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Gastric Cancer

, Volume 16, Issue 1, pp 1–27 | Cite as

Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry

  • Atsushi Nashimoto
  • Kohei Akazawa
  • Yoh Isobe
  • Isao Miyashiro
  • Hitoshi Katai
  • Yasuhiro Kodera
  • Shunichi Tsujitani
  • Yasuyuki Seto
  • Hiroshi Furukawa
  • Ichiro Oda
  • Hiroyuki Ono
  • Satoshi Tanabe
  • Michio Kaminishi
Open Access
Special Article

Abstract

Background

The Japanese Gastric Cancer Association (JGCA) started a new nationwide gastric cancer registration in 2008.

Methods

From 208 participating hospitals, 53 items including surgical procedures, pathological diagnosis, and survival outcomes of 13,626 patients with primary gastric cancer treated in 2002 were collected retrospectively. Data were entered into the JGCA database according to the JGCA classification (13th edition) and UICC TNM classification (5th edition) using an electronic data collecting system. Finally, data of 13,002 patients who underwent laparotomy were analyzed.

Results

The 5-year follow-up rate was 83.3 %. The direct death rate was 0.48 %. UICC 5-year survival rates (5YEARSs)/JGCA 5YEARSs were 92.2 %/92.3 % for stage IA, 85.3 %/84.7 % for stage IB, 72.1 %/70.0 % for stage II, 52.8 %/46.8 % for stage IIIA, 31.0 %/28.8 % for stage IIIB, and 14.9 %/15.3 % for stage IV, respectively. The proportion of patients more than 80 years old was 7.8 %, and their 5YEARS was 51.6 %. Postoperative outcome of the patients with primary gastric carcinoma in Japan have apparently improved in advanced cases and among the aged population when compared with the archival data. Further efforts to improve the follow-up rate are needed.

Conclusions

Postoperative outcome of the patients with primary gastric carcinoma in Japan have apparently improved in advanced cases and among the aged population when compared with the archival data. Further efforts to improve the follow-up rate are needed.

Keywords

Gastric cancer Nationwide registry 5-year survival rate (5YEARS) Japan 

Introduction

The registration committee of the Japanese Gastric Cancer Association (JGCA) started a new registration program in 2008 after a 10-year blank period, and we reported the 5-year follow-up data of the patients treated in 2001 [1]. The registration has been continuing, and here we report the results of those treated in 2002.

Materials and methods

Leading hospitals in Japan voluntarily downloaded and fulfilled the database provided by the JGCA and sent the anonymized data to the JGCA data center. The collected data were analyzed according to the previously reported methods [1].

Results

Data of 14,394 patients were collected from 208 hospitals; 126 (60.6 %) hospitals participated in both years, but 82 hospitals were new, which was a 10 % increase as compared to the previous year (13,067 patients from 187 hospitals). The geographic distribution of the registered patients among the 47 prefectures is illustrated in Fig. 1. In Tokyo, 2,332 patients per year were registered, followed by 1,464 in Osaka. Four other prefectures registered more than 500 patients. On the other hand, the number of registered patients was fewer than 100 in 10 prefectures, and there were no registered patients in 2 prefectures.
Fig. 1

Geographic distribution of registered patients by prefecture

Patients with remnant stomach cancer, non-epithelial malignant tumor, and gastric cancer combined with malignant tumor of other organs were excluded. Patients who were treated by endoscopic mucosal resection were also excluded. Data of 768 patients lacked essential items. Consequently, data of the remaining 13,002 patients were used for the final analysis.

The results are shown in Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, and 28. Data given for each category of patients are: total number of patients, survival rates by year, standard error of 5YEARS, the number of direct death within 30 postoperative days, the number of patients lost to follow-up within 5 years, the number of 5-year survivors, and main cause of death, such as local and/or lymph node metastasis, peritoneal metastasis, liver metastasis, distant metastasis, recurrence at unknown site, other cancer, and other disease. Figures 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17 provide cumulative survival curves of patients stratified by essential categories.
Table 1

Primary cancer

Categories

No. of patients

Direct death

Lost f.u.

1 years (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Primary cancer

13626

89

2233

88.1

79.6

74.5

71.2

68.9

0.4

7436

454

1483

388

243

322

167

567

333

lost f.u. lost to follow-up, years(%) years of cumulative survival rate, SE standard error, rec recurrence, peritoneal peritoneal recurrence, R recurrence of unknown site

Table 2

Resected cases and unresected cases and other surgeries

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Resected cases

13002

63

2173

89.8

81.6

76.5

73.1

70.7

0.4

7286

410

1283

357

215

278

158

539

303

Unresected cases

355

21

25

25.7

7.3

2.9

1.9

1.5

0.7

4

37

183

24

24

32

2

12

12

Table 3

Sex (resected cases)

Categories

No. of

patients

Direct death

Lost f.u.

1 years (%)

2 years

(%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Male

8887

43

1464

89.7

81.4

76.1

72.5

70.0

0.5

4939

292

805

280

136

203

133

425

210

Female

4115

20

709

90.1

82.2

77.4

74.3

72.3

0.7

2347

118

478

77

79

75

25

114

93

Table 4

Age (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

<39

297

0

50

93.0

83.2

82.1

80.2

79.4

2.4

190

5

36

1

4

4

0

1

6

40–59

3622

10

581

93.4

86.7

83.2

80.3

78.8

0.7

2316

78

327

67

61

64

28

42

58

60–79

8075

40

1279

89.1

80.5

74.8

71.4

68.9

0.5

4450

282

798

255

142

180

110

387

192

>80

1008

13

263

81.6

71.6

63.9

57.0

51.4

1.8

330

45

122

34

8

30

20

109

47

Table 5

Tumor location (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

U

2681

18

434

87.3

77.5

71.1

67.1

64.3

1.0

1356

104

267

99

76

68

39

150

88

M

5182

8

881

93.6

88.4

84.4

81.7

79.7

0.6

3322

102

339

101

62

72

48

153

102

L

4249

28

766

90.3

81.8

76.8

73.2

70.8

0.7

2338

159

380

124

46

90

59

200

87

Whole

584

8

62

63.7

37.9

28.7

22.9

19.3

1.7

88

37

256

20

24

45

5

22

25

U upper third, M middle third, L lower third

Table 6

Macroscopic type (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Type0

6869

13

1294

98.1

96.1

94.0

92.1

90.2

0.4

4959

40

69

31

22

24

105

244

81

Type1

363

0

62

89.1

78.6

71.1

68.2

65.5

2.6

187

12

22

24

9

9

5

20

13

Type2

1717

21

291

87.0

75.8

68.1

63.0

60.4

1.2

798

86

147

118

49

61

20

105

42

Type3

2575

17

364

79.6

63.3

54.3

49.1

46.0

1.0

914

181

532

158

79

102

22

115

108

Type4

923

9

86

63.7

37.9

28.2

21.5

17.7

1.3

127

55

450

12

39

72

2

36

44

Type5

339

2

43

83.9

74.5

67.0

63.7

60.6

2.8

171

16

51

9

12

8

3

13

13

Table 7

Histological type (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 years (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Papillary adenocarcinoma (pap)

464

6

86

88.2

78.8

70.7

66.7

64.3

2.4

227

15

30

36

7

13

10

26

14

tub 1

2846

9

542

96.2

92.4

88.3

85.9

83.6

0.7

1877

32

71

47

14

29

51

146

37

tub 2

3458

18

585

91.0

82.8

77.0

73.3

70.8

0.8

1936

120

259

131

64

63

48

169

83

por 1

1746

10

301

85.0

75.1

70.1

66.3

64.4

1.2

867

81

192

72

41

63

13

69

47

por 2

2449

15

309

83.0

70.2

64.2

59.6

57.0

1.0

1148

120

530

43

63

80

16

81

59

Signet-ring cell carcinoma (sig)

1581

5

279

94.2

89.0

85.8

83.6

81.5

1.0

1030

18

127

4

17

18

16

30

42

Mucinous adenocarcinoma (muc)

259

0

34

83.7

68.6

61.9

59.3

55.2

3.2

116

14

53

4

5

6

2

11

14

Adenosquamous carcinoma

17

0

0

52.9

29.4

23.5

23.5

23.5

10.3

4

2

1

4

1

0

1

1

3

Squamous cell carcinoma

6

0

0

100.0

66.7

50.0

50.0

50.0

20.4

3

0

0

2

0

1

0

0

0

Miscellaneous carcinoma

75

0

18

77.9

69.0

64.2

62.4

58.8

6.1

29

4

6

11

1

1

0

2

3

tub 1 tubular adenocarcinoma, well-differentiated type; tub 2 tubular adenocarcinoma, moderately differentiated type; por 1 poorly differentiated adenocarcinoma, solid type, por 2, poorly differentiated adenocarcinoma, non-solid type

Table 8

Histological findings (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Differentiated type

6768

33

1213

93.0

86.6

81.3

78.1

75.7

0.5

4040

167

360

214

85

105

109

341

134

Undifferentiated type

6035

30

923

86.5

76.5

71.5

67.8

65.5

0.6

3161

233

902

123

126

167

47

191

162

Other type

98

0

18

74.9

61.5

55.7

54.4

51.8

5.3

36

6

7

17

2

2

1

3

6

Table 9

Lymphatic invasion(ly) (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

ly0

5744

10

1089

97.8

95.3

93.3

91.3

89.6

0.4

4108

22

108

21

21

23

80

202

70

ly1

3156

16

524

92.6

84.9

79.7

75.4

72.7

0.8

1833

67

278

88

42

58

38

148

80

ly2

2208

14

321

83.2

69.1

59.8

54.9

51.3

1.1

891

135

370

142

74

87

25

103

60

ly3

1769

23

217

67.1

46.1

36.4

31.2

28.6

1.1

387

183

516

105

77

103

12

78

91

Table 10

Venous invasion(v) (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 years (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

v0

8027

22

1456

95.8

91.6

88.3

85.8

83.4

0.4

5344

105

384

68

57

69

107

308

129

v1

2800

21

405

85.1

72.9

65.1

60.3

57.6

1.0

1284

146

446

110

81

84

32

121

91

v2

1347

11

183

75.5

57.8

48.3

42.9

40.8

1.4

425

100

291

97

44

75

13

68

51

v3

676

9

104

66.1

45.5

38.2

33.3

31.5

1.9

151

54

145

80

31

44

3

34

30

Table 11

Depth of invasion (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

pT1(M)

3293

9

689

98.8

97.8

96.4

94.9

93.5

0.5

2410

3

7

3

2

4

40

109

26

pT1(SM)

3110

6

550

98.0

95.8

93.5

91.7

89.7

0.6

2268

17

12

17

13

9

51

129

44

pT2(MP)

1341

4

252

95.8

91.5

87.2

84.8

82.1

1.1

869

25

31

27

16

13

17

62

29

pT2(SS)

2115

14

306

87.8

76.0

67.9

62.5

59.1

1.1

996

110

236

128

73

69

29

104

64

pT3(SE)

2567

26

301

72.5

51.0

40.3

33.6

30.3

1.0

614

192

839

153

94

138

14

109

113

pT4(SI)

458

4

52

57.7

34.6

26.3

21.9

20.6

2.0

68

47

154

28

17

42

4

21

25

Table 12

pT classification (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

pT1

6403

15

1239

98.4

96.9

95.0

93.3

91.7

0.4

4678

20

19

20

15

13

91

238

70

pT2

3456

18

558

90.9

82.0

75.3

71.1

67.9

0.8

1865

135

267

155

89

82

46

166

93

pT3

2567

26

301

72.5

51.0

40.3

33.6

30.3

1.0

614

192

839

153

94

138

14

109

113

pT4

458

4

52

57.7

34.6

26.3

21.9

20.6

2.0

68

47

154

28

17

42

4

21

25

Table 13

Lymph node metastasis (resected cases)

categories

No. of patients

Direct death

Lost f.u.

1 yearr (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

pN0

7603

20

1482

97.6

95.3

92.9

90.9

88.9

0.4

5350

29

132

52

21

34

107

303

93

pN1

2619

17

374

86.3

73.9

66.6

61.4

58.9

1.0

1240

115

402

124

59

81

28

124

72

pN2

2032

15

246

76.4

56.0

44.5

38.1

34.6

1.1

547

172

542

132

88

114

15

79

97

pN3

522

9

41

54.9

30.1

20.3

16.5

14.3

1.6

61

86

158

36

43

41

3

22

31

Table 14

Peritoneal cytology (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec

Distant meta.

R

Other cancer

Other disease

Unknown

CY0

5075

16

761

89.9

80.0

73.2

68.6

65.6

0.7

2675

229

576

200

117

112

60

199

146

CY1

761

16

71

52.2

26.1

18.3

15.0

12.3

1.3

72

45

386

28

36

52

2

33

36

Table 15

Peritoneal metastasis (P) (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year(%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

fP0

12004

47

2082

92.3

85.2

80.3

77.0

74.5

0.4

7087

349

862

308

184

218

154

503

257

fP1

762

15

62

48.9

23.3

13.9

9.9

8.3

1.1

49

48

402

44

28

56

4

31

38

Table 16

Liver metastasis (H) (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

fH0

12441

57

2114

91.0

83.1

78.0

74.6

72.2

0.4

7114

386

1197

229

200

247

156

517

281

fH1

326

6

34

39.8

22.3

15.5

12.7

11.4

1.9

23

10

63

122

12

28

0

17

17

Table 17

Distant metastasis including peritoneal and liver metastasis (M) (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec

Distant meta.

R

Other cancer

Other disease

Unknown

fM0

12530

56

2128

90.4

82.5

77.5

74.1

71.7

0.4

7104

376

1186

322

185

262

155

518

294

fM1

216

6

15

53.2

29.5

18.1

13.5

12.4

2.4

22

21

73

28

26

15

1

11

4

Table 18

Japanese stage (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

StageIA

5640

14

1113

98.5

97.1

95.4

93.8

92.2

0.4

4126

11

11

10

4

11

86

215

53

StageIB

1822

5

364

97.2

94.4

90.8

88.1

85.3

0.9

1216

14

41

25

15

12

27

79

29

StageII

1424

3

220

95.0

86.5

80.2

75.5

72.1

1.2

834

50

100

43

30

30

15

69

33

StageIIIA

1178

6

159

88.6

74.0

63.1

56.1

52.8

1.5

501

81

199

55

30

40

14

56

43

StageIIIB

678

4

85

82.1

58.0

43.8

34.9

31.0

1.9

161

61

205

38

31

31

5

32

29

StageIV

1902

30

180

55.6

31.0

21.7

17.4

14.9

0.9

218

180

708

180

101

149

8

80

98

Table 19

Japanese stage (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

StageI

7462

19

1477

98.2

96.4

94.3

92.4

90.5

0.4

5342

25

52

35

19

23

113

294

82

StageII

1424

3

220

95.0

86.5

80.2

75.5

72.1

1.2

834

50

100

43

30

30

15

69

33

StageIII

1856

10

244

86.2

68.2

56.1

48.4

44.9

1.2

662

142

404

93

61

71

19

88

72

StageIV

1902

30

180

55.6

31.0

21.7

17.4

14.9

0.9

218

180

708

180

101

149

8

80

98

Table 20

TNM stage (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Stage IA

5564

15

1111

98.2

97.1

95.5

93.9

92.3

0.4

4062

10

9

9

4

11

84

210

54

Stage IB

1950

5

385

97.0

93.8

89.9

87.5

84.7

0.9

1294

17

49

25

15

20

28

84

33

Stage II

1614

5

261

94.0

85.4

78.4

73.3

70.0

1.2

903

62

125

64

35

34

14

80

36

Stage IIIA

1048

9

133

86.1

68.4

58.2

50.6

46.8

1.6

399

75

204

44

33

37

15

55

53

Stage IIIB

477

1

58

79.6

55.6

41.9

32.2

28.8

2.2

107

45

166

19

18

28

4

17

15

Stage IV

1924

27

184

57.3

32.8

22.4

17.9

15.2

0.9

223

180

704

189

107

142

12

83

100

Table 21

TNM stage (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

StageI

7514

20

1496

98.1

96.2

94.1

92.2

90.3

0.4

5356

27

58

34

19

31

112

294

87

StageII

1614

5

261

94.0

85.4

78.4

73.3

70.0

1.2

903

62

125

64

35

34

14

80

36

StageIII

1525

10

191

84.1

64.4

53.2

44.9

41.2

1.3

506

120

370

63

51

65

19

72

68

StageIV

1924

27

184

57.3

32.8

22.4

17.9

15.2

0.9

223

180

704

189

107

142

12

83

100

Table 22

Surgical approach (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Laparotomy

12166

59

2021

89.6

81.2

76.0

72.4

69.9

0.4

6745

391

1238

346

204

273

147

514

287

Thoracolaparotomy

152

2

13

70.7

52.0

41.4

38.5

35.4

4.0

45

14

35

6

10

5

3

12

9

Laparoscopic

658

2

136

97.7

96.4

95.0

94.4

93.3

1.0

481

4

6

4

0

0

8

13

6

Others

6

0

2

80.0

60.0

60.0

60.0

60.0

21.9

2

1

0

0

0

0

0

0

1

Table 23

Surgical procedures (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Distal gastrectomy

7743

32

1405

93.1

86.9

82.6

79.9

77.7

0.5

4742

197

515

179

72

124

83

283

143

Total gastrectomy

3966

25

548

81.2

67.5

60.1

54.9

51.9

0.8

1635

207

752

164

138

145

45

194

138

Proximal gastrectomy

523

2

111

94.8

91.3

88.3

86.5

85.1

1.6

341

5

12

9

2

4

7

22

10

Pylorus-preserving gastrectomy

397

1

37

99.5

98.2

95.9

94.8

92.6

1.3

332

1

2

3

1

1

3

14

3

Segmental or local gastrectomy

351

3

67

95.0

91.2

86.2

82.9

81.2

2.2

224

0

2

2

2

4

17

24

9

Surgical mucosal resection

22

0

5

100.0

89.5

78.9

78.9

73.3

10.2

12

0

0

0

0

0

3

2

0

Table 24

Lymph node dissection (D) (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 ysr (%)

2 ysr (%)

3 ysr (%)

4 ysr (%)

5 ysr (%)

SE at 5 ysr

Alive

Local rec.

Peri-toneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Un-known

D0

802

12

125

80.5

73.7

69.1

67.0

65.6

1.7

420

17

95

34

10

17

18

49

17

D1

2553

15

457

86.4

79.1

74.6

71.2

68.8

1.0

1356

58

276

65

29

56

48

145

63

D1 + α

1684

7

349

92.0

86.1

83.2

80.9

78.6

1.1

1008

39

94

27

13

31

21

77

25

D1 + β

882

2

165

93.5

88.3

85.6

83.5

81.4

1.4

563

18

45

19

8

9

9

33

13

D2

6056

20

907

91.6

82.2

76.0

72.1

69.6

0.6

3424

240

654

183

126

124

53

201

144

D3

343

2

35

82.8

66.6

58.4

51.1

47.7

2.8

138

28

67

21

17

17

3

6

11

Table 25

Resection margins (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

PM− and DM−

12217

56

2089

91.0

83.1

78.1

74.7

72.3

0.4

6984

355

1102

332

192

240

155

500

268

PM+ and/or DM+

397

7

43

50.9

32.2

23.4

18.4

16.2

2.0

50

34

144

18

15

34

2

27

30

Table 26

Combined resection of neighboring organs (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

No combined resection

7955

33

1494

92.0

85.6

81.4

78.6

76.5

0.5

4729

193

588

161

80

132

98

326

154

Combined resection

4309

29

615

85.1

73.2

66.3

61.5

58.7

0.8

2032

191

651

183

123

135

55

192

132

PM proximal margin, DM distal margin

Table 27

Combined resected organs (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

Caudal pancreas

313

1

35

74.2

54.5

45.5

39.7

37.5

2.9

96

28

77

15

17

22

3

10

10

Spleen

1444

10

189

84.7

68.8

59.6

53.7

49.7

1.4

573

80

288

61

70

49

15

68

51

Transverse colon

101

1

19

71.6

52.3

43.0

38.0

36.7

5.2

25

5

27

4

2

9

0

7

3

Transverse mesocolon

53

1

7

82.9

61.4

53.2

40.3

38.1

7.0

15

3

15

2

1

4

0

5

1

Diaphragma

9

0

1

50.8

25.4

0.0

0.0

0.0

0.0

0

0

0

4

2

0

0

1

1

Liver

96

2

11

63.6

49.2

40.2

34.5

33.2

5.0

24

7

11

17

4

8

2

6

6

Gallbladder

2121

12

339

89.1

81.9

77.3

73.5

71.2

1.0

1215

59

213

73

22

40

28

80

52

Adrenal gland

10

0

0

90.0

80.0

80.0

80.0

80.0

12.6

8

1

0

0

0

0

0

0

1

Kidney

7

0

2

85.7

85.7

85.7

68.6

68.6

18.6

3

0

0

0

0

0

1

1

0

Small intestine

10

0

1

90.0

70.0

60.0

60.0

60.0

15.5

5

0

1

0

0

0

0

2

1

Abdominal wall

1

0

0

0.0

0.0

0.0

0.0

0.0

0.0

0

0

0

1

0

0

0

0

0

Ovary

22

0

3

67.4

52.1

41.7

41.7

41.7

11.0

7

0

11

0

1

0

0

0

0

Pancreas head (PD)

20

2

2

85.0

69.1

58.4

41.8

35.9

11.3

6

2

0

1

0

2

1

5

1

Others

66

0

4

86.4

75.6

67.9

67.9

67.9

5.8

41

1

5

3

2

1

4

2

3

PD pancreatoduodenectomy

Table 28

Curative potential (resected cases)

Categories

No. of patients

Direct death

Lost f.u.

1 year (%)

2 years (%)

3 years (%)

4 years (%)

5 years (%)

SE at 5 years

Alive

Local rec.

Peritoneal

Liver rec.

Distant meta.

R

Other cancer

Other disease

Unknown

A

8102

20

1585

97.8

95.4

92.9

90.6

88.6

0.4

5674

58

119

66

39

39

113

300

109

B

3078

14

398

88.3

72.5

62.1

56.1

52.5

0.9

1318

206

508

137

94

115

39

155

108

C

1505

28

149

49.0

24.7

16.4

12.1

9.9

0.8

109

126

624

150

78

120

3

71

75

Fig. 2

Kaplan–Meier survival for all patients with primary gastric cancer. 5YEARS 5-year survival rate

Fig. 3

Kaplan–Meier survival for resected cases and unresected cases

Fig. 4

Kaplan–Meier survival of resected cases stratified by sex

Fig. 5

Kaplan–Meier survival of resected cases stratified by age

Fig. 6

Kaplan–Meier survival of resected cases stratified by tumor location. W whole stomach

Fig. 7

Kaplan–Meier survival of resected cases stratified by macroscopic type

Fig. 8

Kaplan–Meier survival of resected cases stratified by histological findings

Fig. 9

Kaplan–Meier survival of resected cases stratified by lymphatic invasion

Fig. 10

Kaplan–Meier survival of resected cases stratified by depth of tumor invasion

Fig. 11

Kaplan–Meier survival of resected cases stratified by pT classification

Fig. 12

Kaplan–Meier survival of resected cases stratified by lymph node metastasis

Fig. 13

Kaplan–Meier survival of resected cases stratified by peritoneal cytology

Fig. 14

Kaplan–Meier survival of resected cases stratified by peritoneal metastasis

Fig. 15

Kaplan–Meier survival of resected cases stratified by Japanese Gastric Cancer Association (JGCA) stage

Fig. 16

Kaplan–Meier survival of resected cases stratified by TNM stage

The 5YEARS in 13,626 patients with primary gastric cancer was 68.9 % (Table 1; Fig. 2). During the 5-year follow-up, 2,233 patients were lost; the follow-up rate was 83.6 %. Of the 13,626 patients, 13,002 underwent gastric resection. Accordingly, the resection rate was 95.4 %, and the 5YEARS of the resected patients was 70.7 % (Table 2; Fig. 3). Sixty-three of 13,002 resected cases died within 30 days postoperatively. The direct death rate was 0.48 %. The frequent causes of death in patients who had undergone gastrectomy were peritoneal metastasis (n = 1,283), followed by other diseases (n = 539), local recurrence including node metastasis (n = 410), liver metastasis (n = 357), recurrence at unknown site (n = 278), and other cancer (n = 158).

The proportion of male patients was 68.4 % with 5YEARS of 70.0 %; for female patients 5YEARS was 72.3 %, which was better statistically (Table 3; Fig. 4). Patients more than 80 years old were 7.8 % of all patients, and their 5YEARS was 51.4 % (Table 4; Fig. 5). On the other hand, 5YEARS of the patients under 39 years old was 79.4 % (P < 0.001). Cancer was located in the upper-third of the stomach in 21.1 % of the cases, and its 5YEARS was relatively low at 64.3 % (Table 5; Fig. 6). Patients with type 4 cancer amounted to 7.2 %, and their 5YEARS was markedly low at 17.7 % (Table 6; Fig. 7). The 5YEARS of type 3 was 46.0 % and that of type 2 was 60.4 %. For histological type, frequency of the undifferentiated type including poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma was 46.8 % and its 5YEARS was 65.5 %, which was inferior to that of the differentiated type (75.7 %, P < 0.001; Tables 7, 8; Fig. 8). The grade of lymphatic invasion (ly0–ly3) and venous invasion (v0–v3) showed significant correlations with the prognosis (Tables 9, 10; Fig. 9).

A high incidence of early-stage cancer remained characteristic in 2002, as shown in Tables 11 and 12. The proportion of pathological M and SM (pT1) cancer was 49.7 %, and its primary cause of death was not cancer recurrence (17.9 %, n = 87) or other cancer (18.7 %), but other diseases (49.0 %, n = 238). The proportion of pathological MP and SS (pT2) was 26.8 %, SE (pT3) 19.9 %, and SI (pT4) 3.6 %. The 5YEARS of these subsets were 67.9 %, 30.3 %, and 20.6 %, respectively (Figs. 10, 11). The primary cause of death in advanced cancer was cancer recurrence, and the peritoneal recurrence rate was remarkably high in the pT3 and pT4 subsets. For the lymph node metastasis, the proportion of pN0 was 59.5 %, pN1 20.4 %, pN2 15.9 %, and pN3 4.1 %, and the 5YEARS of each subset was 88.9 %, 58.9 %, 34.6 %, and 14.3 %, respectively (Table 13; Fig. 12).

Peritoneal washing cytology was carried out in 5,836 patients with advanced gastric cancer; the positive rate was 13.0 %. The 5YEARS of cytology-positive (CY1) patients was 12.3 %, which was almost as dismal as the 5YEARS of the P1 patients (8.3 %; Tables 14, 15; Figs. 13, 14). The 5YEARS of patients with liver metastasis (H1) was 11.4 %, and of those with other types of distant metastasis was 12.4 % (Tables 16, 17).

The 5YEARS of the patients stratified by JGCA staging system was 92.2 % for stage IA, 85.3 % for stage IB, 72.1 % for stage II, 52.8 % for stage IIIA, 31.0 % for stage IIIB, and 14.9 % for stage IV. These JGCA 5YEARSs seemed to correlate well with TNM 5YEARSs, which were 92.3 % for stage IA, 84.7 % for stage IB, 70.0 % for stage II, 46.8 % for stage IIIA, 28.8 % for stage IIIB, and 15.2 % for stage IV (Table 18, 19, 20, 21; Figs. 15, 16).

For operative procedures, the proportion of patients who underwent laparoscopic gastrectomy was only 5.1 % in 2002, and their 5YEARS was 93.3 % (Table 22). Eligibility for laparoscopic surgery was strictly limited at that time, and the laparoscopic approach was selected almost exclusively in patients with the preoperative diagnosis of early gastric cancer. Only 1.2 % of the patients were treated by thoracolaparotomy, and their 5YEARS was 35.4 %. Thoracolaparotomy was usually carried out in patients with advanced gastric cancer with esophageal invasion more than 3 cm in length. Total gastrectomy was performed for 30.5 % of the patients, and their 5YEARS was 51.9 % (Table 23). D2 lymph node dissection, a standard procedure for resectable advanced gastric cancer according to the JGCA treatment guidelines, was performed in 49.2 % of the patients (Table 24) [2, 3]. The risk of direct death among those who underwent D2 gastrectomy was only 0.3 %. The proportion of patients treated with less invasive surgery such as proximal gastrectomy, pylorus-preserving gastrectomy, segmental gastrectomy, and local resection of the stomach was 9.8 %. D0, D1, D1 + α, and D1 + β dissection were carried out in 6.5 %, 20.7 %, 13.7 %, and 7.2 % of the patients, respectively. D0 and D1 dissection were carried out mainly in patients with noncurative factors or poor surgical risks. The incidence of positive resection margin (PM+ and/or DM+) was 3.1 % (Table 25). Combined resection of other organs was performed in 35.1 % (Table 26). The frequent combined resected organs in patients who underwent gastrectomy were gallbladder (n = 2121), spleen (n = 1444), caudal pancreas (n = 313), transverse colon (n = 101), liver (n = 96), and so on in descending order (Table 27).

The curative potential of gastric resection was an important prognostic factor. The proportion of patients with no residual tumors with high probability of cure (resection A) was 63.9 %, and their 5YEARS was 88.6 %. On the other hand, patients with definite residual tumors (resection C) amounted to 11.9 % of all patients who underwent laparotomy, and their 5YEARS was 9.9 % (Table 28; Fig. 17).
Fig. 17

Kaplan–Meier survival of resected cases stratified by curative potential of gastric resection

Discussion

Estimates of the worldwide incidence, mortality, and prevalence of 26 cancers in the year 2002 were available in the GLOBOCAN series of the International Agency for Research on Cancer [4]. With an estimated 934,000 new cases per year in 2002 (8.6 % of new cancer cases), the incidence of stomach cancer is in fourth place, after cancers of the lung, breast, and colon and rectum. It is the second most common cause of death from cancer (700,000 deaths annually).

The data presented in this report were collected from 208 hospitals in Japan. Cancer incidence rate (annual number of newly diagnosed cases per 100,000 population) in Japan in 2002 was approximately 520 for males and 370 for females. The incidences of various cancers in Japan are estimated from data collected by the cancer registry system in a dozen prefectures. According to these statistics, the number of cancer incidences in 2002 was approximately 589,000. The stomach was the leading site (21 %) for males and the second highest site (14 %) for females. The number of new patients who were diagnosed as gastric cancer in 2002 was estimated to be 106,760 [5]. Accordingly, 13,626 patients registered by this program corresponded to approximately 13 % of the whole population affected by gastric cancer in Japan. Even though these patients may not represent the average features of gastric cancer found in this country, this report is considered to have analyzed the largest number of patients for the past 10 years, clarifying the trends of gastric cancer in Japan. Just for reference, the proportion of patients registered in the nationwide registry of other organs of all patients diagnosed were 6 % in colon cancer, 24 % in esophageal cancer, 25 % in liver cancer, and 26 % in lung cancer, respectively [6].

The reliability of the results in this report depends on the quality of data accumulated in the JGCA database. Because of the complexity of the JGCA staging system, the error checking system on the data entry screen did not function completely. In several categories such as lymph node metastasis (N), the JGCA system could not be converted to the TNM system automatically. Therefore, the registration committee had to make great efforts to confirm raw data sent to the data center from the participating hospitals.

As compared with our archived data of 12,004 patients treated in 2001 [1], the proportion of early cancer declined from 51.2 % to 49.7 % [pT1 (M) cancer, 27.4 % to 25.6 %, and pT1 (SM) cancer, 23.8 % to 24.1 %], suggesting that an increasing number of patients with mucosal cancer were sent for endoscopic treatment. These data suggest that we should start to register gastric patients treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD) as soon as possible. The surgical mortality within 30 days significantly improved, from 0.6 % to 0.48 % (P < 0.001). Just for reference, it was 4.0 % in 1963 and 1.0 % in 1991 [7], Moreover, the nationwide database of gastrointestinal surgery in 2008 showed that was 0.2 % in gastrectomy and 0.4 % in total gastrectomy [8].

Accordingly with the rapidly aging society in Japan, the proportion of patients more than 80 years old continued increasing (Fig. 18): it was 0.7 % in 1963, 4.9 % in 1990, 7.0 % in 2001, and 7.8 % in 2002, respectively. Although the risk for surgery increases in elderly patients who have comorbidities, evaluations of risk can allow interventions that may decrease morbidity and mortality. Appropriate treatments should be offered to the elderly. However, these data have the intrinsic weakness of being retrospectively collected 7 years after surgery. Unfortunately, we in Japan continue to have a legal difficulty in registering personal information, which is essential for long-term and prospective follow-up. The overall follow-up rate in our program was 83.5 %. In other words, the outcome of 17.5 % of the patients is unknown. The proportion of patients who were lost to follow-up in the Japanese nationwide registry of colon cancer, liver cancer, and thyroid cancer was 19.6 %, 25.8 %, and 20.6 %, respectively [6]. Rules and regulations regarding handling of these data will have to change radically to overcome the issue of accuracy and reliability of the nationwide registry in Japan, and this could be out of the hands of the surgeons who have contributed to the best of their abilities to gather these data. On the other hand, the Japanese Association of Clinical Cancer Centers, consisting of 25 cancer center hospitals, reported that their follow-up rate was 98.5 %, and 5YEARS of 9,980 patients who underwent surgery from 1997 to 2000 were 90.4 % for TNM stage I, 67.8 % for stage II, 43.3 % for stage III, and 9.3 % for stage IV, respectively [9]. When the patients with gastric cancer had a medical examination in clinical cancer centers, they registered the place where their family records were registered, and office workers of the clinical cancer centers confirmed regularly their safety from the family registration; this was the reason for the extremely high follow-up rate. In the current analyses, 5YEARS in stage IV patients was 15.2 %. We might have overestimated our 5YEARS in stage IV patients, but we found that our follow-up rate increased as the stage advanced; the follow-up rate of stage IV patients was 90.4 %. These data suggest that the lower follow-up rate may not have had serious effects on 5YEARSs in our program. Although, the correlation between follow-up rate and survival rate is complicated, our follow-up system needs to be improved if we are to evaluate the survival rates more accurately.
Fig. 18

Chronological change of gastric cancer patients older than 80 years. The nationwide registry was suspended for a decade from 1992

Cytological examination was conducted in 3,481 (59.4 %) of 5,857 patients with T2, T3, or T4 cancer. The 5YEARS of CY1 patients was 12.3 % and their 5YEARS was as poor as that of patients with peritoneal metastasis. Although this examination was not carried out commonly in the days of 2002, it could still be regarded as a significant and independent prognostic factor from the data that were available. These findings further support the need for staging laparoscopy for accurate preoperative staging in patients with advanced gastric cancer.

JGCA restarted a nationwide registration from 2008. The object of the new nationwide registry was primarily to calculate the stage-specific 5YEARSs among patients who underwent gastrectomy. Therefore, the structure of the database was required to be simple, and the number of registration items was kept to a minimum. Undoubtedly, the next objective would be to collect and analyze data of patients with inoperable disease, remnant gastric cancer, gastrointestinal stromal tumor, malignant lymphoma of the stomach, and other entities that were excluded in the current project. We also began to register patients who were treated by EMR/ESD by adding additional items and updating data entry software from 2011.

We hope that this report will be useful when surveying trends and changes in the clinical practice and treatment results of gastric cancer in Japan. Details of the individual data presented in this report will soon become available for scientific and clinical research with the permission of the registration committee. In addition, most of the surgical and pathological data could easily be transferred to the international database in the near future for various analyses. The registration committee will continue the efforts to improve the registration system, ultimately to collect meaningful annual data.

Notes

Acknowledgments

The JGCA Registration Committee appreciates the great effort of participating hospitals in registering accurate and detailed data for this project. I wish to express my great gratitude to Ms. Yoshimi Sugamura, Niigata University Medical and Dental Hospital, for her valuable assistance.

Conflict of interest

The authors declare that there are no conflicts of interest related to the contents of this manuscript.

Open Access

This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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Copyright information

© The Author(s) 2012

Authors and Affiliations

  • Atsushi Nashimoto
    • 1
  • Kohei Akazawa
    • 2
  • Yoh Isobe
    • 3
  • Isao Miyashiro
    • 4
  • Hitoshi Katai
    • 5
  • Yasuhiro Kodera
    • 6
  • Shunichi Tsujitani
    • 7
  • Yasuyuki Seto
    • 8
  • Hiroshi Furukawa
    • 9
  • Ichiro Oda
    • 10
  • Hiroyuki Ono
    • 11
  • Satoshi Tanabe
    • 12
  • Michio Kaminishi
    • 13
  1. 1.Department of SurgeryNiigata Cancer Center HospitalNiigataJapan
  2. 2.Department of Medical InformaticsNiigata University Medical and Dental HospitalNiigataJapan
  3. 3.Department of SurgeryNational Hospital Organization Tokyo Medical CenterTokyoJapan
  4. 4.Department of SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  5. 5.Department of SurgeryNational Cancer Center HospitalTokyoJapan
  6. 6.Department of SurgeryNagoya University School of MedicineNagoyaJapan
  7. 7.Department of Surgery and Science, Graduate School of Medical ScienceKyushu UniversityFukuokaJapan
  8. 8.Department of Gastrointestinal Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan
  9. 9.Department of SurgerySakai City HospitalSakaiJapan
  10. 10.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  11. 11.Endoscopy DivisionShizuoka Cancer Center HospitalShizuokaJapan
  12. 12.Department of GastroenterologyKitasato University School of MedicineKanagawaJapan
  13. 13.Department of SurgeryShowa General HospitalTokyoJapan

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