PATHOLOGICAL PROGNOSTIC FACTORS IN THE 2ND BRITISH STOMACH-CANCER GROUP TRIAL OF ADJUVANT THERAPY IN RESECTABLE GASTRIC-CANCER

The second British Stomach Cancer Group trial was a prospective random ised controlled trial of adjuvant radiotherapy or cytotoxic chemothera py after gastrectomy for adenocarcinoma. It recruited between 1981 and 1986. No survival advantage has been demonstrated for the patients re ceiving either type of adjuvant therapy compared with those undergoing surgery alone. We report on 436 patients randomised into the trial to gether with 203 patients, who did not fulfil the trial criteria, refer red to the trial. A univariate (log-rank) analysis of pathological fac tors obtained from the local referring centres showed that tumour size , macroscopic type, number of sites involved, depth of invasion, invol vement of resection lines and lymph nodes and histological grade were significant determinants of survival. Histological review by two exper ienced histopathologists found that the Lauren classification and hist ological grade, but not the Ming classification, were significant prog nostic factors. The degree of lymphocytic and eosinophilic infiltratio n and presence of dysplasia assessed by one of the pathologists showed a significant correlation with survival. However, inter-observer corr elation for these histological parameters and grade was poor. Multivar iate analysis identified only depth of invasion, resection line and no dal involvement as significant independent pathological variables infl uencing survival. This study confirms the need for expert preparation of the resected specimen to obtain the important information on depth of invasion and nodal status and also reveals some variation in histol ogical assessment, particularly grading, in gastric carcinoma.