Biologic predictors of survival in node-negative gastric cancer

Objective To evaluate factors predictive of survival following curative resection for node-negative gastric adenocarcinoma. Summary Background Data Presence or absence of lymph node metastases is the most powerful predictor of survival following curative resection for gastric adenocarcinoma. Factors predictive of survival in node-negative gastric cancer have not been clarified. Methods Histopathology and clinical outcome for all patients undergoing R0 resections for gastric adenocarcinoma at a tertiary center between 1985 and 2001 were reviewed. Results Of 1,256 R0 resections performed, 507 (40%) were nodenegative, 465 were T1-T3, and 317 of these were adequately staged, as defined by histologic evaluation of at least 15 lymph nodes. Median age was 67 years, and 62% were male. Forty percent had T1 tumors, 34% were T2, and 26% were T3. Median tumor size was 3 cm. Vascular invasion (VI) was present in 17% of tumors and neural invasion (NI) in 31%. Extended (D2) lymphadenectomy was performed in 75% of cases. Five- and 10-year disease-specific survival rates were 79% and 67% respectively. Factors associated with poorer disease-specific survival on univariate analysis were male gender, serosal invasion, presence of VI, presence of NI, and resection other than distal subtotal gastrectomy. On multivariate analysis, NI was not an independent predictor of survival, but correlated directly with advancing T stage and tumor size. Conclusions Serosal invasion and presence of VI are strong predictors of poor survival in this disease. NI correlates with T stage and tumor size and may serve as a marker of advanced disease.