Survival in lymph node-negative gastric cancer: the Western experience

Lymph node status is the strongest prognostic indicator for survival after gastrectomy for gastric adenocarcinoma (GAC) (1). However, for patients who undergo resection and are deemed to be ‘node-negative’ based on pathologic exam, the relevant prognostic indicators and guidelines for adjuvant therapy remain unclear. Our group has recently published the long-term survival results of a large, multi-institutional database of North American patients undergoing gastrectomy for GAC, of which 317 patients were lymph node-negative (2). To date, it is the largest published series of a Western experience with node-negative GAC. The median follow-up time was significant at 68 months, and the overall recurrence rate was 17%. We evaluated endpoints of time to recurrence and overall survival (OS). Our data showed that greater depth of tumor invasion (indicated by T-stage) was independently significant in predicting shorter time to recurrence in a competing risks regression model whereas OS was negatively impacted by higher tumor stage, lymphovascular invasion, signet ring histology, and having less than 15 nodes examined.