Prognostic factors for gastric cancer influencing clinical practice

Abstract

Despite a slow decline in the incidence of gastric cancer over the last 90 years, we can still expect to see over 100,000 patients die of this disease each decade in England and Wales. The 5-year survival rate has not improved during this century, which is largely due to the stage at diagnosis being unchanged. There are a number of prognostic determinants in gastric cancer which have clinical relevance. Age is an important determinant; patients under 40 years commonly have more advanced diffuse lesions than older patients so that a higher index of suspicion needs to be maintained in younger patients with persistent symptoms. Conflicting reports make it unclear whether the duration of symptoms bears any relationship to tumor stage, but there is some evidence that actively shortening the symptom duration by early investigation can have a beneficial effect in the proportion of patients diagnosed with early cancers. The site of the tumor is important; unfortunately, the proportion of patients with cardia lesions is increasing and this has had the effect of reducing the overall survival. Tumor size should not play a part in the decision to resect a lesion as most studies show no clear relationship between tumor size and stage. Tumor stage is the most important prognostic determinant and efforts to increase the proportion of stage I cancers presenting for surgery can be shown to alter the natural history of the disease, by diagnosing it when it is still surgically curable.

Prognostic Score in Gastric Cancer: The Importance of a Conjoint Analysis of Clinical, Pathologic, and Therapeutic Factors

“…32,33 Lymphatic involvement is one of the most important prognostic factors in gastric cancer. 12,34 The prognostic value of LR in the evaluation of lymph node status found in this study confirms the results from previous studies. 1,35,36 The extent of lymph node dissection to optimize the benefit to the patient is still controversial.…”

“…Nevertheless, for gastric cancer, as well as for other cancers, the prognostic value of these factors has been consistently recognized. 1,4,12,34,42,43 Neglecting them may lead to important problems in the interpretation of scientific results, including the difficulty of inferring therapeutic results for each patient individually, in addition to a morphological staging group, and the impossibility of ascribing different survival rates to the treatment, because clinical factors are not taken into account. 44 Several alternative models designed to improve the accuracy of prognostic estimates of gastric cancer patients are published in the medical literature.…”

“…10,11 Therefore, tumor staging, according to the tumornode-metastasis classification, is considered the most important prognostic factor in gastric cancer. 12,13 Nevertheless, the consistent discrepancy between the survival rate in Japan and Western countries cannot be solely explained by the earlier disease stage at diagnosis, because this difference persists even in the comparison of groups stratified by stage. 5,[14][15][16] One possible explanation is the better pathologic staging due to routinely performed extended lymphadenectomies, the so-called staging migration phenomenon.…”

Role of symptoms in diagnosis and outcome of gastric cancer

“…Indeed, the duration of symptoms has been considered as a relevant prognostic factor in several studies. At least 14 studies have evaluated this prognostic aspect but all showed that duration of symptoms was not related to poor outcome [19,32,[43][44][45][46][60][61][62][63][64][65][66][67] . It would have seemed obvious that the sooner a patient is treated for cancer, the better the prognosis will be.…”

Ecoendoscopia na avaliação pré-operatória do estádio em doentes com câncer gástrico: correlação com os achados cirúrgicos e/ou histopatológicos

“…A profundidade do tumor nas paredes do estômago é um dos principais fatores prognósticos no paciente com carcinoma gástrico (4,21,30) , daí a importância em defini-la no pré-operatório. A TC e a US podem visualizar o espessamento da parede gástrica e a infiltração de órgãos adjacentes, porém são pouco precisos para determinar a profundidade do tumor na parede do estômago.…”