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Ji Yeong An, MD; Tae Kyung Ha, MD; Jae Hyung Noh, MD; Tae Sung Sohn, MD; Sung Kim, MD

Arch Surg. 2009;144(1):38-45.

Objective  This study examined the prognosis of patients with stage IV gastric cancer by subgroups after surgical treatment.

Design  Retrospective study.

Setting  Tertiary care referral center.

Patients  A total of 1056 patients with stage IV gastric cancer who underwent gastrectomy from January 1, 1995, through December 31, 2006, were divided into the following 3 groups: T4N1-3M0 (group 1), T1-3N3M0 (group 2), and T(any)N(any)M1 (group 3).

Main Outcome Measures  The clinicopathological characteristics, recurrence pattern, and survival were compared among the 3 groups.

Results  There was a significant difference in the surgical curability, operation type, Lauren classification, histological differentiation, lymphatic invasion, number of lymph nodes retrieved, and adjuvant therapy among the 3 groups. The 5-year survival rates in groups 1, 2, and 3 were 18.3%, 27.1%, and 9.3%, respectively (P < .001). After R0 resection, locoregional recurrence (40.9%) followed by peritoneal recurrence (27.3%) was most common in group 1, whereas distant (30.2%) and peritoneal recurrence (26.7%) were most common in group 2. Multivariate analysis showed the following significant prognostic factors for survival: surgical curability and adjuvant therapy for group 1; surgical curability, surgical extent, adjuvant therapy, and number of retrieved lymph nodes for group 2; and surgical extent and chemotherapy for group 3.

Conclusions  Each subgroup of stage IV gastric cancer had different clinical outcomes, including histological behavior, recurrence pattern, survival, and prognostic factors. Therefore, subclassification of stage IV gastric cancer into IVA (T1-3N3M0), IVB (T4N1-3M0), and IVM (T[any]N[any]M1) might be useful for a more accurate prediction of prognosis and selection of appropriate therapeutic options.

Author Affiliations: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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Arch Surg. 2009;144(1):45.
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