Abstract
Background
Tumor thickness and nodal status are important predictors of survival following curative resection for gastric cancer. Lymphovascular invasion (LVI) is a potential predictor of biological behavior. The relationship between LVI and tumor thickness (T status) has not been established in population-based studies.
Methods
Clinicopathological and survival data of 577 patients at nine centers, from between 1991 and 1997, was collected from patient records and a Provincial Cancer Registry. The primary endpoint of the study was death. A secondary analysis of a node-negative subgroup examined the significance of LVI with respect to T status.
Results
The population disease-specific survival was 28%. In a multivariate analysis, T, N, M, esophageal margin, tumor morphology, and residual tumor category were independent predictors of survival. LVI was documented in 58% of resected tumors. LVI correlated with advancing T and N status but was not significant in a multivariate population model. Subgroup analysis of node-negative gastric cancer found T status and LVI to be independent predictors of survival. LVI was associated with a 5-year survival of 8%, versus 43% among patients in whom it was absent (P < .001).
Conclusions
T status and N status were the most important independent predictors of survival in a population-based study of gastric cancer. LVI correlated with advancing N and T status. Multivariate analysis of node-negative patients showed LVI and T status are independent predictors of survival.
Similar content being viewed by others
REFERENCES
Fenogilo-Preiser C, Carneiro F, Correa P, et al. Gastric carcinoma. Hamilton SR, Aaltonen LA, eds. Pathology and Genetics of Tumors of the Digestive System Lyon: IARC Press, 2000: 39–52
Canadian Cancer Statistics, 2001. www.hc-sc.gc.ca. Accessed September 10, 2003.
Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer 1999;79:1522–30.
Davis PA, Sano T. The differences in gastric cancer between Japan, USA and Europe: What are the facts? What are the suggestions?. Crit Rev Oncol Hematol 2001;40:77–94.
Adachi Y, Shiraishi N, Suematsu T, et al. Most important lymph node information in gastric cancer: multivariate prognostic study. Ann Surg Oncol 2000;7:503–7.
Mullaney PJ, Wadley MS, Hyde C, et al. Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer. Br J Surg 2002;89:1405–8.
Ichikura T, Ogawa T, Chochi K, et al. Minimum number of lymph nodes that should be examined for the International Union Against Cancer/American Joint Committee on Cancer TNM Classification of Gastric Carcinoma. World J Surg 2003;27:330–33.
Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–14.
Volpe CM, Driscoll DL, Douglass HO. Outcome of patients with proximal gastric cancer depends on extent of resection and number of resected lymph nodes. Ann Surg Oncol 2000;7:139–44.
Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol 2002;9:894–900.
Siewert JR, Bottcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–59.
Karpeh MS, Leon L, Klimstra D, et al. Lymph node staging in gastric cancer: is location more important than number?. Ann Surg 2000;232:362–71.
Bouvier AM, Haas O, Piard F, et al. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer 2002;94:2862–8.
Faivre J, Forman JE, Gatta G, et al. Survival of patients with oesophageal and gastric cancers in Europe. Eur J Cancer 1998;34:2167–75.
Barchielli A, Amorosi A, Balzi D, et al. Long-term prognosis of gastric cancer in a European country: a population-based study in Florence (Italy). 10-year survival of cases diagnosed in 1985–1987. Eur J Cancer 2001;37:1674–80.
Hansson LE, Ekstrom AM, Bergstrom R, et al. Surgery for stomach cancer in a defined Swedish population: current practices and operative results. Eur J Surg 2000;166:787–95.
Miska S, Benhamiche AM, Jouve JL, et al. Prognostic factors after curative resection for gastric cancer. A population-based study. Eur J Cancer 2000;36:390–6.
AJCC Cancer Staging Manual. Chicago: Lippincott-Raven, 1997.
Hosmer DW, Lemeshow S. Applied Survival Analysis New York: Wiley, 1999.
Otsuji E, Toma A, Kobayashi S, et al. Long-term benefit of extended lymphadenectomy with gastrectomy in distally located early gastric carcinoma. Am J Surg 2000;180:127–32.
Maehara Y, Kakeji Y, Koga T, et al. Therapeutic value of lymph node dissection and the clinical outcome for patients with gastric cancer. Surgery 2002;131:S85–91.
Marubini E, Bozzetti F, Miceli R, et al. Lymphadenectomy in gastric cancer: prognostic role and therapeutic implications. EJSO 2002;28:406–12.
Ramacciato G, Aurello P, D’Angelo F, et al. Does extended lymphadenectomy influence prognosis of gastric carcinoma after curative resection?. Hepato-Gastroenterology 2000;47:1470–4.
Onate-Ocana LF, Aiello-Crocifoglio V, Mondragon-Sanchez R, et al. Survival benefit of D2 lymphadenectomy in patients with gastric adenocarcinoma. Ann Surg Oncol 2000;7:210–7.
Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base report on poor survival of US gastric carcinoma patients treated with gastrectomy. Cancer 2000;88:921–32.
Yokota T, Kunii Y, Teshima S, et al. Significant prognostic factors in patients with node-negative gastric cancer. Int J Surgery 1999;84:331–6.
Hyung WJ, Lee JH, Choi SH, et al. Prognostic impact of lymphatic and/or blood vessel invasion in patients with node-negative advanced gastric cancer. Ann Surg Oncol 2002;9:562–7.
Kooby DA, Suriawinata A, Klimstra DS, et al. Biologic predictors of survival in node-negative gastric cancer. Ann Surg 2003;237:828–37.
Hayashi H, Ochiai T, Suzaki T, et al. Superiority of a new UICC-TNM staging system for gastric carcinoma. Surgery 2000;127:129–35.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dicken, B.J., Saunders, L.D., Jhangri, G.S. et al. Gastric Cancer: Establishing Predictors of Biologic Behavior with Use of Population-Based Data. Ann Surg Oncol 11, 629–635 (2004). https://doi.org/10.1245/ASO.2004.09.002
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2004.09.002