Clinicopathological Analysis of Stage IV Gastric Cancer

Lee, Kyung Keun; Kwon, Sung Joon

Abstract

BACKGROUND: Gastric cancer continues to present a therapeutic challenge because it is one of the most common carcinomas in the world. This study attempted to identify the prognostic effect of gastric resection and to clarify the meaning of distant metastasis in stage IV gastric cancer patients. METHOD: It was a retrospective study using 174 stage IV gastric cancer patient (96 who was operated on and 78 who was not) who were diagnosed during the four years from 1992 to 1996. Several clinicopathologic factors were analyzed to find their prognostic significance for these patient. RESULT: The mean survival duration (MSD) was significantly different according to whether or not an operation was performed, being 18.8 0.6 months for the group that was operated on and 5.4 0.6 months for the group that was not operated on (p=0.0000). With respect to the stage IV patients who was operated on, the MSD was significantly different depending on the Borrman's classification (types 2/3/4 with 11.3 +/- 2.7, 23.0 +/- 2.7, and 8.3 +/- 1.8 months, respectively, p=0.008) as was the presence of distant metastasis (MO/M1 with 24.4 +/- 3.0, 11.5 +/- 1.4 months respectively, p=0.0006). When between curatively and non-curatively resected patients were compared, the MSD was statistically different (18.0 +/- 2.8 and 10.0 +/- 1.5 months, respectively, p=0.0415). In a multivariate survival analysis using Cox's proportional hazard model, Borrman's type and the presence of distant metastasis were clarifed a powerful prognostic factors with ratios of risk of 2.7579 and 1.8825, respectively.
CONCLUSION
This study suggests a prognostic benefit for surgery in cases with resectability. Furthermore, we recommend subclassifing stage IV gastric cancer as stage IVa which has no distant metastasis and IVb which has distant metastasis, considering the significant survival difference between these two groups.