Prognostic Significance of Lymphovascular Invasion in Node-Negative Gastric Cancer

Abstract

Background The aim of this study was to investigate the prognostic value of lymphovascular invasion (LVI) in gastric cancer patients without lymph node metastasis. Methods A total of 699 patients with primary tumor pT1-3/pN0-1 gastric adenocarcinoma who underwent curative resection from 2001 to 2010 were categorized into 3 groups: One-hundred and eleven patients with pN0/LVI(+), 475 with pN0/LVI(-), and 103 with pN1. Results The tumors in patients with N0/LVI(+) had more aggressive clinicopathologic features than those in patients with N0/LVI(-). However, there was no significant difference in patient characteristics between patients with pN0/LVI(+) and those with pN1, except for histologic grade. There were no significant differences in the overall survival rate in patients with pN0/LVI(+) compared to those with pN0/LVI(-) or the pN1 stage. However, the recurrence-free survival rate of the pN0/LVI(+) group was lower than that of the pN0/LVI(-) group (p < 0.001), while no significant difference was observed between the pN0/LVI(+) and the N1 groups (p = 0.216). In multi-variate analysis, LVI was identified as a poor prognostic factor related to recurrence-free survival in node-negative gastric cancer patients. pT3 stage and less than D2 lymphadenectomy were poor prognostic factors affecting recurrence-free survival, and less than D2 lymphadenectomy was an independent poor prognostic factor for overall survival in pN0/LVI(+) patients. Conclusions LVI could be an indicator of biological aggressiveness and may be a reliable prognostic factor for node-negative gastric cancer. LVI should be considered in postoperative management of gastric cancer.