Recurrence in node-negative advanced gastric cancer: Novel findings from an in-depth pathological analysis of prognostic factors from a multicentric series

Table 1 Clinical, pathological, and surgical features of 478 N0 gastric cancer patients n (%)

	Values
Male	291 (60.9)
Female	187 (39.1)
mean age (range)	67.1 (31-90)
Tumor markers1 (positive)	33/282
Tumor location
Upper	67 (14.1)
Middle	104 (21.7)
Lower	261 (55.6)
Multiple	46 (9.6)
Tumor mean size (range), cm	4.311 (0.8-14)
Tumor invasion (T)
T2	278 (58.2)
T3	181 (37.8)
T4a	19 (4.0)
Lauren histotype
Intestinal	315 (65.9)
Diffuse	81 (16.9)
Mixed / Unavailable	82 (17.1)
Histological grading (G)
G1	87 (18.2)
G2	287 (60.0)
G3	104 (21.8)
Type of surgery
Subtotal gastrectomy	266 (55.7)
Total gastrectomy	212 (44.3)
Mean retrieved node number2	26.2
(range)	(15-85)
Associated resections	53 (11.1)
(splenectomies)	[41 (8.5)]
30-d mortality	9 (1.88)
Major morbidity	61 (12.7)

¹CEA and/or CA19.9 above the normal values of 7 ng/mL and 36 UI/mL, respectively;

²This value reflects the exclusion from our analysis of patients with less than 15 retrieved nodes.

Table 2 Prognostic factors for recurrence in N0 gastric cancer patients

	Group 1 (with recurrence)	Group 2 (no recurrence)	P value3
	(n = 41)	(n = 437)
Gender (male)	28	263	0.308
Age (> 65)	19	201	0.966
Tumor markers1	6/25	27/207	0.138
Tumor location (upper)	7	60	0.555
Tumor size (> 5 cm)	16	132	0.242
Tumor invasion (T)
T2	19	259	0.108
T3	13	168	0.395
T4a	9	10	0.001
Lauren histotype
Intestinal	24	291	0.768
Diffuse	12	69	0.012
Mixed / Unavailable	5	77	0.509
Histological grading (G)
G1	7	80	0.844
G2	22	265	0.382
G3	12	92	0.222
Retrieved nodes2 (mean) > 25	26	273	0.905
Associated resections - yes	8	45	0.772
Major morbidity - yes	8	53	0.175

¹Almost 1 tumor marker positive, including CEA, CA 19.9, or other tumor marker. Only 282 cases were available for analysis;

²This value reflects the exclusion from our analysis of patients with less than 15 retrieved nodes;

³P values of χ² test for gender, tumor markers, tumor location, tumor invasion (T), Lauren histotype, histological grading (G), associated resections, post-operative morbidity. P values of Student t-test for age, tumor size, and the number of retrieved nodes.

Table 3 Histological assessment of N0 patients with and without cancer recurrence, matched according to demographic and pathological characteristics

	Group 1 (41 N0 patients with recurrence)	Group 2bis (41 N0 patients without recurrence)	P value3
Lymphatic embolization	34	13	0.001
Microvascular infiltration	11	7	0.285
Perineural infiltration	19	6	0.001
p531	49.1% (0-100)	33.8% (0-100)	0.041
Ki671	52.7% (30-80)	33.1% (15-70)	0.038
HER22	7	8	0.785

¹Our immunohistochemical analysis of p53 and Ki67 differ from some of those found in other studies because we expressed them as the number of cancer cells showing immunohistochemical staining over 100 cells, thus as a rate and not as a binomial variable (yes/no). Statistical analysis was retrospectively performed by Student t-test;

²Immunohistochemical detection, both 2+ and 3+ were considered positive;

³P values of χ² test for lymphatic embolization, microvascular infiltration, perineural infiltration, and HER2. P values of Student t-test for p53 and Ki67.