Prognostic relevance of demographics and surgical practice for patients with gastric cancer in two centers: in Poland versus Germany
Although studies comparing the surgical treatment of gastric carcinoma in Japan and Western industrialized countries have revealed differing survival rates, no studies to date have been performed comparing Western and Eastern Europe. This study aimed to compare demographics and surgical practice as well as the related prognostic impact on gastric cancer patients treated in Poland and Germany.
This retrospective study included gastric cancer patients treated between 1999 and 2004 by surgical departments in Gdansk (Poland) and Cologne (Germany). Univariate and multivariate analyses of demographic, histopathological, surgical, and prognostic data were performed.
Included were 117 patients from Gdansk and 130 patients from Cologne. The Cologne patients showed higher incidence rates of serious comorbidity, pT1 cancer, and distant metastasis than those from Gdansk. Indications for and frequency of selected surgical procedures differed significantly. D2-lymphadenectomy was performed in 89% of the Cologne patients, while D1-lymphadenectomy was done for 85% of the Gdansk patients. Univariate analysis yielded a 5-year survival rate of 28.3% for the Gdansk patients, and 40.3% for the Cologne patients (p = 0.056). Independent prognostic factors were pT category (p = 0.002), pN category (p < 0.001), pM category (p = 0.027), residual tumor (R) category (p = 0.004), age (p = 0.012), and number of resected lymph nodes (p = 0.005).
Significant differences of clinical and surgical parameters exist between gastric cancer patients treated in Poland and Germany. In addition to established independent prognostic factors, we found that survival improved with each additionally resected lymph node.
- Parkin D, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108. CrossRef
- Bollschweiler E, Holscher A. Carcinoma of the esophagus—actual epidemiology in Germany. Onkologie. 2001;24:180–4. CrossRef
- Lissowska J, Gail M, Pee D, Groves FD, Sobin LH, Nasierowska-Guttmejer A, et al. Diet and stomach cancer risk in Warsaw, Poland. Nutr Cancer. 2004;48:149–59. CrossRef
- Kovoor P, Hwang J. Treatment of resectable gastric cancer: current standards of care. Expert Rev Anticancer Ther. 2009;9:135–42. CrossRef
- Bollschweiler E, Boettcher K, Hoelscher A, Sasako M, Kinoshita T, Maruyama K, et al. Is the prognosis for Japanese and German patients with gastric cancer really different? Cancer. 1993;71:2918–25. CrossRef
- Bonenkamp J, van de Velde CJH, Kampschoer G, Hermans J, Hermanek P, Bemelmans M, et al. Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients. World J Surg. 1993;17:410–14 (discussion 415).
- Menke H, Klein A, John K, Junginger T. Predictive value of ASA classification for the assessment of the perioperative risk. Int Surg. 1993;78:266–70.
- Davenport D, Bowe E, Henderson W, Khuri SF, Mentzer RM. National Surgical Quality Improvement Program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status Classification (ASA PS) levels. Ann Surg. 2006;243:636–41 (discussion 641–44).
- Moenig S, Baldus S, Bollschweiler E, Hölscher A. Surgery of gastric cancer—quality assurance. Viszeralchirurgie. 2005;42:42–8.
- Grundmann R, Hölscher A, Bembenek A, Bollschweiler E, Drognitz O, Feuerbach S, et al. Diagnosis of and therapy for gastric cancer—work-flow. Zentralbl Chir. 2009;134:362–76. CrossRef
- Siewert J, Hölscher A, Becker K, Gossner W. Kardiakarzinom. Versuch einer therapeutisch relevanten Klassifikation. Chirurg. 1987;58:25–9.
- Sobin L, Wittekind C. UICC (2002) TNM classification of malignant tumors. 6th ed. New York: Wiley; 2002.
- Japanese Research Society of Gastric Cancer (JRSGC). Japanese classification of gastric carcinoma. 2nd English Edn. Gastric Cancer. 1998;1:10–24.
- Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–9. CrossRef
- Bollschweiler E. Benefits and limitations of Kaplan–Meier calculations of survival chance in cancer surgery. Langenbecks Arch Surg. 2003;388:239–44. CrossRef
- Bollschweiler E, Breckheimer S, Monig S, Holscher AH. The prognostic relevance of age and comorbidity in patients with resected gastric cancer. Zentralbl Chir. 2009;134:71–6. CrossRef
- Bollschweiler E, Lubke T, Monig S, Holscher A. Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy. BMC Surg. 2005;5:8. CrossRef
- Popiela T, Kulig J, Kolodziejczyk P, Sierzega M. Changing patterns of gastric carcinoma over the past two decades in a single institution: clinicopathological findings in 1557 patients. Scand J Gastroenterol. 2002;37:561–7. CrossRef
- Popiela T, Kulig J, Kolodziejcyk P. Twenty-year experience with multimodal treatment of gastric cancer patients in Poland. Zentrbl Chir. 2001;126:763–71. CrossRef
- Siewert J, Bottcher K, Stein H, Roder J. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg. 1998;228:449–61. CrossRef
- Noguchi Y, Yoshikawa T, Tsuburaya A, Motohashi H, Karpeh MS, Brennan MF. Is gastric carcinoma different between Japan and the United States? Cancer. 2000;89:2237–46. CrossRef
- Cheong O, Kim B, Yook J, Park YK, Ryu SY. Modified radical lymphadenectomy without splenectomy in patients with proximal gastric cancer: comparison with standard D2 lymphadenectomy for distal gastric cancer. J Surg Oncol. 2008;98:500–4. CrossRef
- Peyre C, Hagen J, De Meester S, Altorki NK, Ancona E, Griffin SM, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56. CrossRef
- Shukla P, Pavoor R, Barreto G. Gastric cancer in Europe (Br J Surg 2008; 95: 406–408). Br J Surg. 2008;95:1189 (author reply 1189).
- Holscher A, Bollschweiler E, Metzger R, Monig S. D2 lymphadenectomy superior to D1 lymphadenectomy in gastric cancer surgery. Zentralbl Chir. 2003;128:786–7. CrossRef
- Bonenkamp J, Hermans J, Sasako M, van de Velde CJH. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14. CrossRef
- Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9. CrossRef
- Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30. CrossRef
- Hartgrink H, van de Velde CJ, Putter H, Bonenkamp JJ, Kranenbarg EK, Songum I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77. CrossRef
- McCulloch P, Nita M, Kazi H, Gama-Rodrigues J. Extended versus limited lymph node dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2004;(4).
- Oh S, Hyung W, Li C, Song J, Kang W, Rha SY, et al. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol. 2009;99:275–80. CrossRef
- Monig S, Collet P, Baldus S, Schamcpfeffer K, Schroder W, Thiele J, et al. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol. 2001;76:89–92. CrossRef
- Krijnen P, den Dulk M, Meershoek-Klein KE, Jansen-Landheer ML, van de Velde CJH. Improved survival after resectable non-cardia gastric cancer in The Netherlands: the importance of surgical training and quality control. Eur J Surg Oncol. 2009;35:715–20.
- Prognostic relevance of demographics and surgical practice for patients with gastric cancer in two centers: in Poland versus Germany
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Volume 14, Issue 3 , pp 234-241
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- Author Affiliations
- 1. Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, Poland
- 2. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany