Clinicopathologic factors associated with recurrence and long-term survival in node-negative advanced gastric cancer patients

Background: despite a better prognosis in node-negative advanced gastric cancer (GC), a proportion of patients have a tumor recurrence within five years and eventually die due to cancer-related causes. The present study aimed to evaluate the predictive factors of tumor recurrence and long-term survival in node-negative advanced GC. Methods: a total of 646 node-negative advanced GC patients who underwent a curative gastrectomy in our institution were included in the study. The impact of different clinicopathologic factors on tumor recurrence and overall survival were analyzed. Results: tumor recurrences were observed in 181 patients and the cumulative recurrence rate at two-years and five-years were 50.8% and 86.2%, respectively. Lymphovascular invasion, advanced T stage (T3-T4) and an inadequate number of retrieved lymph nodes (LNs) were independent predictive factors of tumor recurrence in node-negative advanced GC. Older age, an upper 1/3 tumor, lymphovascular invasion, infiltration growth pattern (INF) and the depth of tumor invasion (T4 stage) were independently associated with long-term survival. With regard to node-negative patients with >= 15 retrieved LNs, infiltration growth pattern (INF) and advanced T stage (T3-T4) were independent risk factors for both tumor recurrence and long-term survival. Conclusion: in addition to lymphovascular invasion, inadequate RLNs and advanced T stage, the prognostic significance of infiltration growth pattern in node-negative advanced GC was especially emphasized.These risk factors should be considered when selecting candidates for adjuvant chemotherapy and postoperative surveillance.