Prognostic Value of Immunomorphological Changes in Stage IA Gastric Cancer Patients

ABSTRACT

Lymphocytic infiltration within and around a tumor and distinctive types of regional lymph node reaction such as sinus histiocytosis, paracortical lymphoid cellular hyperplasia, and follicular hyperplasia at the cortical area are morphological changes often found in solid tumors. These histological features indicate the immunologically mediated tumor-retarding responses of the host. The aim of the present study was to assess the real prognostic value of both lymphocytic infiltration and the various types of lymph node reactions in patients with stage IA gastric carcinoma and their role compared with the value of other prognostic factors. We reviewed 119 patients with stage IA gastric carcinoma who were admitted to and operated on at the Department of Surgery, Presbyterian Medical Center, from January 1989 to December 1991. The 5-year survival rate was 93.23%, and the mean survival time was 91.18 months. Univariate analysis showed that the degree of lymphocytic infiltration was significantly related to survival(p<0.05). The 5-year survival rates according to the degree of lymphocytic infiltration were 66.67% in grade 0, 92.31% in grade 1, 95.83% in grade 2, and 100% in grade 3. The correlation between survival and age, tumor size, tumor site, or nuclear grade was not statistically significant. Our data indicated that the longer survival in cases of stage IA gastric carcinomas was associated with the presence of certain types of lymph node reactions such as sinus histiocytosis, paracortical lymphoid cellular hyperplasia, and follicular hyperplasia at the cortical area, but these correlations were also not stastistically significant. Although arguments may exist for using the presence or absence of sinus histiocytosis to stratify patients in prospective studies of adjuvant treatment, we suggest that adjuvant treatment after curative resection for gastric cancer is needed ever in the group without lymphocytic infiltration and regional lymph node reactivities. Also, we will study advanced gastric cancer, as well as early stomach cancer in future research.