Prognostic factors in gastric carcinoma. Results of the German gastric carcinoma study 1992

Abstract

Background. The impact of patient‐ and tumor‐dependent factors and the postoperative course on the prognosis of patients who underwent resection for gastric carcinoma between 1986 and 1989 were analyzed in a prospective multicenter observation study. Methods. Resection techniques, the extent of lymph node dissection, and the histopathologic assessment of the specimen were standardized at all participating centers. A total of 1654 patients were enrolled. Follow‐up is complete for 99.2% of the patients, with a median follow‐up time of 48 months. Prognostic factors were assessed by multivariate analysis. Results. In the total patient population there was an independent prognostic effect of nodal status, a International Union Against Cancer (UICC)‐R0 resection, distant metastases, the pT category, three or more risk factors on preoperative risk analysis, and the presence of postoperative complications. Multivariate analysis in the subgroup of patients who had a UICC‐R0 resection confirmed the nodal status as the major independent prognostic factor. Conclusion. These data suggest that the prognosis of patients who undergo gastrectomy for gastric carcinoma may be improved by a complete resection of the primary tumor and its lymphatic drainage, resulting in a UICC‐R0 resection. In addition, a detailed preoperative risk analysis and identification of high‐risk patients and meticulous attention to the technical details of the surgical procedure to reduce the frequency of postoperative complications may improve the prognosis.

Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy

“…The chance of achieving a complete resection of the tumor through surgery alone in these cases is less than 50%. 2 During the last 15 years, attempts have been made to use preoperative chemotherapy with the twin goals of 1) downstaging the primary tumor to increase the possibility of a successful complete resection and 2) destroying occult lymph node and distant metastases to decrease the rate of tumor recurrence. In Phase II studies of neoadjuvant chemotherapy, patients with clinical responses have had a significantly better prognosis than nonresponding patients, particularly when a complete (UICC R0) resection was performed.…”

Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

“…Furthermore, most oesophagogastric cancer surgery in Britain and much of the West, has by tradition, been performed by general surgeons. Radical lymphadenectomy is a painstaking, technically demanding procedure, which has usually remained within the province of small numbers of specialist upper gastrointestinal surgeons (Roder et al, 1993). Thus, the D1 perigastric lymphadenectomy remains the most commonly performed operation for gastric cancer in the West.…”

A multimodal treatment approach including high-dose chemotherapy in very advanced gastric cancer: evidence for control of metastatic disease

“…6,8,10,[17][18][19][20] Despite these promising results, the OS could not be improved in comparison to results from studies administering conventional CT in metastatic gastric cancer. [2][3][4] The reasons for this could be as follows: (1) the present study selected far advanced disease as reflected by a rate of 65% patients with ECOG status 2 and 3.…”