Imbalance between expression of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in invasiveness and metastasis of human gastric carcinoma

AIM: The expressive balance between matrix metalloproteinase-9 (MMP-9) and its tissue inhibitor of metalloproteinase-1 (TIMP-1) plays a critical role in maintaining the degradation and synthesis of extracellular matrix. Loss of such balance is associated with invasion and metastasis of tumors. This study aimed to determine the expression of MMP-9 and TIMP-1 in gastric carcinoma, and the association of the expressive imbalance between MMP9 and TIMP-1 with the invasion and metastasis and prognosis of gastric carcinoma.METHODS: We used immunohistochemistry to determine the expressions of MMP-9, TTMP-1 and proliferating cell nuclear antigen Ki-67 in the gastric specimens taken from 256 patients with primary gastric carcinoma. The patients were followed-up for up to 96 months.RESULTS: No association between the expression of MMP9 and TIMP-1 and patients' sex and age, tumor size and location of gastric carcinoma was observed. The incidence of the positive expression of MMP-9 in cases with tumors invasion to muscularis propria and visceral peritoneum (70.13% and 69.09%, respectively) was significantly higher than that in cases with tumor invasion only to lamina propria or submucosa (42.50 %, P=0.0162). The positive correlation between MMP-9 expression and the depth of tumor invasion was observed (Pearson correlation coefficient=0.2129,P=0.016). Along with the increase of the metastatic station of lymph nodes, the incidence of the MMP-9 expression was increased by degrees; a positive correlation between them was observed (Pearson correlation coefficient=0.2910,P=0.0001). There was also a significant correlation between MMP-9 expression and the TNM stage in gastric carcinoma (Pearson correlation coefficient=0.3027, P＜0.0001). The incidence of MMP-9 expression in stage Ⅱ and Ⅲ/Ⅳ (75.00%and 76.15%, respectively) was significantly higher than those in stage Ⅰ (46.15 %, P＜0.0001). A negative correlation between TIMP-1 immunoreactivity and the depth of invasion,status of lymph node metastasis and TNM stage was observed (Pearson correlation coefficient =-0.1688, -0.3556and -0.3004, P=0.023, ＜0.0001 and ＜0.0001, respectively).Four types of co-expression of MMP-9 and TIMP-1 were observed; i.e. MMP-9 positive but T IMP-1 negative (n=115),both positive (n=52), both negative (n=62) and MMP-9negative but TIMP-1 positive (n=27). The frequency of serosal invasiveness was significant higher in patients with MMP-9 but without TIMP-1 expression than those with other types of the co-expression (P=0.0303). The incidence of lymph node metastasis was highest in patients with MMP-9but without TIMP-1 expression, and lowest in those with TIMP-1 but without MMP-9 expression (P＜0.0001). The survival rate in patients with MMP-9 but without TIMP-1expression was lower than that in those with TIMP-1 but without MMP-9 expression (P=0.0014).CONCLUSION: Our results in gastric carcinoma demonstrated a significant positive association of MMP-9 over-expression with proliferation of tumor cells, the depth of invasiveness,lymph node metastasis and TNM stage, suggesting MMP-9can serve as a molecular marker of tumor invasion and metastasis. We also demonstrate a significant negative relationship of TIMP-1 expression with the depth of invasiveness and lymph node metastasis, which provide a new idea in the tumor biological and genetic treatment.The interaction between MMP-9 and TIMP-1 in the processes of tumor invasion and metastasis is that MMP-9 mainly promotes tumor invasion and metastasis and TIMP-1 inhibits functions of MMP-9. The imbalance between MMP-9 and TIMP-1 expression may suggest the occurrence of tumor invasion and metastasis, predict poor prognosis. For patients with imbalanced MMP-9 and TIMP-1 expression, the optimal treatment scheme needs to be selected.     

Impact of lymph node micrometastasis in hilar bile duct carcinoma patients

AIM: To immunohistochemically examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma (HBDC) and to evaluate the clinical significance of the results. METHODS: A total of 361 regional lymph nodes from 25 patients with node-negative HBDC were immunostained with an antibody against cytokeratins 8 and 18 (CAM 5.2), and immunohistochemical staining of VEGF-C was performed in 34 primary resected tumors. RESULTS: Lymph node micrometastasis was detected in 6 (24%) of the 25 patients and 10 (2.8%) of the 361 lymph nodes. Patients with micrometastasis showed significantly poorer survival rates than those without (P=0.025). VEGF-C expression was positive in 17 (50%) of 34 HBDC, and significantly correlated with lymph node metastasis (P=0.042) and microscopic venous invasion (P=0.035). CONCLUSIONS: It is suggested that immunohistochemically detected lymph node micrometastasis has an impact on the outcome of HBDC. VEGF-C expression is highly correlated with lymph node metastasis in HBDC and might therefore be a useful predictor.     

胃癌组织Maspin,uPA,MMP-7表达的意义

目的:观察胃癌及正常胃黏膜Maspin,uPA, MMP-7表达的意义．方法:应用免疫组化SP法检测胃管状腺癌30 例,胃印戒细胞癌30例,正常胃黏膜组织20例中Maspin,uPA,MMP-7的表达情况．结果:在胃管状腺癌中Maspin,uPA,MMP-7 阳性表达率分别为50％,70％和80％;胃印戒细胞癌中阳性表达率分别为46．7％,76．7％和 90％;正常胃黏膜组织中阳性表达率分别为 90％,35％和30％．Maspin的表达与浸润深度、淋巴结转移相关,而与肿块的大小和TNM分期无关．uPA和MMP-7的表达与浸润深度、淋巴结转移、TNM分期相关,而与肿块的大小无关．Maspin的表达与uPA和MMP-7的表达呈负相关(P=0．012,r=-0．322;P=0．008,r= -0．341);uPA的表达与MMP-7的表达呈正相关 (P=0．034,r=0．274)．结论:Maspin在胃癌中表达下调,uPA和 MMP-7在胃癌中过表达,他们在胃癌的浸润转移中起重要作用,可作为反应胃癌病理生物学行为的有效指标．     

AE1/AE3免疫组化法在检测胃癌淋巴结微转移中的作用

目的 探讨AE1／AE3免疫组化标记检测胃癌根治标本中淋巴结内微小转移癌及其临床意义。方法 对64例胃癌病人根治切除后阴性的淋巴结及胃周软组织的石蜡包埋组织用S-P法进行AE1／AE3染色标记。结果 64例118枚淋巴结中，根据HE染色阴性再经AE1／AE3标记发现，8例患者13枚淋巴结有微转移灶，病例总阳性率12．50％（8／64），淋巴结总阳性率11．02％（13／118）。微转移与浸润深度有关，深层组织的微转移阳性率高于浅层（P〈0．05），弥漫型胃癌微转移率（62．50％）明显高于肠型胃癌（5．36％），两者之间具有显著差异性。结论 AE1／AE3染色标记检测微转移淋巴结可能对准确地确定临床分期、诊疗及判断预后有积极临床意义。     

胃癌中胸苷磷酸化酶和基质金属蛋白酶2的表达及意义

目的探讨胃癌中胸苷磷酸化酶（TP）和基质金属蛋白酶2（MMP-2）表达的意义及其与肿瘤浸润转移的关系。方法免疫组化SP法检测69例不同胃黏膜组织（正常胃黏膜组10例、慢性胃炎组10例、胃癌组39例、胃癌转移的淋巴结组10例）中TP和MMP-2的表达情况。结果胃癌组织及淋巴结胃癌转移灶中TP与MMP-2的表达较正常组及慢性胃炎组显著增高（P〈0．05）。TP与MMP-2表达与胃癌患者的性别、年龄及肿瘤的分化程度无关。肿瘤≥5cm组及T3-4组TP阳性率湿著高于〈5cm组及T1-2组,有远处转移的胃癌组TP阳性率高于无远处转移组,差具有显著性（P〈0．05）;临床Ⅰ-Ⅱ期和Ⅲ-Ⅳ期之间TP阳性率的差异也具有显著性（P〈0．001）。MMP-2在T1-2组与T3-4组的阳性率分别为60．87％和93．75％,有显著性差异（P〈0．05）。在有淋巴结转移的胃癌组MMP-2阳性率显著高于无淋巴结转移组（P〈0．05）;临床Ⅰ-Ⅱ期阳性表达59．09％,Ⅲ-Ⅳ期阳性表达为94．12％,两组有显著性差异（P〈0．05）。而MMP-2表达却与肿瘤大小及远处转移无关。TP表达阳性的胃癌中MMP-2阳性率88．00％高于TP阴性组的50．00％。结论胃癌中TP与MMP-2表达增高与肿瘤进展的病理临床参数有关;TP的表达与MMP-2的表达有关,提示TP在影响肿瘤进展的过程中可能通过MMP-2促进肿瘤浸润转移。     

SOCS2和STAT3蛋白的表达及其与胃癌生物学行为的关系

目的:探讨SOCS2和STAT3蛋白在胃癌组织中的表达及其与胃癌生物学行为的关系.方法:应用免疫组织化学方法检测55例胃癌组织和55例正常胃组织中SOCS2和STAT3蛋白的表达情况,并分析二者与胃癌分化程度、淋巴结转移、浸润深度和临床分期及患者性别、年龄之间的关系,同时分析二者的相关性.结果:SOCS2在胃癌组织中的阳性表达率为25.5%,明显低于正常胃组织中的91.1%(P<0.05),且表达与分化程度、淋巴结转移、临床分期相关(P<0.05);STAT3在胃癌组织中的阳性表达率为72.7%,明显高于正常组织的18.2%(P<0.05),且表达与分化程度、淋巴结转移、浸润深度和临床分期相关(P<0.05),SOCS2与STAT3的表达呈负相关(r=-0.486,P<0.01).结论:SOCS2在胃癌组织中低表达,STAT3异常活化可促进细胞的过度增殖,促进胃癌的发展,二者的相互调节在胃癌发生发展中起重要作用.     

Expression of MMP—2,TIMP—2 protein and the ratio of MMP—2／TIMP—2 in gallbladder carcinoma and their significance

AIM: To study the correlation between expression of MMP-2, TIMP-2 protein and the ratio of MMP-2/TIMP-2 and clinicalpathological parameters of patients with gallbladder carcinoma.METHODS: Carcinomas (n=45) and polypoid lesions (n=15) of the gallbladder were studied for the expression of MMP-2 and TIMP-2 protein by immunohistochemical avidin-biotin-complex method and image analysis. Clinicalpathological data of patients with gallbladder carcinoma such as histological type, grade of differentiation, level of infiltration, liver invasion and lymph node involvement, etc, were recorded.RESULTS: There was significant difference between the average level (1.123±0.108 VS 1.030±0.054, P=0.002) of MMP-2, the ratio (1.050±0.013 VS0.937±0.078, P=0.003) of MMP-2/TIMP-2 in gallbladder carcinomas and in polypoid lesions of the gallbladder. Significant difference was found between the expression of MMP-2 in early stage and advanced tumors, but there was no correlation between MMP-2 protein expression and histological type, differentiation degree, infiltration level, lymph node involvement or liver invasion. Although no difference was observed between TIMP-2 expression and histological type or differentiation degree, signific ant difference was found between TIMP-2 expression and different Nevin stage, infiltration level, local lymph node involvement or liver invasion (1.168±0.067 VS1.048±0.075, 1.170±0.062 vs 1.039±0.06g, 1.039±0.076 VS1.147±0.083, 1.048±0.074 vs 1.103±0.095, P＜0.05). MMP-2/TIMP-2 ratio did not correlate with histological type, grade of differentiation and liver invasion, but significant differences were found between MMP-2/TIMP-2 ratio and different Nevin stage, infiltration level and lymph node involvement in patients with carcinoma of gallbladder.CONCLUSION: TIMP-2 and MMP-2/TIMP-2 ratio could reflect more accurately biological characteristic of gallbladder carcinoma and MMP-2/TIMP-2 ratio might be a new significant marker in early diagnosis, in the judgment of invasion or metastasis and the estimate of prognosis in patients with gallbladder carcinomas.     

Metastasis of primary gallbladder carcinoma in lymph node and liver

AIM: To evaluate the patterns with metastasis of gallbladder carcinoma in lymph nodes and liver. METHODS: A total of 45 patients who had radical surgery were selected. The patterns with metastasis of primary gallbladder carcinoma in lymph nodes and liver were examined histopathologically and classified as TNM staging of the American Joint Committee on Cancer. RESULTS: Of the 45 patients, 29 (64.4%) had a lymph node positive disease and 20 (44.4%) had a direct invasion of the liver. The frequency of involvement of lymph nodes was strongly influenced by the depth of the primary tumor (P= 0.0001). The postoperative survival rate of patients with negative lymph node metastasis was significantly higher than that of patients with positive lymph node metastasis (P= 0.004), but the postoperative survival rate of patients with Nl lymph node metastasis was not significantly different from that of patients with N2 lymph node metastasis (P= 0.3874). The postoperative survival rate of patients without hepatic invasion was significantly better than that of patients with hepatic invasion (P= 0.0177). CONCLUSION: Complete resection of the regional lymph nodes is important in advanced primary gallbladder carcinoma (PGC). The initial sites of liver spread are located mostly in segments IV and V. It is necessary to achieve negative surgical margins 2 cm from the tumor. In patients with hepatic hilum invasion, extended right hepatectomy with or without bile duct resection or portal vein resection is necessary for curative resection.     

K-19 mRNA RT-PCR in detecting micrometastasis in regional lymph nodes of gastric cancer

AIM: To investigate the value and prospect of RT-PCR in detecting micrometastasis in regional lymph nodes of gastric cancer. METHODS: Histopathology was used and K19 mRNA expression was detected by RT-PCR in tumor tissues and lymph nodes from gastric cancer patients undergoing radical resection of gastric carcinoma. RESULTS: K19 mRNA was expressed in all tumor specimens of 30 cases; of the 126 lymph nodes, 26 were histopathologically positive (20.6%), and 42 positive (33.3%) by RT-PCR. Amplification fragments of 460 and 540 bp were shown in all the tumor tissues and metastatic lymph nodes after K19 andβ-actin RT-PCR, while only a 540 bp fragment appeared in the lymph nodes of non-tumor patients. CONCLUSION: K19 mRNA RT-PCR is sensitive and specific in testing micrometastasis in regional lymph nodes of gastric cancer, and it is superior to routine histopathology.     

Expression of insulin-like growth factor-2, c-MET, matrix metalloproteinase-7 and MUC-1 in primary lesions and lymph node metastatic lesions of gastric cancer

BACKGROUND/AIMS: Lymph node metastases are thought to be formed as lymphatic flow, so the first metastasis is formed in the lymph node nearest the primary tumor and then further lymph node metastases are formed continuously down stream. In this study of gastric cancer, we evaluated whether IGF-2 (insulin-like growth factor-2), c-MET (hepatocyte growth factor receptor), MMP-7 (matrix metalloproteinase-7) and MUC-1, which are associated with nodal metastasis from primary tumor, are concerned with metastasis from nodal metastatic lesion to other nodes. METHODOLOGY: Tissue specimens were obtained from 146 patients who underwent gastrectomy at the Department of Surgery II of Kanazawa University between 1989 and 1997. We evaluated the expression of IGF-2, c-MET, MMP-7 and MUC-1 in 146 primary tumors and 66 metastatic lymph nodes by immunohistological staining. RESULTS: In primary lesions, these 4 factors had significant association with lymphatic vessel infiltration and MMP-7 and MUC-1 had significant association with nodal metastases. In nodal metastatic lesions, positive rates of MMP-7 and MUC-1 were higher than in primary lesions. Furthermore, 37 (73%) of the 51 cases with positive staining for MMP-7 in metastatic lesions in perigastric lymph nodes and 5 (33%) of the 15 cases without the staining had nodal metastases in group 2 or more, showing significant difference (P < 0.05). And 37 (76%) of the 49 cases with positive staining for MUC-1 in metastatic lesions in perigastric lymph nodes and 5 (29%) of the 17 cases without the staining had nodal metastases in group 2 or more, showing significant difference (P < 0.01). CONCLUSIONS: MMP-7 and MUC-1 were associated with not only nodal metastasis from primary tumor but also metastasis from nodal metastatic lesion to other nodes.     

Significance of Survivin and PTEN expression in full lymph node-examined gastric cancer

AIM:To study the relationship between Survivin andPTEN expression and lymph node metastasis,depth ofinvasion and prognosis of gastric cancer patients in Chi-na.METHODS:Specimens of gastric cancer tissue were col-lected from the Affiliated Hospital of Jianghan University.All the 140 patients had complete examination data.Alllymph nodes were found by the fat-clearing method.Theinterrupted serial 4-micron sections,routine hematoxylinand eosin staining and immunohistochemical methodswere used to detect the lymph node metastases.Gastriccancer tissue microarray was performed to test the ex-pression of Survivin and PTEN(17A)in gastric cancer byimmunohistochemical method.All data were processedusing x~2 test,Fisher's exact test,Kaplan-Meyer Log-rankmethod and Cox multivariate analysis(SPSS 12.0 soft-ware).RESULTS:One hundred and eighteen specimenswere used in our tissue microarray(utilization rate was82.4%).A total of 7580 lymph nodes were found.Metas-tases were found in 90 specimens and 1618 lymph nodeswere detected.The positive rate of Survivin and PTENexpression was 52.5%(62/118)and 76.2%(90/118),respectively.A highly positive correlation was found be-tween Survivin and PTEN expression(x~2=4.17,P=0.04).Survivin expression was positively correlated with UICCN stage(x~2=8.69,P=0.03)and histological classifica- tion(x~2=4.41,P=0.04)by x~2 tests.PTEN expression waspositively correlated with depth of invasion(P=0.02)andhistological classification(x~2=5.47,P=0.02).But Survivinand PTEN expressions were not related with prognosis ofgastric cancer patients.A significant correlation betweenlymph node metastasis and prognosis was demonstratedby Cox multivariate analysis(x~2=4.85,P=0.028).CONCLUSION:Survivin is positively correlated withPTEN expression in gastric cancer and is a molecularmarker of lymph node metastasis while PTEN expressionis a molecular marker of advanced gastric cancer.UICCN stage is the most important prognostic factor of gastriccancer in China.     

胃癌组织中PTEN,MMP-9和Caspase-3表达的关系

目的:研究PTEN,MMP-9和Caspase-3在胃癌及正常胃组织中的表达,探讨他们在胃癌的发生、发展、浸润和转移中的作用．方法:选择临床病理资料齐全的胃癌蜡块标本54例,另取正常胃黏膜标本15例作对照．采用SP免疫组化方法检测PTEN,MMP-9和 Caspase-3在其中的表达．结果:胃癌中PTEN低表达(28/54,51．9％),且肿瘤浸润深(P=0．004)、有淋巴(P=0．003) 和远隔转移(P=0．01 5)、临床分期高(P= 0．001)、病理分化低(P=0．008)时降低．胃癌中MMP-9高表达(41／54,75．9％),且肿瘤浸润深(P=0．040)、有淋巴转移(P=0．025)、临床分期高(P=0．039)、病理分化低(P=0．009)时增高．胃癌中Caspase-3低表达(12／54,22．2％), 且有淋巴转移(P=0．045)、临床分期高(P= 0．015)、病理分化低(P=0．035)时降低．胃癌中PTEN与MMP-9(r=-0．543,P=0．001), Caspase-3与MMP-9的表达负相关(r=0．741, P=0.001),PTEN与Caspase-3的表达正相关(r =0．515,P=0．001)．结论:胃癌中PTEN,Caspase-3低表达,MMP-9 高表达;PTEN、MMP-9和Caspase-3可作为胃癌诊断和预后判断的指标．     

Expression of vascular endothelial growth factor C and chemokine receptor CCR7 in gastric carcinoma and their values in predicting lymph node metastasis

AIM: To study the expression of vascular endothelial growth factor C (VEGF-C) and chemokine receptor CCR7 in gastric carcinoma and to investigate their associations with lymph node metastasis of gastric carcinoma and their values in predicting lymph node metastasis. METHODS: The expression of VEGF-C and CCR7 in gastric carcinoma tissues obtained from 118 patients who underwent curative gastrectomy was examined by immunohistochemistry. Among these patients, 39 patients underwent multi-slice spiral CT (MSCT) examination. RESULTS: VEGF-C and CCR7 were positively expressed in 52.5 and 53.4% of patients. VEGF-C expression was more frequently found in tumors with lymph node metastasis than those without it (P<0.001). VEGF-C expression was also closely related to lymphatic invasion (P<0.001), vascular invasion (P<0.01), and TNM stage (P<0.001). However, there was no significant correlation between VEGF-C expression and age at surgery, gender, tumor size, tumor location, Lauren classification, and depth of invasion. CCR7 expression was significantly higher in patients with lymph node metastasis compared with those without lymph node metastasis (P<0.001) and was also associated with tumor size (P<0.01), depth of invasion (P<0.001), lymphatic invasion (P<0.001), and TNM stage (P<0.001). However, the presence of CCR7 had no correlation to age at surgery, gender, tumor location, Lauren classification, and vascular invasion. Among the 39 patients who underwent MSCT examination, only CCR7 expression was related to lymph node metastasis determined by MSCT (P<0.05). In the current retrospective study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of VEGF-C and CCR7 expression in the diagnosis of lymph node metastasis for patients with gastric carcinoma were 73.8%, 70.2%, 72.6%, 71.4% and 72.0%, and 82.0%, 77.2%, 79.4%, 80.0% and 79.7%, respectively. After subdivision according to the combination of VEGF-C and CCR7 expression, receiver operating characteristic (ROC) analysis showed that the accuracy of the combined examination of VEGF-C and CCR7 expression in predicting lymph node metastasis was relatively high (area under ROC curve [Az]=0.83). CONCLUSION: The expression of VEGF-C and CCR7 is related to lymph node metastasis of gastric carcinoma and both of them may become new targets for the treatment of gastric carcinoma. Furthermore, the combined examination of VEGF-C and CCR7 expression in endoscopic biopsy specimens may be useful in predicting lymph node metastasis of gastric carcinoma and deciding the extent of surgical lymph node resection.     

胰头癌淋巴结微转移的检出及其分析

目的 通过对胰头癌切除标本中淋巴结微转移的检测,分析淋巴结微转移对胰头痛临床分期及预后的影响,探讨其临床价值.方法 以手术显微镜法完整取出20例冈胰头癌行区域性胰十二指肠切除术标本中的淋巴结,常规病理检测淋巴结转移,免疫组化检测淋巴结微转移.结果 20例标本中共找到677枚淋巴结,常规病理显示13例共87枚淋巴结发生转移.在病理检测阴性的590枚淋巴结中,免疫组化检测又发现3例57枚淋巴结存在微转移.常规病理结合免疫组化检测,淋巴结转移阳性患者从65%(13/20)增加到80%(16/20);转移淋巴结的检出率从12.9%(87/677)上升到21.3%(144/677),相差显著(P<0.05).微转移检测使3例ⅡA期患者转为ⅡB期,有淋巴结微转移患者的1年内肿瘤转移、复发率为75%,而无微转移者的转移、复发率为25%.结论 胰头癌淋巴结微转移的检出有助于肿瘤分期的确定和预后的判断.     

MMP-7与Fas蛋白在胃癌组织中的表达及意义

目的:探讨基质金属蛋白酶-7(MMP-7)蛋白和Fas蛋白在胃癌组织中的表达、相互关系及意义.方法:应用免疫组化方法检测了82例胃癌组织及30例周边正常胃黏膜中MMP-7和Fas的表达情况.结果:胃癌组织中MMP-7蛋白阳性率显著高于正常胃黏膜(73.2%vs10%,P<0.001);正常胃黏膜中Fas蛋白阳性率显著高于胃癌组织(39.1%vs93.3%,P<0.001).MMP-7阳性表达率与淋巴结转移、TNM分期显著相关(P<0.001),而与肿瘤细胞分化程度无显著性相关.Fas蛋白阳性表达率与肿瘤细胞分化程度显著相关(P<0.05),而与淋巴结转移、TNM分期无显著性相关.胃癌组织中MMP-7与Fas表达具有显著等级负相关(r=-0.597,P<0.001).结论:MMP-7与Fas表达胃癌的生物学行为密切相关,且两者之间的表达强度具有显著等级负相关.     

Clinical results and prognostic factors of radiologically node-positive gastric carcinoma

Lymph node metastasis determined by histologic examination is an important prognostic indicator in gastric carcinoma. However, prognostic value of lymph node metastasis detected by computed tomography (CT) is unknown. The aim of this study was to evaluate clinical results and prognostic factors of patients with radiologically node-positive gastric carcinoma. The study included 78 patients with primary gastric carcinoma and lymph node metastasis confirmed by CT. The level of lymph node metastasis was simply graded as follows: level I included perigastric nodes; level II included intermediate nodes along the left gastric, common hepatic, and celiac arteries; and level III included distant nodes along the hepatoduodenal ligament, pancreas, spleen, and abdominal aorta. Sixty patients (79%) had stage IV tumors showing one or more of the following: level III lymph node metastasis in 37, pancreatic invasion in 27, peritoneal dissemination in 23, and liver metastasis in 19. Overall 1- and 5-year survival rates were 29% and 6%, respectively, and the 1-year survival rate was significantly influenced by the level of lymph node metastasis on CT (55% for level I, 27% for level II, 7% for level III, P < 0.01). In patients with gastrectomy, prognostic factors were tumor size (<10 cm versus >10 cm, P < 0.01), gross type (localized versus infiltrative, P < 0.01), histologic type (well differentiated versus poorly differentiated, P < 0.01), and curability of the disease (curative versus noncurative, P < 0.01). Our study indicates that prognosis of patients with radiologically node-positive gastric carcinoma is poor because of high frequency of extensive tumor spreads. Patients having only positive level I nodes on CT are candidates for curative gastrectomy, which may offer long-term survival.