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Japanese Journal of Clinical Oncology 2007 37(6):429-433; doi:10.1093/jjco/hym067
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© 2007 Foundation for Promotion of Cancer Research

Risk Factors for Para-aortic Lymph Node Metastasis of Gastric Cancer from a Randomized Controlled Trial of JCOG9501

Eiji Nomura1,, Mitsuru Sasako2, Seiichiro Yamamoto3, Takeshi Sano2, Toshimasa Tsujinaka4, Taira Kinoshita5, Hiroshi Furukawa6, Toshio Shimizu7, Masahiro Hiratsuka8, Osamu Kobayashi9, Yukinori Kurokawa3, Nobuhiko Tanigawa on behalf of the Gastric Cancer Surgical Study Group of the Japan Clinical Oncology Group1

1 Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka
2 Gastric Surgery Division, National Cancer Center Hospital, Tokyo
3 Cancer Information and Epidemiology Division, National Cancer Center Research Institute, Tokyo
4 Department of Surgery, Osaka National Hospital, Osaka
5 Department of Surgery, National Cancer Center Hospital East, Kashiwa, Chiba
6 Department of Surgery, Sakai Municipal Hospital, Sakai, Osaka
7 International Medical Center of Japan, Tokyo
8 Department of Surgery, Itami City Hospital, Itami, Hyogo
9 Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan

For reprints and all correspondence: Eiji Nomura, Department of General and Gastroenterological Surgery, Osaka Medical College, 2–7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. E-mail: sur035{at}poh.osaka-med.ac.jp

Received May 24, 2006; accepted January 29, 2007

Background: No risk factor has been confirmed for para-aortic lymph node (PAN) metastasis from gastric cancer. To identify the risk factors and the most frequent route of metastasis to PAN, we analyzed the prospective data from a phase III trial.

Methods: In JCOG9501 comparing D2 and D2 + PAN dissection, 260 patients with T2(SS)-T4 gastric cancer underwent radical gastrectomy with PAN dissection. The association between various clinicopathological factors and PAN metastasis was examined.

Results: Macroscopic N stage and tumor size ≥ 5 cm were significant risk factors for PAN metastasis after adjusting for other factors. The proportion of PAN metastasis was clearly different between the N0–1 group and the N2–4 group (2.8% versus 20.5%). In the additional multivariate analysis including 17 regional lymph node stations, station No. 7 was the only station with statistical significance (P = 0.002, odds ratio = 41.0).

Conclusion: Macroscopic N stage and tumor size were associated with PAN metastasis, and the lymphatics along the left gastric artery seemed to be the most frequent route to the nodes surrounding the aorta. These findings may be useful in predicting PAN metastasis.

Key Words: gastric cancer • para-aortic lymph node metastasis • risk factors • randomized controlled trial


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[Abstract] [Full Text] [PDF]


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