title: Prognosis of patients with gastric cancer and solitary lymph node metastasis.
abstract: OBJECTIVE
  To investigate the relationship of solitary lymph node metastasis (SLNM) and age with patient survival in gastric cancer (GC).
  
  
  METHODS
  The medical records databases of China's Beijing Cancer Hospital at the Peking University School of Oncology and Shanghai Tenth People's Hospital affiliated to Tongji University were searched retrospectively to identify patients with histologically proven GC and SLNM who underwent surgical resection between October 2003 and December 2012. Patients with distant metastasis or gastric stump carcinoma following resection for benign disease were excluded from the analysis. In total, 936 patients with GC + SLNM were selected for analysis and the recorded parameters of clinicopathological disease and follow-up (range: 13-2925 d) were collected. The Kaplan-Meier method was used to stratify patients by age (≤ 50 years-old, n = 198; 50-64 years-old, n = 321; ≥ 65 years-old, n = 446) and by metastatic lymph node ratio [MLR < 0.04 (1/25), n = 180; 0.04-0.06 (1/25-1/15), n = 687; ≥ 0.06 (1/15), n = 98] for 5-year survival analysis. The significance of intergroup differences between the survival curves was assessed by a log-rank test.
  
  
  RESULTS
  The 5-year survival rate of the entire GC + SLNM patient population was 49.9%. Stratification analysis showed significant differences in survival time (post-operative days) according to age: ≤ 50 years-old: 950.7 ± 79.0 vs 50-64 years-old: 1697.8 ± 65.9 vs ≥ 65 years-old: 1996.2 ± 57.6, all P < 0.05. In addition, younger age (≤ 50 years-old) correlated significantly with mean survival time (r = 0.367, P < 0.001). Stratification analysis also indicated an inverse relationship between increasing MLR and shorter survival time: < 0.04: 52.8% and 0.04-0.06: 51.1% vs ≥ 0.06: 40.5%, P < 0.05. The patients with the shortest survival times and rates were younger and had a high MLR (≥ 0.06): ≤ 50 years-old: 496.4 ± 133.0 and 0.0% vs 50-65 years-old: 1180.9 ± 201.8 and 21.4% vs ≥ 65 years-old: 1538.4 ± 72.4 and 37.3%, all P < 0.05. The same significant trend in shorter survival times and rates for younger patients was seen with the mid-range MLR group (0.04-0.06), but the difference between the two older groups was not significant. No significant differences were found between the age groups of patients with MLR < 0.04. Assessment of clinicopathological parameters identified age group, Borrmann type, histological type and tumor depth as the most important predictors of the survival rates and times observed for this study population.
  
  
  CONCLUSIONS
  GC patients below 51 years of age with MLR of SLNM above 0.06 have shorter life expectancy than their older counterparts.
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Chun-Qiu
authors.initials: CQ
authors.lastname: Chen
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Xiao-Jiang
authors.initials: XJ
authors.lastname: Wu
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Zhao-De
authors.initials: ZD
authors.lastname: Bu
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Ke-Qiang
authors.initials: KQ
authors.lastname: Zuo
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Zi-Yu
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Chun-Qiu Chen, Zhen Yu, Ke-Qiang Zuo, Department of General Surgery, Tenth People's Hospital of Shanghai, Tongji University, School of Medicine, Shanghai 200072, China.
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Ji
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Age; Gastric cancer; Metastatic lymph node ratio; Solitary lymph node metastasis; Survival