Proposal of the Nodal Stage Based on the Number of Metastatic Lymph Nodes in Patients with Gastric Cancer

Min, Jin Sik; Lee, Kyong Sik; Kim, Yong Il; Noh, Sung Hoon; Yoo, Chang Hak

Abstract

BACKGROUND AND AIMS: Lymph node metastasis is a significant prognostic factor in gastric cancer. The current methods of nodal staging according to UICC and Japanese rules are too complicated and variation in classification makes comparative analysis on a worldwide base difficult. Therefore, a more simple and objective staging method of lymph node metastasis is needed. The purpose of this study is to evaluate the prognostic significance of the number of metastatic lymph nodes to be adopted for new classification of nodal stage in gastric cancer.
METHODS
From 1987 to 1994, 2,317 patients who underwent curative resection (D2 or more lymphadenectomy), without distant metastasis and who had more than 15 lymph nodes retrieved were studied retrospectively.
RESULTS
The survival rates were significantly decreased in association with an increasing number of metastatic lymph nodes. We subdivided the number of metastatic lymph nodes as Nl: one to six, N2: seven to fifteen, and N3: sixteen or more on the basis of frequency of the patients and survival rates. This newly proposed nodal stage based on the number of metastatic lymph nodes, was closely correlated with the depth of cancer invasion as well as currently used nodal staging by anatomical site of the metastatic node. In multivariate analysis, the number of metastatic nodes was the most significant prognostic factor in gastric cancer.
CONCLUSIONS
The number of metastatic lymph nodes was a significant prognostic factor after curative resection of gastric cancer and might be adopted for classification of nodal stage in gastric cancer. The proper subdivision of the number of metastatic nodes was 0, 1-6, 7-15, 16 or more.