Abstracts
1998 Digestive Disease Week

#971

SURVIVAL OF GASTRIC CANCER PATIENTS IS DETERMINED BY THE PRESENCE OF LYMPHANGITIS CARCINOMATOSIS. G.P. Schwab, A. Klingler, G. Wetscher, M. Gadenståtter, H.G. Schwelberger, A. Kreczy, R. Pointner. Dpts. of Surgery & Pathology, University of Innsbruck, Dpt of Surgery, Hospital of Zell/See, Austria, Europe.

Background: Several well known prognostic factors influence the outcome of radically operated gastric cancer patients, i.e. the depth of tumor infiltration and the extent of lymph node metastases. We studied the influence of lymphangitis carcinomatosis (LC) on the survival in a prospective study. Methods: 131 consecutive patients with gastric cancer underwent gastrectomy for cure between 1986 and 1989. Systematic lymph node dissection was done in all patients. L.C was seen histologically in 47 patients in the stomach, at the lesser or major omentum and/or the fatty tissue around dissected lymph nodes (Group I). Group II comprised 84 patients without LC. The tumor-stage according to the UICC-classification (1992), histologic grading and the tumor size have been evaluated in both groups. Results: LC was more frequent in patients with higher UICC-stage (p=0.001), higher histologic grading (p=0.003) and larger tumor size (p=0.0001). LC, the UICC-stage, tumor grading, tumor size and patient's age had a strong influence on survival according to univariate analysis, using the logrank test. Cox's proportional hazards model was employed and the presence of LC significantly impaired survival even after adjustment for these prognostic factors (p=0.005, Fig.).

Conclusions: Lymphangitis carcinomatosis is an independend risk factor in gastric cancer. It should therefore be included in prognostic tumor classifications. Lymphangitis carcinomatosis in gastric cancer is associated with an advanced tumor spread not curable by surgery alone. Adjuvant chemotherapy should be considered in these patients.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.