Treatment of Gastric Cancer With Paraaortic Lymph Node Metastasis

Patients with gastric cancer and paraaortic lymph node (PAN) metastasis suffered poor prognosis. The median survival time of the patients who received palliative chemotherapy was only about 12.8 months. However, the standard treatment strategy for patients with gastric cancer and PAN metastasis was controversial. This study aimed to evaluate the survival benefit of conversion chemotherapy followed by surgery in patients with gastric cancer and radiologically suspicious PAN metastasis compared with palliative chemotherapy alone. Twenty-four patients (19 males and 5 females) between January 1, 2008 and December 31, 2013 were analyzed. Fifteen patients received conversion chemotherapy followed by gastrectomy with D2 lymphadenectomy, and 9 received palliative chemotherapy. The median follow-up was 16.5 months (range: 3–50 months). The estimated median overall survival (OS) of patients who underwent the operation was longer than those who received palliative chemotherapy (44.0 versus 13.0 months; P = 0.007). Cox proportion hazard analysis indicated that surgery was a good prognostic factor for prolonged survival compared with that of palliative chemotherapy (hazard ratio: 0.211; 95% confidence interval, 0.061–0.732; P = 0.014). Moreover, the 1-year OS rate of surgical patients whose PAN shrank to <1 cm was better than those who received palliative chemotherapy (87.5 versus 55.6%; log-rank P = 0.008). In conclusion, patients with gastric cancer and radiologically suspicious PAN metastasis obtained a survival benefit from conversion chemotherapy followed by gastrectomy plus D2 lymphadenectomy.