Gastric cancer and the search for a good prognostic classification: a challenge

INTRODUCTION: Gastric cancer is the second most common cancer worldwide. The standard treatment is radical surgical resection, but 60% of patients will present recurrence. TNM classification (6th edition, American Joint Committee on Cancer) recommends the removal of at least 15 regional lymph nodes to carry out an adequate pathological staging. But in our environment, only 20% of cases have the minimum recommended, so it would be very important to have an alternative prognostic. We designed a retrospective study to evaluate different prognostic factors in patients inadequately staged. MATERIAL AND METHODS: We focused on patients with serosal involvement (pT3). The evaluation included general parameters such as age, sex, tumor site, histological type, type of gastrectomy, histological grade, number of nodes analyzed </≥ 10, lymph node ratio (LNR) with a 20% cutoff value, and adjuvant treatment. The association between clinicopathological variables and recurrence was investigated by univariate and multivariate logistic regression. It was considered statistically significant with P < 0.05. RESULTS: A total of 92 patients who met the criteria were studied. Median age 65 years; 68% men, 32% women; median follow-up time for the overall population, 44 months (range 15–119 months); number of nodes analyzed, median 7 (range 0–14 nodes); recurrence in 59%; median time to recurrence, 15 months (range 3–48 months); the cumulative risk of relapse at five years, 64%. Multivariate statistical analysis showed that the LNR (P = 0.03) and total number of nodes analyzed </≥ 10 (P = 0.04) were independent predictors for the risk of recurrence. CONCLUSION: LNR and total number of nodes analyzed with a threshold of 10 (</≥ 10 nodes analyzed) were independent predictors of recurrence in patients with gastric carcinoma pT3 and an insufficient number of nodes examined.