Shiu et al studied clinical, pathologic and treatment variables for patients with adenocarcinoma of the stomach using both univariate and multivariate analysis. Five factors were found to be independent predictors of patient death. The authors are from Memorial-Sloan Kettering Cancer Center in New York.
Univariate Analysis of Factors
|
Factor |
Favorable |
Unfavorable |
|
sex |
male |
female |
|
age |
> 65 years |
<= 65 years |
|
site of tumor |
antrum or body |
fundus or diffuse |
|
tumor diameter |
<= 10 cm |
> 10 cm |
|
TMN stage |
I or II |
III or IV |
|
N stage |
N0 |
N1, which is better than N2 |
|
number of lymph nodes involved by metastases |
0 to 3 |
4 or more |
|
histologic grade of the tumor |
1 or 2 (low or intermediate) |
3 (high grade) |
|
serosa involved |
no (T1 or T2) |
yes (T3 or T4) |
|
type of gastrectomy |
distal |
total or proximal subtotal |
|
margin of resection |
negative |
positive for tumor |
|
splenectomy |
not done |
done |
|
scope of lymphadenectomy |
R 1.5 or 2.0 |
R 0 |
|
scope of lymphaden-ectomy relative to nodal stage (R score minus N status) |
1.5 or 2.0 |
< 1.5 (1 to –3) |
|
adjuvant chemotherapy |
not given |
given |
from Table 2 page 8 and Table 3 page 9
where:
• The scope of lymphadenectomy (R) was listed as 1, 1.5 or 2. R1 = dissection of lymph nodes within 3 cm of tumor only; R2 = local nodes plus secondary draining nodes (left gastric, celiac, splenic, hepatic); R1.5 in-between R1 and R2.
• I added T4 to the table for serosal involvement.
• The N stage used was from earlier TNM staging criteria (1988). N1 was metastasis to lymph nodes within 3 cm from the edge of the primary tumor. N2 was metastasis to nodes more than 3 cm from the edge of the primary tumor, or to other regional nodal groups (left gastric, hepatic, splenic, celiac). There was no N3.
Cox Proportional Hazards Model
|
Independent Variable |
Adverse Feature |
Relative Risk of Death |
|
number of lymph nodes involved by metastases |
>= 4 nodes |
1.979 |
|
histologic grade |
high grade |
1.7993 |
|
TNM stage |
III or IV |
1.7362 for Stage III |
|
scope of lymphaden-ectomy relative to nodal stage (R minus N) |
<= 1.0 |
1.6372 |
|
splenectomy |
done |
1.5721 |
from Table 4 page 10
where:
• I added Stage IV as an adverse feature for TNM stage.
• High grade = poorly differentiated.
• The minimum (R – N) could be either –2 or –3 depending if wanted to include an N3 group (developed after paper written).
Observations:
(1) Extensive radical gastrectomy with wide lymphadenectomy may be associated with improved survival.
(2) Splenectomy should be avoided unless technically necessary for tumor resection or as part of a planned resection of splenic hilar lymph nodes.
(3) Administration of adjuvant chemotherapy may worsen survival.
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
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