Long-term survival results and prognostic factors of early gastric cancer

Abstract

Abstract. In spite of the favorable prognosis of early gastric cancer (EGC), recurrence or second primary cancers present in certain patients after curative surgery. It is crucial to identify who are at high risk and when. In the present study, 323 patients with EGC who underwent curative surgery were studied. A total of 22 patients (6.8%) died of recurrence, 9 patients (2.8%) died of a second primary cancer and 65 patients (20.1%) died of comorbid diseases during the 0.3-33 years of follow-up. Among the 22 patients with recurrence, hematogenous metastases were noted in over half of the cases (77.3%, 17/22); of these cases 15 patients had a recurrence within the first decade after surgery. Histological differentiation and nodal status were correlated with recurrence. Among the second primary cancers, remnant gastric, liver, lung and colon were the most common sites, and the second primary cancers primarily occurred in the second decade after surgery (6/9). Multivariate analysis identified nodal status (HR=4.20), vessel involvement (HR=3.40) and histological differentiation (HR=3.52) as independent prognostic factors for disease-free survival. However, gender, age and differentiation were independent influencing factors for overall survival. Comorbid diseases, recurrence and second primary cancers are the main cause of death in EGC patients after curative resection. Thus, treatment of comorbid diseases and a periodic follow-up schedule may contribute to improved prognosis. IntroductionEarly gastric cancer (EGC) is defined as gastric carcinoma confined to the mucosa and/or submucosa irrespective of lymph node involvement and tumor size, according to the Japanese Classification of Gastric Carcinoma (JCGC) (1). Compared to advanced gastric cancer (AGC), EGC has a more favorable prognosis after curative resection; the 5-year survival rate is higher than 90% in Japan (2), Korea (3), and slightly lower in Italy, France and the US (4-6). In spite of the very favorable prognosis of EGC, recurrence or second primary cancers present in certain patients after curative surgery, with the recurrence or second primary cancer rate varying from 1.4 to 13.7% (5,7-11). It is crucial to understand the prognostic factors and features of recurrence in patients with EGC and to identify who are at high risk and when; a subsequent follow-up schedule or adjuvant therapy may be considered accordingly.The incidence of EGC is approximately 10% among in-patients with gastric carcinoma in China. However, due to the relatively low incidence of recurrence and favorable prognosis after curative resection for EGC, relevant studies have been limited. Furthermore, most previous reports have focused on short-term survival results and few have investigated survival over 10 years (4,5,7,(9)(10)(11). In the present study, we assessed the long-term survival profiles of patients with EGC at our single institute through 0.3-33 years of follow-up. Survival rate, characteristics of recurrence and causes of death were analyzed, and prognostic factors were als...

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