PROGNOSTIC FACTORS IN ADENOCARCINOMA OF THE GASTRIC CARDIA - PATHOLOGICAL STAGE ANALYSIS AND MULTIVARIATE REGRESSION-ANALYSIS

Purpose: To clarify the pathologic stages of adenocarcinoma of the gas tric cardia in which the prognosis is worse than in adenocarcinoma of the middle or distal part of the stomach, and to determine prognostic factors in these stages by multivariate analysis, Patients and Methods : We analyzed 2,536 cases of surgically resected gastric adenocarcinom a of all pathologic stages. Four hundred seventy-two cases of gastric carcinoma, in which cumulative survival of gastric cardia was poor, we re subjected to Cox regression analysis for prognostic factors, and to logistic regression analysis for factors influencing venous or lympha tic invasion, Results: The prognosis of adenocarcinoma of the gastric cardia was inferior when compared with similarly staged carcinomas of the middle or lower part of the stomach when there was invasion of pro per muscle layer or subserosal layer, with no lymph node metastasis or with only adjacent (group 1) lymph nodes metastases (T2N0 or T2N1, ac cording to the Japanese classification). In these stages, the prognost ic factors were age, histologic type, venous invasion, and location of the tumor in the upper part of the stomach. Tumor location in the upp er stomach was also a predictor for the presence of venous invasion. C onclusion: The prognosis of adenocarcinoma of the gastric cardia is po or in patients with T2 tumors with no or few lymph node metastases. Ad ditional treatment after surgery may be necessary to improve the survi val of this population. (C) 1997 by American Society of Clinical Oncol ogy.