Recurrences and relation to tumor growth potential and local immune response in node-negative advanced gastric cancer

Biological characteristics and the prognosis for subjects with node-negativ e advanced gastric cancer have been given little attention in related liter ature. We analyzed data on 112 patients with serosally invasive gastric can cer who were lymph node metastasis-negative; all had been surgically treate d in the Department of Surgery II, Kyushu University Hospital, between 1970 and 1992. Recurrences and relation to the growth potential of the tumor an d local immune response were examined. Thirty patients died with a recurren ce of the gastric cancer, and in these patients, the tumor was larger, the whole stomach was more frequently involved and infiltrative growth was more common, compared to findings in patients who were recurrence-free. Periton eal recurrence was evident in half the number of patients and the 5-year su rvival rate was 74.5%. Tumor growth potential was evaluated, based on the l evel of proliferating cell nuclear antigen (PCNA) of the primary tumor and on dendritic cell infiltration into the tumor, determined as a level of loc al immune function of the host. Higher growth potential and lower immune le vels were more frequent in patients with recurrences. Multivariate analysis revealed that tumor size and PCNA labeling index were significant prognost ic factors for node-negative gastric cancers. In a subset of advanced gastr ic cancers, there was no apparent distinct lymph node metastasis and the pr ognosis was better. However, cancer cells with a higher growth potential an d a lower immune response in the host can biologically amplify and mainly i nfiltrate the gastric wall, extend to the serosa and disseminate trans-sero sally into the peritoneum.