The prognosis of patients with advanced gastric cancer who undergo curative resection is still unsatisfactory. The relationship between prognosis and various factors such as stage, lymph node metastasis, serosal invasion and regional lymph node reaction uollicular hyperplasia and sinus histiocytosis) was evaluated. Of the factors studied, the only one that correlated well with survival was sinus histiocytosis. Lymph node metastasis was related weakly to prognosis. No correlation between prognosis and stage, serosal invasion or follicular hyperplasia was observed. Sinus histiocytosis may represent the morphological tumour-host immune reaction. Lymph node metastases or histological types were not related to regional lymph node reaclion. These results suggest that sinus histiocytosis could be a useful prognostic factor for gastric cancer. Intensive postoperative follow-up for recurrence may be necessary even for patients with low-grade sinus histiocytosis in whom curative surgery is attempted.
The survival rate of patients with gastric cancer has improved owing to the early detection ofcancer and to progress in surgery, chemotherapy and immunotherapy . The 5-year survival rate for early gastric cancer'-3 is > 90 per cent. However, in patients with advanced gastric cancer who undergo curative resection the 5-year survival rateL6 varies from 28 to 61 per cent.
There are a number of prognostic factors for gastric cancer. Maruyama et 0 1 . ' reported that factors such as peritoneal, liver and distant lymph node metastases, and Borrmann type IV cancer (diffusely infiltrating carcinoma ) could reduce the success of surgical treatment. Kodama et a/.' reported that lymph node metastases and serosal invasion significantly affect the 5-year survival rate.
It is known that the tumour-bearing host mounts an immune response against its own neoplasm, chiefly by cell-mediated immunity'. Experimentally, regional lymph nodes are capable of interfering with the growth of tumour cells8. Regional lymph nodes may block the implantation and growth of distant metastases'. These results suggest that regional lymph nodes may play an important role in the development of cancer. Initially Black et a/.'' reported that sinus histiocytosis in regional lymph nodes in breast cancer correlated well with the survival rate. They also observed that follicular hyperplasia in the regional lymph nodes was associated with longer survival' I .
In a previous study it has been shown that postoperative survival of patients with oesophageal cancer correlated with sinus histiocytosis responses in regional lymph nodes".
The aim of this study was t o evaluate the relationship between prognosis and factors such as cancer stage, lymph node metastases, serosal invasion and regional lymph node reaction in patients with gastric cancer undergoing curative surgery.