Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

Table 1 Demographic, clinical, and pathological features predicting overall survival in patients with proximal gastric carcinoma involving esophagus

Characteristics	Number of patients (%)	Months after surgery (mean ± SD)	P value	1-yr survival %	3-yr survival %	5-yr survival %
Age (yr)			0.108
< 70	97 (68.3)	30 ± 17		91.1	65.3	40.1
≥ 70	45 (31.7)	27 ± 19		77.0	49.3	17.3
Gender			0.594
Male	109 (76.8)	28 ± 17		71.1	61.1	23.1
Female	33 (23.2)	30 ± 18		88.3	60.1	48.1
Helicobacter pylori infection			0.400
Negative	80 (56.3)	30 ± 18		87.3	67.6	29.4
Positive	62 (43.7)	27 ± 17		87.1	50.8	32.3
Surgical modality			0.950
Partial gastrectomy	112 (78.9)	29 ± 18		85.7	68.6	35.1
Total gastrectomy	21 (14.8)	28 ± 18		76.2	65.3	0.0
Ivor-Lewis procedure	9 (6.3)	29 ± 17		89.2	60.6	34.3
Siewert type			0.444
Type II	116 (81.7)	29 ± 17		86.8	63.8	27.2
Type III	26 (18.3)	33 ± 19		88.5	50.2	40.2
Bormann’s type			0.380
Polypoid	2 (1.4)	27 ± 26		100.0	50.1	50.1
Fungating	17 (12.0)	34 ± 20		83.3	70.9	53.2
Ulcerated	96 (67.6)	28 ± 17		88.0	56.3	26.8
Flat	27 (19.0)	26 ± 18		86.5	66.6	29.6
Tumor size (cm)			0.087
< 3	19 (13.4)	30 ± 17		87.0	72.1	17.2
3.1-7.9	112 (78.9)	30 ± 17		89.7	61.5	38.5
> 8	11 (7.7)	18 ± 15		63.6	26.5	0.0
Surgical margin			0.165
Negative	126 (88.7)	30 ± 17		88.8	60.6	30.1
Positive	16 (11.3)	23 ± 19		74.5	66.2	33.1
Lymphovascular invasion			0.050
Negative	56 (39.4)	33 ± 18		90.9	65.6	31.2
Positive	86 (60.6)	27 ± 17		84.	57.6	31.7
Perineural invasion			0.003
Negative	55 (38.7)	35 ± 18		92.7	63.4	41.3
Positive	87 (61.3)	26 ± 17		83.6	59.4	19.3
Tumor differentiation			0.0003
Well	1 (0.7)	57		100.0	100.0	100.0
Moderately	70 (49.3)	34 ± 17		95.2	69.3	44.2
Poorly	70 (49.3)	24 ± 16		81.3	52.7	11.3
Undifferentiated	1 (0.7)	4		0.0	0.0	0.0
Tumor histopathology			0.548
Adenocarcinoma (nitric oxide synthase)	112 (78.9)	31 ± 17		89.6	71.0	34.2
Adenocarcinoma with micropapillary feature	24 (16.9)	24 ± 10		100	0.0	0.0
Adenosquamous carcinoma	9 (6.3)	28 ± 15		88.9	33.3	0.0
Mucinous carcinoma	9 (6.3)	24 ± 14		88.9	30.5	30.5
Signet ring cell carcinoma	23 (16.2)	23 ± 19		69.3	58.5	39.0
Carcinoma with neuroendocrine features	7 (4.9)	28 ± 17		100.0	50.0	25.0
Carcinoma with mixed types	37 (26.1)	24 ± 13		86.3	50.1	50.1
Pathologic T stage			0.400
1A	2	38 ± 27		100.0	50.0	50.0
1B	2	47 ± 3		100.0	100.0	100.0
2	12	27 ± 17		83.3	72.9	54.7
3	125	29 ± 17		87.0	59.8	29.2
4A	0	0		-	-	-
4B	1	18		100.0	0.0	0.0
Pathologic N stage			0.001
0	36	35 ± 17		94.4	72.0	53.5
1	22	32 ± 17		91.3	70.1	70.1
2	35	30 ± 17		85.3	64.7	15.9
3A	35	25 ± 17		85.3	57.4	14.4
3B	14	15 ± 9		70.7	41.3	10.3
Pathologic M stage			0.005
M0	130	28 ± 18		88.3	64.5	32.5
M1	12	12 ± 4		75.0	13.1	13.1
Overall stage			0.012
1A	4	42 ± 16		100.0	75.0	75.0
1B	7	30 ± 15		100.0	100.0	100.0
2A	26	34 ± 19		88.5	63.0	42.0
2B	26	32 ± 17		84.6	66.8	60.7
3A	29	31 ± 17		93.1	72.6	19.8
3B	29	27 ± 18		86.2	62.9	15.3
3C	9	18 ± 10		76.2	15.2	15.2
4	12	16 ± 9		75.0	13.1	13.1

Table 2 Univariate analysis of overall survival in patients with lymph node metastasis

		Overall survival
Characteristic	No. of patients (%)	HR	95% CI1		P value
Celiac axis lymph node
Negative	130 (92)	1.00
Positive	12 (8)	3.33	1.40	7.95	0.007
Perineural invasion
Negative	55 (38.7)	1.00
Positive	87 (61.3)	1.48	0.54	4.11	0.447
Number of nodes retrieved/case
10	21 (15)	1.00
≥ 11	121 (85)	1.48	0.72	3.06	0.290
≤ 15	46 (32)	1.00
≥ 16	96 (68)	2.29	1.24	4.22	0.008
≤ 23	100 (70)	1.00
≥ 24	42 (30)	1.15	0.65	2.03	0.627
Number of positive nodes/case
≤ 6	58 (41)	1.00
≥ 7	48 (34)	1.72	1.20	2.46	0.003
≤ 15	92 (65)	1.00
≥ 16	14 (10)	2.30	1.40	3.77	0.001
Lymph node ratio
0	36 (25)	1.00
≤ 0.2	40 (28)	1.34	0.61	2.97	0.467
> 0.2	66 (46)	2.28	1.15	4.51	0.018

¹Hazards ratios (HR), 95% confidence interval (CI) and P values for postoperative time to recurrence and overall survival were adjusted according to important clinical characteristics. Survival time was defined as the period from the surgical treatment to endpoint of follow-up.

Table 3 Independent overall survival predictors retained by multivariate analysis

Factor	No. of patients	Multivariate analysis
		HR	95% CI		P value
Celiac axis lymph node		Compared to pN0
Negative	130
Positive	12	1.76	0.68	4.57	0.246
Number of positive nodes/case		Compared to pN0
LN+≥ 7	48	1.34	0.6	2.96	0.467
LN+≥ 16	14	2.77	1.15	4.51	0.018
Lymph node ratio		Compared to pN0
≤ 0.2	40	3.8	1.28	11.26	0.016
> 0.2	66	7.79	2.05	29.57	0.003
Overall stage pIV		Compared to pI
	12	18.43	2.27	145.62	0.002
Tumor differentiation poorly differentiated		Compared to well differentiated
	70	1.42	0.79	2.55	0.243

LN: Lymph node; HR: Hazards ratio; CI: Confidence interval.