The most important prognostic factors in gastric cancer are depth of invasion and lymph node metastasis. Therefore, the prognosis for serosa and lymph node negative gastric cancer is favorable. However, there is no general agreement on the prognostic factors in this subset of patients. This study was undertaken to evaluate the prognostic significances of venous invasion (VI), lymphatic invasion (LI), and perineural invasion (NI) in T1 and T2 gastric cancer without lymph node involvement.

We retrospectively evaluated 206 patients with T1 and T2, lymph node negative gastric cancer who underwent a curative resection from 1989 to 1993 at Kangnam St. Mary's Hospital, Seoul, Korea. The Chi-square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and the Cox regression method was used to evaluate independent prognostic significance.

The rate of VI, LI and NI correlated well with the depth of tumor invasion. The rates of VI (+) for T1 vs T2 was 0% vs 5.1%, of LI (+) was 5.6% vs 26.8%, and of NI (+) was 1.6% vs 26.8% in NI (+). There were 13 recurrent cases, 10 cases out of the 13 were T2 gastric cancers, and the recurrence rate was higher in LI (+) andNI (+) cases than in LI (−) and NI (−) cases. The 5-year survival rates were 93.4% in LI (−) cases, 77.4% in LI (+) cases, 92.5% in NI (−) cases, 74% in NI(+) cases, 95.9% in LI (−) NI (−) cases, and 73.9% in LI (+) NI (+) cases. Multivariate analysis demonstrated that simultaneous LI and NI was the only significant factor influencing the prognosis.

These results suggest that simultaneous lymphatic and perineural invasion may be an independent prognostic factor in patients with T1 and T2 gastric cancer without lymph node metastasis.