Results of Surgical Treatment for Advanced Gastric Cancer Analysis of prognostic factors

Kwon, Sung Joon

Abstract

BACKGROUND: Gastric cancer is still the leading cause of cancer death in Korea. Until recently, more than two thirds of the gastric cancer is diagnosed at the advanced stage and to know the optimal treatment and the independent prognostic factors are important.
METHODS
A retrospective study of 378 patients with gastric cancer who underwent a surgical treatment in advanced stages (T3 and T4) at Hanyang University Hospital from 1992 to 1997 was performed to evaluate the clinicopathological characteristics and the prognostic factors. These patients were operated on by one surgeon.
RESULTS
There were 245 males and 133 females (ratio = 1.8:1) with a median age of 57 years (range = 26-87 years). Gastric resection with curative intent was performed in 258 patients (68.3%), but 120 patients had palliative surgery (palliative gastric resection, bypass, or laparotomy only). A D2 or a more extended lymph-node dissection was performed in 87.8% of the cases. In the univariate analysis using 13 kinds of factors (age, sex, tumor site, size, histologic type, gross type, lymphatic invasion, venous invasion, TNM stage, type of surgery, curability, distance of resection margin from the edge of the tumor, splenectomy), poor survival was related to increasing age, tumor location in the upper one third, larger tumor size, Borrmann type-4 tumors, venous invasion of the tumor, advanced tumor stage, performance of a total gastrectomy, palliative surgery, and splenectomy. The multivariate analysis revealed that curability, type of resection, gross type, TNM stage, age, and venous invasion were significant prognostic factors. In conclusion, the prognosis for advanced gastric cancer (T3 and T4) is mostly influenced by curability, type of resection, gross type, and TNM stage.
CONCLUSIONS
Therefore, early diagnosis of gastric cancer and the development of more effective adjuvant treatment modalities, especially in T3 and T4 tumors, might be the most important factor to improve their survival.