Prognostic impact of lymphatic and/or blood vessel invasion in patients with node-negative advanced gastric cancer

Background: Heterogeneous survival rates in patients with similar clinicopathologic characteristics or molecular prognostic markers have been noted. This study was conducted to evaluate the prognostic effect of lymphatic and/or blood vessel invasion (LBVI), identified by routine hematoxylin and eosin staining, on the outcome of patients with node-negative advanced gastric cancer. Methods: A total of 280 patients who underwent curative gastrectomy for advanced gastric cancer without lymph node metastasis were retrospectively reviewed. Univariate and multivariate analyses of the clinicopathological features, recurrences, and prognoses of patients with and without LBVI were performed. Results: Lymphatic vessel invasion (LVI) was noted in 20.0%, blood vessel invasion (BVI) in 5.4%, and either LVI or BVI in 22.5%. None of the clinicopathologic features was related to LBVI. Patients with LBVI had a recurrence rate of 26.8%, whereas patients without LBVI had a recurrence rate of 13.5% (P = .018). The 5-year survival rates were 82.4% for patients without LBVI and 67.1% for patients with LBVI (P = .0222). LBVI was shown to be an independent risk factor for recurrence (relative risk, 2.30; 95% confidence interval, 1.06-4.99) and poor prognosis (relative risk, 1.88; 95% confidence interval, 1.07-3.29). Conclusions: LBVI is an adverse prognostic indicator and the presence of LBVI seems to provide useful information for the prognosis and clinical management of patients with node-negative advanced gastric carcinoma.