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Gastric Cancer: Establishing Predictors of Biologic Behavior with Use of Population-Based Data

From the Departments of Surgery (BJD, CdeG, SMH), Public Health Sciences (LDS, GSJ), Laboratory Medicine and Pathology (SA), and Oncology (CC), University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.

Correspondence: Address correspondence and reprint requests to: Dr. S. M. Hamilton, 2D2 Walter C. Mackenzie Health Sciences Center, 8440-112 St. University of Alberta Hospital, Edmonton, Alberta, Canada T6G 2B7; Fax: 780-407-7394; e-mail: shamilto{at}cha.ab.ca

Background: Tumor thickness and nodal status are important predictors of survival following curative resection for gastric cancer. Lymphovascular invasion (LVI) is a potential predictor of biological behavior. The relationship between LVI and tumor thickness (T status) has not been established in population-based studies.

Methods: Clinicopathological and survival data of 577 patients at nine centers, from between 1991 and 1997, was collected from patient records and a Provincial Cancer Registry. The primary endpoint of the study was death. A secondary analysis of a node-negative subgroup examined the significance of LVI with respect to T status.

Results: The population disease-specific survival was 28%. In a multivariate analysis, T, N, M, esophageal margin, tumor morphology, and residual tumor category were independent predictors of survival. LVI was documented in 58% of resected tumors. LVI correlated with advancing T and N status but was not significant in a multivariate population model. Subgroup analysis of node-negative gastric cancer found T status and LVI to be independent predictors of survival. LVI was associated with a 5-year survival of 8%, versus 43% among patients in whom it was absent (P < .001).

Conclusions: T status and N status were the most important independent predictors of survival in a population-based study of gastric cancer. LVI correlated with advancing N and T status. Multivariate analysis of node-negative patients showed LVI and T status are independent predictors of survival.

Key Words: Adenocarcinoma • Neoplasm invasiveness • Prognosis • Stomach neoplasm • Survival analysis

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