Influence of Nodal Yields on Staging of Gastric Cancer and on Survival

PURPOSE: In the fifth edition of International Union Against Cancer (UICC) TNM, nodal staging for gastric cancer is based on the number of metastatic lymph nodes. Variability in the extent of lymphadenectomy and lymph node retrieval can affect the number of metastatic lymph nodes. In this study, the authors attempted to evaluate the influence of nodal yields on the staging of gastric cancer and survival rates. METHODS: A retrospective study was performed in 4354 consecutive patients with gastric cancer, who had undergone curative resection (R0) with nodal yields of 15 or more from 1986 to 1995. Patients were classified into three groups according to the number of nodes examined: patients with nodal yields of 15 or more but less than 30 for group A, 30-39 for group B, and 40 or more for group C. The number of metastatic lymph nodes and the survival rates for each pTNM stage were analyzed for each group. RESULTS: The number of metastatic lymph nodes significantly increased with nodal yields. Greater nodal yields resulted in a higher survival rates with a statistically significant difference between patients with nodal yields of 30 or more, and those with less than 30 in stage IB (p<0.05) and IIIB (p<0.01). CONCLUSION: Our results suggest two possibilities of stage migration and survival benefit according to the difference of nodal yields. Therefore, for minimizing stage migration and maximizing the benefit of survival, at least 30 or more lymphnodes should be resected and examined in gastric cancer surgery.

Analysis of Clinicopathological Factors Associated with Lymph Node Metastasis in Early Gastric Cancer Review of 2,137 cases / 대한암학회지

PURPOSE: The majority of patients with early gastric cancer show long-term survival after surgery. So a special attention must be directed to preserving gastric function in these patients. When node-negative early gastric cancer could be diagnosed preoperatively, then minimally invasive surgery can be performed to ensure a postoperative better quality of life. MATERIALS AND METHODS: The pathological records of 2,137 consecutive patients with early gastric cancer who underwent curative operations from January 1986 to December 1998 at Seoul National University Hospital were reviewed. RESULTS: Lymph node metastases were observed in 285 patients (13.3%). In mucosal carcinoma, lymph node metastases were observed in 50 of 1,108 cases (4.5%), and in submucosal carcinoma, in 234 of 1,026 cases (22.8%). The tumor size, depth of invasion and gross appearance were associated with lymph node metastasis. In mucosal carcinoma, the size and histologic differ entiation were associated with lymph node metastasis. In submucosal carcinoma, the size and gross appearance were associated with lymph node metastasis. CONCLUSION: In early gastric cancer, the limited surgery can be applied only to cases satisfying the following criteria; (1) mucosal tumor, (2) size < or =2 cm, (3) elevated type or (4) depressed type which are histologically differentiated and (5) size < or =1 cm among the depressed type his tologically undifferentiated.

Chronological Changes of Clinicopathologic Features in Gastric Cancer

BACKGROUND: This study was designed to analyze chronological changes of the clinicopathologic features in patients with gastric cancer who had undergone gastric operations at Seoul National University Hospital. METHODS: A retrospective review of the clinicopathologic features of a total of 2,217 gastric cancer patients was made for four different years: 407 patients in 1986, 507 patients in 1990, 646 patients in 1994, and 657 patients in 1997. RESULTS: The overall male-to-female ratio was 2.4:1, and there was no significant differences among the year groups. The mean ages were 53.2, 53.4, 54.5, and 55.9 years for each year group, respectively. The most common presenting symptoms were epigastic pain (44.5%), epigastric discomfort (19.5%), and indigestion (11.6%). The duration from onset of symptoms to operation has been shortened in recent years, and the proportions of operations delayed over 6 months were 43.0%, 40.2%, 38.0%, and 27.4% in each year group, respectively. The main cause of delayed diagnosis was neglect of symptoms by the patients (60.7%). The ratio of gastric cancer detected by routine health check-up without symptoms has increased significantly (p<0.01), being 1.2%, 3.4%, 5.1%, and 7.5% in each year group, respectively. Poorly differentiated carcinomas were the most common histopathologic type overall (57.6%), and there was no significant change in the distribution of histologic differentiation over time. The proportion of earlier stages has increased over time (p<0.01), and the ratios of early gastric cancers were 19.7%, 23.1%, 30.3%, and 35.3% in each year group, respectively. The postoperative survival rate of the 1994 year group was improved significantly when compared to that of the 1986 or the 1990 year group (p=0.01); however, there were no significant differences among these year groups with the same stage of the disease. CONCLUSIONS: These results suggest that the shortened duration of diagnostic delay and, partly, the early detection of the cancer by routine health check-ups have resulted in stage shifting (increased proportion of earlier stages) and improved survival.