
GA
Minicozzi
Anna Maria
AM
Morgagni
Paolo
P
Marrelli
Daniele
D
Bruno
Lorenzo
L
Rosa
Fausto
F
Marchet
Alberto
A
Coniglio
Arianna
A
Saragoni
Luca
L
Veltri
Marco
M
Pacelli
Fabio
F
Roviello
Franco
F
Nitti
Donato
D
Giulini
Stefano M
SM
De Manzoni
Giovanni
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology