Prognostic factors in patients with node-negative gastric cancer: an Indian experience

Abstract

Background: The status of the regional nodes is the most important prognostic factor in gastric cancer. There are subgroups of patients with different prognosis even in node-negative patients of gastric cancer. The aim of this study is to analyze the factors influencing the prognosis in Indian patients with node-negative gastric cancer.

Methods: This was a retrospective analysis of patients who underwent radical gastrectomy in a tertiary cancer centre in India between 1991 and 2007. The study group included only patients with histologically node-negative disease. Various clinical, pathological and treatment related factors in this group of patients were analyzed to determine their prognostic ability by univariate and multivariate analyses.

Results: Among the 417 patients who underwent gastrectomy during this period, 122 patients had node-negative disease. A major proportion of the patients had advanced gastric cancer. The 5-year overall survival and disease-free survival in all node-negative gastric cancer patients was 68.2% and 67.5% respectively. The overall recurrence rate in this group was 27.3%. On univariate analysis, the factors found to significantly influence the disease-free survival were the size, location and presence or absence of serosal invasion of the primary tumor. However, on multivariate analysis, only tumor size more than 3 cm and serosal invasion were found to be independently associated with an inferior survival.

Conclusion: Serosal invasion and primary tumor size more than 3 cm independently predict a poor outcome in patients with node-negative gastric cancer.

Figure 1

Survival in node negative gastric cancer patients according to tumor size. The disease-free survival of patients with tumor size ≤3 cm was higher than that of patients with tumors size >3 cm.

Figure 2

Survival in node negative gastric cancer patients according to serosal invasion. The disease-free survival of patients with serosal invasion was lower than that of patients without serosal invasion.