title: Prognostic factors and recurrence pattern in node-negative advanced gastric cancer.
abstract: OBJECTIVE
  Despite better overall survival in node-negative advanced gastric cancer (AGC), a significant proportion of patients develop recurrence and they may benefit from adjuvant therapy. The aim of this study was to evaluate the prognostic factors and recurrence pattern of node-negative AGC.
  
  
  METHODS
  A total of 424 patients who underwent curative gastrectomy with extended lymphadenectomy for node-negative AGC between 2003 and 2005 were retrospectively reviewed. Patients with tumor involvement of adjacent organs (T4b), gastric cancer recurrence, tumor in the remnant stomach, less than 15 harvested lymph nodes, and those who received neoadjuvant chemotherapy were excluded.
  
  
  RESULTS
  Invasion to deeper layers, undifferentiated histology, signet ring cell type compared with tubular adenocarcinoma, and tumor size larger than 6.3 cm correlated with poorer prognosis in univariate analysis. In multivariate one, however, only differentiation and depth of invasion, especially the presence of serosa involvement were significant. The 5-year survival rates of the four groups classified by differentiation and depth of invasion [T2/3 (differentiated type), T2/3 (undifferentiated type), T4a (differentiated type), and T4a (undifferentiated type)] were 98%, 92%, 80%, and 72%, respectively (P < 0.01). In terms of recurrence pattern, Lauren's type and depth of invasion were significant. Recurrence with peritoneal seeding was associated with the diffuse type and invasion into the subserosa or serosa, while hematogenous metastasis was related to the intestinal type and invasion to the proper muscle or subserosa layer.
  
  
  CONCLUSIONS
  Differentiation and serosa involvement should be considered to stratify patients with node-negative AGC for adjuvant treatment.
authors.affiliation: Department of Surgery, Ulsan University College of Medicine and Asan Medical Centre, 388-1, Pungnap 2-dong, Songpa-ku, Seoul 138-736, Republic of Korea.
authors.forename: I S
authors.initials: IS
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Yook
authors.forename: T H
authors.initials: TH
authors.lastname: Kim
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: K C
authors.initials: KC
authors.lastname: Kim
authors.forename: S T
authors.initials: ST
authors.lastname: Oh
authors.forename: B S
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000556:secondary; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*