Prognosis of gastric carcinoma with emphasis on lymph node status

A retrospective study of surgical treatment for 123 patients with primary gastric carcinoma was made. Tumour-stage, presence of distant organ metastases, lymph node involvement, depth of wall-penetration and curative resection were the important prognostic criteria. Five-year survival rate was 22.8% in the whole series and 37.5% after curative (R0 M0) resection (p = 0.0029). Seventy-two patients (58.5%), i.e. 47 without (N0) and 25 with lymph node metastases (N1 + N2), underwent, R0-resection. The overall recurrence rate was significantly lower (4% vs. 36%; p = 0.004) and the 5-year survival rate higher (46% vs. 28%; p = 0.007) for the R0-N0-group than for the R0-N1 + N2-group. Distant organ metastases-related mortality was similar in these two groups of patients (51% vs. 60%; p = 0.7).

The poor prognosis of gastric carcinoma indicates the need for improved surgical technique and/or adjuvant therapy, but the necessity for adjuvant therapy without having performed D2 gastrectomy does not seem founded.