Advertisement

Digestive Diseases and Sciences

, Volume 37, Issue 5, pp 757–763 | Cite as

Prognosis of gastric carcinoma after curative surgery

A population-based study using multivariate crude and relative survival analysis
  • Patrick Arveux
  • Jean Faivre
  • Marie-Christine Boutron
  • Françoise Piard
  • Laurence Dusserre-Guion
  • Elisabeth Monnet
  • Patrick Hillon
Original Articles

Abstract

A population-based series of 246 gastric cancer patients operated for cure and who survived the postoperative phase was reviewed to determine prognostic factors after potentially curative treatment. The overall five-year observed survival rate was 34.8%, and the relative survival rate was 43.9%. Previous history of gastric ulceration, tumor location, tumor size, gross appearance, extension within the gastric wall, and number of proximal lymph nodes involved were significantly related to both crude and relative survival rates. Age was a significant prognostic factor when considering crude survival rates, but it had no influence on relative survival rates. Multivariate analysis of crude and relative survival gave similar results except for age. The covariates retained in the final model were, by decreasing importance, extension within the gastric wall, lymph node involvement, gross appearance and tumor location. Combining the two major prognostic criteria, tumor extension through the gastric wall and lymph node involvement, four prognostic categories could be determined with five-year corrected survival rates ranging from 92% in patients with a carcinoma limited to the gastric wall to 17% in patients with more than two positive nodes whatever the extension in the gastric wall. Gross appearance had no influence on prognosis for carcinomas limited to the gastric wall, but had a significant impact on prognosis of more extended carcinomas. From these data, a simple staging system requiring only routinely available pathological data was proposed. This classification could be helpful for planning multicenter clinical trials on this disease where progress in therapy is needed.

Key Words

gastric carcinoma prognosis multivariate analysis relative survival 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Faivre J, Justrabo E, Hillon P, Milan C, Klepping C: Gastric carcinoma in Côte d'Or (France). A population based study. Gastroenterology 88:1874–1879, 1985Google Scholar
  2. 2.
    Borrman R: Geschwultse des magens und duodenums.In Handbuch des speziellen pathologischen anatomie und histologie. Vol IV. F Henke, O Lubarsh (eds). Berlin; Springer-Verlag 1926, pp 864–871Google Scholar
  3. 3.
    Oota K, Sobin LH: Histological typing of gastric and oesophageal tumors. Geneva, World Health Organization, 1977Google Scholar
  4. 4.
    Esteve J, Benhamou E, Crosdale M, Raymond L: The relative survival and the estimation of the net survival: Elements for further discussion. Stat Med 9:529–538, 1990Google Scholar
  5. 5.
    Hakulinen T, Abeywickrama K: Computer program package for relative survival rates. Comp Prog Biomed 19:197–207, 1985Google Scholar
  6. 6.
    Cox DR: Regression models and life-tables (with discussion). J R Stat Soc (B) 34:187–220, 1972Google Scholar
  7. 7.
    Hakulinen T, Tenkanen L: Regression analysis of relative survival rates. Appl Stat 36:309–317, 1987Google Scholar
  8. 8.
    Dixon WJ, Brown MB, Engelman L, Frane JW, Hill MA, Jennrich RI, Toporek JD: BMDP Statistical Software. Los Angeles, University of California Press, 1981Google Scholar
  9. 9.
    Cancer Registry of Norway: Survival of cancer patients. Cases diagnosed in Norway 1968–1975. Oslo, Salvesen, 1980Google Scholar
  10. 10.
    Hakulinen T, Pukkala E, Makama M, Lehtonen M, Saxen E, Teppo L: Survival of cancer patients in Finland in 1953–1974. Ann Clin Res 13(suppl 31):27–30, 1981Google Scholar
  11. 11.
    Vassilakos P, Raymond L, Obradovic M, Heimendiger J, Hickson A. Cancer à Genève. Incidence, survie, mortalité (1970–1983). Genève, Registre Genevois des Tumeurs, 1984Google Scholar
  12. 12.
    Allum WH, Powell DJ, McConkey CC, Fielding JWL: Gastric cancer: A 25-year review. Br J Surg 76:535–540, 1989Google Scholar
  13. 13.
    Maruyama K: The most important prognostic factors for gastric cancer patients. A study using univariate and multivariate analyses. Scand J Gastroenterol 22(suppl 133):63–68, 1987Google Scholar
  14. 14.
    Elias D, Lasser P, Bognel C, Nadal JM, Rahal K, Pineda R, Rougier P: Adénocarcinomes gastriques réséqués curativement. Analyse multifactorielle des facteurs pronostiques. Gastroenterol Clin Biol 12:729–735, 1988Google Scholar
  15. 15.
    Msika S, Chastang C, Houry S, Lacaine F, Huguier M: Lymph node involvement as the only prognostic factor in curative resected gastric carcinoma: A multivariate analysis. World J Surg 13:118–123, 1989Google Scholar
  16. 16.
    Bozzetti F, Bonfanti G, Morabito A, Bufalino R, Menotti V, Andreola S, Doci R, Gennari L: A multifactirial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surg Gynecol Obstet 162:229–234, 1986Google Scholar
  17. 17.
    Soreide O, Lillestol J, Viste A, Bjerkeset T: Factors influencing survival in patients with cancer of the stomach. A multivariate analysis. Acta Clin Scand 148:367–372, 1982Google Scholar
  18. 18.
    American Joint Committee for Cancer Staging and End Results Reporting: Manual for Staging for Cancer: Chicago, Whiting Press, 1978Google Scholar
  19. 19.
    Ribeiro MM, Seoscas M, Sobrinho-Simoes M: Prognosis in gastric carcinoma. The preeminence of staging and futility of histological classification. Dig Dis Pathol 1:51–68, 1988Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Patrick Arveux
    • 1
  • Jean Faivre
    • 1
  • Marie-Christine Boutron
    • 1
  • Françoise Piard
    • 1
  • Laurence Dusserre-Guion
    • 1
  • Elisabeth Monnet
    • 1
  • Patrick Hillon
    • 1
  1. 1.Registre des Tumeurs Digestives (Equipe associée INSERM-DGS)Dijon CedexFrance

Personalised recommendations