OBJECTIVETo investigate the correlation between extranodal metastasis (EM) and clinicopathologic features as well as the effect of EM on the prognosis in gastric cardia patients.

METHODSRetrospective analysis was performed for the 323 cases with histologically proven adenocarcinoma of gastric cardia who underwent curative resection from January 2000 to January 2007. There were 272 male patients and 51 female patients with their median age of 63 (22 to 85) years. The relationship between clinicopathological features and extranodal metastasis was studied. The effects of the EM on the recurrence and survival of these patients were also analyzed.

RESULTSEM positive was detected in 67 (20.7%) of the 323 patients. The incidence of EM was correlated with tumor Lauren typing, differentiation degree, invasive depth and lymph node metastasis (χ(2) = 4.647-27.216, P < 0.05). The 5-year survival rate and media survival time between patients with EM and those without EM were 12.3%, 34.1% and 20, 39 months, there was a statistically significantly difference (χ(2) = 23.936, P = 0.000) in 5-year survival rate. Multivariate analysis identified that invasive depth, lymph node metustasis and EM as an independent prognostic factor of all the patients. To the last follow up, the cumulative probability of recurrence of EM-positive patients was significant higher than EM-negative patients (59.7% vs. 35.9%; χ(2) = 12.409, P = 0.000). To study furthermore, stratified analysis showed that, in the node-positive patients, the cumulative recurrence rate of EM-positive patients was higher than EM-negative patients (60.9% vs. 40.0%; χ(2) = 8.410, P = 0.004) and the 5-year survival rate of EM-positive patients was less than the EM-negative patients (12.9% vs. 30.1%; χ(2) = 12.939, P = 0.000), the differences were statistically significant.

CONCLUSIONSEM positive is determined to be an independent prognosis factor of gastric cardia after curative resection. EM-positive patients have a high risk for recurrence and a short time to live.