Cancer Res Treat.  2009 Jun;41(2):73-79.

Prognosis of pN3 Stage Gastric Cancer

• Ahn JR
• Jung M
• Kim C
• Hong MH
• Chon HJ
• Kim HR
• Jeung HC
• Hyung WJ
• Lee SS
• Chung HC
• Noh SH
• Rha SY

Abstract

PURPOSE
The aim of this study was to determine the prognosis of pN3 stage gastric cancer patients after they have undergone curative resection, and we also wanted to identify the prognostic factors according to the clinico-pathologic features. MATERIALS AND METHODS: Between January 2000 and December 2004, we retrospectively reviewed the medical records of the patients with histologically confirmed pN3 stage gastric cancer. They underwent both gastrectomy and lymphadenectomy with a curative aim. We categorized the pN3 stage patients into 2 groups; one with pN3 only (pN3M0) and the other with pN3 combined with M1 stage (pN3M1) that included peritoneal seeding, hepatic metastasis or para-aortic LN metastasis. RESULTS: Out of 467 patients with stage IV gastric adenocarcinoma who received surgery, 260 patients underwent curative resection and they were pathologically staged as N3. Among these 260 patients, 78 patients were classified as the pN3/M1 stage. For all the patients, the median follow-up period was 19 months (range: 1~108 months) and the median overall survival time was 16.2 months (95% CI, 14.1~18.3%). The 5-year survival rate of the pN3/M0 group was significantly higher than that of the pN3/M1 group (12.6% vs. 2.6%, respectively, p<0.0001). The identified predictor for a worse prognosis was an advanced T4 stage (HR: 3.38, 95% CI, 1.4~8.3, p=0.008) for the pN3 patients. CONCLUSION: The survival for the pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared to that of the pN3/M1 group. An advanced T stage was a predictor for a poor prognosis for the pN3 patients. Therefore, diverse treatment strategies for these heterogeneous pN3 gastric cancer patients are needed for improving their survival.

Keyword

Advanced gastric cancer; pN3; Prognostic factor; Prognosis; Survival

MeSH Terms

Adenocarcinoma
Follow-Up Studies
Gastrectomy
Humans
Lymph Node Excision
Medical Records
Neoplasm Metastasis
Prognosis
Retrospective Studies
Seeds
Stomach Neoplasms
Survival Rate

Figure

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  Fig. 1 Diagram of the enrolled patients.

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  Fig. 2 Overall survival of the pN3 gastric cancer patients according to the pathology.

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  Fig. 3 The overall survival curve of the pN3 gastric cancer patients according to the T stage.

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