The Effect of Adjuvant Chemotherapy in Gastric Carcinoma Is Dependent on Tumor Histology: 5- Year Results of a Prospective Randomized Trial

Abstract

Gastric carcinoma is decreasing in incidence in Western Europe and the United States. However, this disease is still a major cause of cancer death [1]. Extended surgical procedures over the past 20 years have not profoundly altered the poor outcome of patients with gastric carcinoma [2]. This fact indicates that surgery alone may not be enough to control the disease. In 1978 we began a prospective randomized, one-center trial to determine, whether postoperative treatment with mitomycin C (MMC), 5-fluorouracil (5-FU), and cytosine-arabinoside (Ara-C) given for three courses could substantially improve the overall survival of patients treated by curative resection for gastric carcinoma. The regimen employed had been shown to be the most effective chemotherapy combination at the time the study started [3]. At a median follow-up of 5 years we found no significant effect of adjuvant chemotherapy on overall survival compared with an untreated control group. However, in a retrospective subgroup analysis we observed a significant improvement in the overall survival of patients with the intestinal tumor type, but no effect in patients with mucocellular carcinoma. We therefore believe that there is a selective effect of adjuvant chemotherapy in patients with gastric carcinoma with intestinal type of tumors.