title: The directionality of lymphatic spreading as a prognostic factor in gastric cancer: uni- or multidirectional lymphatic metastases.
abstract: OBJECTIVE
  The most critical problem of the numerical lymph node staging system is difficulty in evaluating preoperative staging. We investigated the directionality of metastatic lymph nodes as an alternative prognostic indicator of gastric cancer.
  
  
  METHODS
  One hundred and seventy two patients who had undergone curative gastrectomy were examined. We divided the stations of lymph nodes into three zones according to the anatomical site. Then patients were classified into two groups according to the number of positive zones, unidirectional or multidirectional lymphatic spreading.
  
  
  RESULTS
  Seventy-five patients showed unidirectional lymphatic spreading, whereas 97 patients showed multidirectional. Logistic regression analysis showed that directionality correlated with the number of metastatic nodes. Directionality was found to be a significant prognostic factor on univariate analysis, but not on multivariate analysis.
  
  
  CONCLUSIONS
  The directionality could be a surrogate marker of total number of metastatic lymph nodes as a prognostic factor in patients with gastric cancer.
authors.affiliation: Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Kitagawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Kokuba
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology*