Strategies for the treatment of advanced gastric cancer with group 2 lymph node metastasis.

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  • ２群リンパ節転移陽性胃癌の治療方針

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Abstract

The therapeutic strategies for gastric cancer with group 2 lymph node metastasis (N2) were studied from the standpoint of both pattern of recurrence and prognosis. A total of 153 patients with N2 gastric cancer resected curatively in the institute from 1983 through 1997 were assessed. The male-to-female ratio was 107:46. The characteristic features of these N2 gastric cancers compared to NO and N1 cancers included predominance of macroscopic types 3 and 4, undifferentiated tubular adenocarcinoma, penetration of serosa, infiltrating growth fasion, and marked lymphatic and venous invasion. Sixty-six patients died of gastric cancer and their recurrent sites were the peritoneum in 43, lymph nodes in 16, liver in 17 and other distant organs in 17 cases. In view of the cumulative survival rates, a significant difference was detected in depth of invasion, lymphatic invasion and numbers of group 2 lymph nodes involved. The most important prognostic factor was the number of metastatic group 2 lymph nodes (hazard ratio: 2.0) by Cox's proportional hazard model. In conclusion, the prognosis of gastric cancer with more than 4 positive N2 lymph nodes is poor, so that extended lymph node dissection or new chemotherapeutic regimen might be necessary for improving the prognosis.

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