Clinical results and prognostic factors of radiologically node-positive gastric carcinoma

Lymph node metastasis determined by histologic examination is an important prognostic indicator in gastric carcinoma. However, prognostic value of lym ph node metastasis detected by computed tomography (CT) is unknown. The aim of this study was to evaluate clinical results and prognostic factors of p atients with radiologically node-positive gastric carcinoma. The study included 78 patients with primary gastric carcinoma and lymph nod e metastasis confirmed by CT. The level of lymph node metastasis was simply graded as follows: level I included perigastric nodes; level II included i ntermediate nodes along the left gastric, common hepatic, and celiac arteri es; and level LII included distant nodes along the hepatoduodenal ligament, pancreas, spleen, and abdominal aorta. Sixty patients (79%) had stage IV tumors showing one or more of the followi ng: level III lymph node metastasis in 37. pancreatic invasion in 27, perit oneal dissemination in 23, and liver metastasis in 19. Overall 1- and 5-yea r survival rates were 29% and 6%, respectively, and the 1-year survival rat e was significantly influenced by the level of lymph node metastasis on CT (55% for level I, 27% for level II, 7% for level III, P < 0.01). In patient s with gastrectomy, prognostic factors were tumor size (<10 cm versus >10 c m, P < 0.01), gross type (localized versus infiltrative, P < 0.01), histolo gic type (well differentiated versus poorly differentiated, P < 0.01), and curability of the disease (curative versus noncurative, P < 0.01). Our study indicates that prognosis of patients with radiologically node-pos itive gastric carcinoma is poor because of high frequency of extensive tumo r spreads. Patients having only positive level I nodes on CT an candidates for curative gastrectomy, which may offer long-term survival.