P-132 - Prognostic factors for node-negative advanced gastric cancer after curative gastrectomy

Abstract

Introduction: It is well established that the existence of lymph node (LN) metastasis are the most important prognostic factor in advanced gastric cancer. Although the number of patients with node negative advanced gastric cancer is small, the question is: whom of them could benefit of aggressive postoperative treatments. Our purpose is to identify the clinicopathological factors that influence the prognostic in node-negative advanced gastric cancer. Methods: Retrospective analysis of a prospective database (n = 476) with gastric cancer cases submitted to curative intent surgery between January 2010 and December 2015, in an Upper GI Surgery Unit. Selection of 61 patients with negative primary node stage T2-4 gastric cancer. We analyzed the following variables: age, gender, clinical stage, T-stage, tumour size, surgery type, lymphadenectomy type, histological type, venous invasion, lymphatic invasion, neural invasion, Lauren’s and Ming’s classification, tumour location, number of resected LN, perioperative blood transfusions, duration of surgery and macroscopic type of tumour. Results: Of the 61 patients, 25 (41%), 23(38%), 10(16%) and 3(5%) had T2,T3,T4a and T4b tumours, respectively. Our recurrence rate was of 11,5%; none of the T2 tumours recur, the recurrence in T3 tumours was 13% (all distant metastasis), in T4a was 40% (66% locoregional and 34% distant metastasis) and also none of the T4b recurs. In univariate analysis lymphadenectomy type, macroscopic type of tumour, T-stage and perioperative blood transfusion significantly correlated with tumour recurrence; while tumour location, T-stage, age and perioperative blood transfusion significantly correlated with cumulative overall survival. In multivariate logistic regression analysis (stepwise forward) lymphadenectomy type and perioperative blood transfusion were significantly and independently correlated with recurrence; age and perioperative blood transfusions with overall survival. Conclusion: Lymphadenectomy type and blood transfusion reliably predict recurrence, as well age and perioperative blood transfusion reliably predict overall survival. More aggressive postoperative treatments and timely follow-up should be considered in patients with these characteristics.