Prognostic Factors for Para-aortic Lymph Node Dissection After Neoadjuvant Chemotherapy for Gastric Cancer.

BACKGROUND/AIM: The prognosis of gastric cancer with para-aortic or bulky lymph node metastases is poor, but the JCOG 0405 study showed relatively good outcomes of neoadjuvant chemotherapy and gastrectomy with para-aortic lymph node dissection. We investigated the prognostic factors for this treatment.

PATIENTS AND METHODS

Twenty patients who underwent gastrectomy and para-aortic lymph node dissection after chemotherapy were enrolled from two institutions. The prognostic factors for overall survival were retrospectively analysed using Cox's proportional hazard models.

RESULTS

The univariate analyses revealed that ypN (3/0-2, p=0.001), ypM1 (para-aortic LYM) (yes/no, p=0.03), histological response (Grade0-1b/2-3, p=0.02), and adjuvant chemotherapy (no/yes, p=0.02) were significant prognostic factors, whereas multivariate analysis revealed ypN and absence of adjuvant chemotherapy to be independent prognostic factors.

CONCLUSION

Posttreatment nodal status may be the best surrogate marker for gastric cancer with gastrectomy and para-aortic lymph node dissection after neoadjuvant chemotherapy. Adjuvant chemotherapy seems to be essential to improve survival.