Abstract
BackgroundCurrently, the TNM staging system is a widely accepted method for assessing the prognosis of the disease and planning therapeutic strategies for cancer. Of the TNM system, the extent of lymph node involvement is the most important independent prognostic factor for gastric cancer. The aim of our study is to evaluate the survival and prognosis of gastric cancer patients with LN#12 or #13 involvement only and to assess the impact of anatomic regions of primary gastric tumor on survival in this particular subset of patients.MethodsAmong data of 1,008 stage IV gastric cancer patients who received curative R0 gastrectomy, a total of 79 patients with LN#12 (n = 68) and/or #13 (n = 11) were identified. All patients performed gastrectomy with D2 or D3 lymph node dissection.ResultsIn 79 patients with LN#12/13 involvement, the estimated one-, three- and five-year survival rate was 77.2%, 41.8% and 26.6% respectively. When we compared the patients with LN#12/13 involvement to those without involvement, there was no significant difference in OS (21.0 months vs. 25.0 months, respectively; P = 0.140). However, OS was significantly longer in patients with LN#12/13 involvement only than in those with M1 lymph node involvement (14.3 months; P = 0.001). There was a significant difference in survival according to anatomic locations of the primary tumor (lower to mid-body vs. high body or whole stomach): 26.5 vs. 9.2 months (P = 0.009). In Cox proportional hazard analysis, only N stage (p = 0.002) had significance to predict poor survival.ConclusionIn this study we found that curatively resected gastric cancer patients with pathologic involvement of LN #12 and/or LN #13 had favorable survival outcome, especially those with primary tumor location of mid-body to antrum. Prospective analysis of survival in gastric cancer patients with L N#12 or #13 metastasis is warranted especially with regards to primary tumor location.
Highlights
The TNM staging system is a widely accepted method for assessing the prognosis of the disease and planning therapeutic strategies for cancer
The 4th N-classification was based on the sites of lymph node metastasis [4,5], whereas in 5th (1997) and 6th (2002) TNM editions, the N staging was based on the number of metastatic lymph nodes [6,7,8,9]
When the 1,008 stage IV gastric cancer patients were divided according to LN#12/13 involvement only or others, there were no differences in the baseline characteristics including age, sex, histological grades and postoperative treatment
Summary
The TNM staging system is a widely accepted method for assessing the prognosis of the disease and planning therapeutic strategies for cancer. The tumor, node, metastasis (TNM) staging system is a widely accepted method for assessing the prognosis of the disease and planning therapeutic strategies [2]. Of the TNM system, the extent of lymph node involvement is the most important independent prognostic factor for gastric cancer [3]. These prerequisites were taken into account in the new TNM classification established in 2002 by the Union Internationale Contra le Cancer (UICC) and American Joint Committee on Cancer (AJCC).
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