Prognostic factors in gastric cancer. Our experience and review of the literature

BACKGROUND: This review of the latest literature and retrospective analysis of the authors' series aimed to identify the most relevant prognostic factors for gastric cancer. METHODS: A total of 81 patients were operated in our series from 1980 onwards. Eighteen patients underwent minor surgery and 5 were not treated. All resected patients underwent R2 lymphadenectomy. RESULTS: In the majority of cases the histiotype was found to be adenocarcinoma. Undifferentiated forms were only found in 8 cases. The prognostic factors identified in our series and in the most recent literature were age, lesion sites, histiotype, the number of metastatic lymph nodes and T3. The poor prognosis in younger patients may be explained by late diagnosis and more aggressive tumours. Neoplasms in the upper third of the stomach have a worse prognosis owing to a faster metastasis rate, lymphatic drainage directly into the left para-aortic lymph nodes and lack of serosa in the gastric fundus, meaning that in practice T2 becomes T3. Lymphatic diffusion represents one of the most important factors, in particular the number of lymph nodes affected by the tumour is decisive for prognosis: from the literature, in both T1-T2 and T3-T4, if > or = 5 lymph nodes are positive then survival rates decrease significantly. CONCLUSIONS: From our personal experience, N2 determines the prognosis in both T2 and T3. N2 is important, but survival diminishes in T3, thus demonstrating the importance of serous infiltration. The majority of Western and Japanese authors deem that T3 represents one of the decisive factors.