PURPOSE: The prognosis of stage IV gastric cancer is poor, but some patients with stage IV gastric cancer survive for more than 5 years. We investigated the prognostic factors of the stage IV gastric cancer in the patients with survival for more than 5 years after resection of the primary lesion. METHODS: We retrospectively analyzed 194 patients that underwent resection of stage IV gastric cancer from January 1997 to June 2000 in our hospital. We investigated clinicopathological characteristics between patients surviving 5 years or more group (n=17) and less than 5 years group (n=177) with chi-square and T-test. We used univariate analysis with Kaplan-Meier method and Log-rank test, and multivariate analysis with Cox proportional hazard model to investigate prognositic factors for survival rate about each characteristic. RESULTS: In clinicopathological characteristics between the two groups, we observed statistical significance in regard to macroscopic findings (P=0.035), but not in the others. Curative resection (P=0.001) and intravenous chemotherapy (P=0.012) had statistically significant influence on 5-year survival curve. Multivariate analysis showed that curative resection was a significant factor for long-term survival rates (P=0.005), but chemotherapy and macroscopic type had no effect on survival rate. CONCLUSION: Although this study has the limitation of a retrospective study and total patient number in the 5-year survival group, curative resection may be important, as a prognostic factor, and active treatments should be performed for stage IV gastric cancer.