Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma

Background-No nodal grouping category of gastric cancer has been universally accepted for the grading of the effectiveness of therapeutic regimens. Aims-To establish an appropriate nodal grouping as a forecaster of distant disease and test its validity as a determinant in survival. Patients-Five hundred and ten patients who underwent curative resections for gastric cancer were studied. Methods-Retrospectively analyse the prognostic significance of the number of metastatic lymph nodes. Results-A total of 17 176 lymph nodes with an average of 34 per specimen were removed, of which 2811 (16%) showed metastases. Among the 510 patients, 287 (56%) had lymph node metastases, with an average of 9 . 8 per metastatic case. The survival of all patients was related to their nodal status, an abrupt decrease in survival was seen between 0 and 1 and 4 compared with 5 or more modes while little difference in survival existed among 1, 2, 3, and 4, and among 5, 6, 7, and 8 positive nodes. Multivariate analysis showed that the number of positive nodes (1-4, 5-8 versus greater than or equal to 9; relative risk 2 . 2) and depth of cancer invasion (three levels; relative risk 1 . 9) were independently correlated with survival. The current nodal stage was not a prognostic factor. Conclusions-Gastric cancer patients with 0, 1 to 4, 5 to 8, and >9 positive nodes may represent four appropriate prognostic groups and should be adopted for classification of nodal stage in gastric cancer.