Shorter Survival of Patients with Upper-Third Gastric Cancer Preoperatively Diagnosed as Stage IA Compared with Those with Middle to Lower Lesions.

ABSTRACT

BACKGROUND: Although preoperatively diagnosed stage IA (cT1N0) gastric cancer includes pathologically advanced disease, patients with cT1N0 middle- to lower-third gastric cancer (MLTG) experience favorable outcomes even if they undergo gastrectomy with limited lymph node dissection; however, whether this is true for upper-third gastric cancer (UTG) patients is unknown. In this study, we examined the survival of patients with cT1N0 UTG compared with patients with MLTG. METHODS: We retrospectively reviewed the data for 1707 consecutive patients with cT1N0 gastric cancer who underwent gastrectomy between 2006 and 2013. Patients were divided into the UTG or MLTG groups, and clinicopathological characteristics and survival were compared between the groups. Factors affecting survival were identified using multivariate analysis. Survival was calculated according to pathological findings. RESULTS: The patient group included 334 UTG patients and 1373 MLTG patients. The 5-year overall survival (OS) of UTG patients was significantly shorter than that of MLTG patients, and UTG was identified as an independent prognostic factor of cT1N0 gastric cancer. Among UTG cases, the OS of pT2-4 or pN1-3 was significantly shorter than that of pT1 or pN0 disease. No significant differences were found between such diseases in MLTG. All relapses in UTG were distant metastases. CONCLUSIONS: cT1N0 UTG with pT2-4 or pN1-3 are prognostic indicators of shorter OS, although MLTG of either disease is associated with favorable prognosis. Thus, UTG is an independent prognostic factor in cT1N0 gastric cancer; however, limited dissection is acceptable for cT1N0 UTG because relapses occur at distant sites.