Comparison of the Prognostic Significance between the Nodal Stage According to the General Rules for the Gastric Cancer Study and the Number of Metastatic Lymph Nodes in Gastric Cancer

Takashi Ichikura, Soichi Tomimatsu, Kazuhiko Uefuji, Yasushi Okusa, Keiichi Fujino, Hirotsugu Ikawa, Shoetsu Tamakuma

Department of Surgery I, National Defense Medical College

Lymph node involvement is recognized to be an important prognostic determinant in gastric cancer. We analyzed 426 patients who underwent a potentially curative resection for gastric cancer invading the muscularis propria or deeper to determine whether the number of metastatic lymph nodes or the nodal stage based on the sites of positive nodes is a better prognostic indicator. In those with more metastatic lymph nodes, survival was decreased. From the survival analysis we were able to divide the patients into three groups based upon the number of positive nodes: 0 to 4 (group A), 5 to 12 (group B), 13 or more (group C). Survival decreased in the order of groups A, B and C in each of the n1 (+), n2 (+) and n3, 4 (+) groups. Significant differences in survival were observed between groups A and B, and between groups A and C in the n1 (+) patients (p<0.01). The differences in survival were also significant between each pair of the three groups in the n2 (+) patients (p<0.01), although the difference was not statistically significant in the n3, 4 (+) patients because of the small number of cases. On the other hand, when the group A patients were analyzed, the n1 (+), and n2 (+) patients had as good an outcome as the n(-) patients. There were no significant differences in survival among the n1 (+), n2 (+) and n3, 4(+) patients in groups B and C. These results suggest that the number of metastatic lymph nodes is a better prognostic indicator than the nodal stage based on the sites of positive nodes.

Key words
gastric cancer, prognostic factor, number of metastatic lymph nodes, nodal stage according to the general rules for the gastric cancer study

Reprint requests
Takashi Ichikura Department of Surgery I, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
February 10, 1993

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