[Prognostic factors of gastric neoplasms: experience with 1,074 cases undergoing surgical treatment at a single center].

Abstract

Aim: The aim of our study was to identify clinicopathological predictors of survival among patients undergoing potentially curative resections for gastric carcinoma.

Patients and methods: From January 1987-March 2004, 1074 patients have been submitted to curative gastric resection for gastric cancer (647 males and 427 females, mean age, 65 +/- 12, min 22, max 92). The surgical procedure consisted of 289 (27%) total and 785 (63%) subtotal gastrectomies. The extent of lymph node dissection was limited D1 (n = 376, 35%) or extended D2 (n = 578, 54%) and D3 (n = 12, 1%); no lymphadenectomy was performed in 108 (10%) cases. The pathological nodal status has been defined based on the number of involved lymph nodes (N1: 1 to 6 positive nodes; N2: 7 to 15 positive nodes; N3: more than 15 positive nodes). The distribution of N stage was: N0 = 278 (26%), N1 = 344 (32%); N2 = 215 (20%); N3 = 129 (12%). Univariate analyses were performed for gender, age, pT stage, pN stage, tumor site, tumor size, and extent of lymphadenectomy. Significant factors were then entered into a Cox regression analysis.

Results: The median number of examined lymph nodes was 17 (mean, 18). Overall, 688 (64%) of patients had lymph node metastases. Of these patients, the median number of involved nodes was 2 (mean, 6). In the univariate analysis age, pT stage, pN stage, tumor size, and extent of lymphadenectomy were found to be significant factors. In the multivariate analysis T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival. The median and mean survival time were 69 and 87 months, respectively. Overall survival was 80%, 51% and 40% at 1, 5, and 10 years, respectively.

Conclusions: T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival in patients submitted to curative gastric resections.