Clinical Analysis of the Dependence of the Survival Rate of Gastric Cancer Patients on Lymph Node Metastatic Patterns

Park, Jun Bom; Kim, Jae Hong; Park, Ju Sup

Abstract

In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.