Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2006

Open Access 01-12-2006 | Research

Time-related improvement of survival in resectable gastric cancer: the role of Japanese-style gastrectomy with D2 lymphadenectomy and adjuvant chemotherapy

Authors: Juan J Grau, Ramon Palmero, Maribel Marmol, Jose Domingo-Domenech, Mariano Monzo, Jose Fuster, Oscar Vidal, Constantino Fondevila, Juan C Garcia-Valdecasas

Published in: World Journal of Surgical Oncology | Issue 1/2006

Login to get access

Abstract

Background

We investigated the change of prognosis in resected gastric cancer (RGC) patients and the role of radical surgery and adjuvant chemotherapy.

Methods

We retrospectively analyze the outcome of 426 consecutive patients from 1975 to 2002, divided into 2 time-periods (TP) cohort: Before 1990 (TP1, n = 207) and 1990 or after (TP2; n= 219). Partial gastrectomy and D1-lymphadenetomy was predominant in TP1 and total gastrectomy with D2-lymphadenectomy it was in TP2. Adjuvant chemotherapy consisted of mitomycin C (MMC), 10–20 mg/m2 iv 4 courses or MMC plus Tegafur 500 mg/m2 for 6 months.

Results

Positive nodes were similar in TP2/TP1 patients with 56%/59% respectively. Total gastrectomy was done in 56%/45% of TP2/TP1 respectively. Two-drug adjuvant chemotherapy was administered in 65%/18% of TP2/TP1 respectively. Survival at 5 years was 66% for TP2 versus 42% for TP1 patients (p < 0.0001). Survival by stages II, IIIA y IIIB for TP2 versus TP1 patients was 70 vs. 51% (p = 0.0132); 57 vs. 22% (p = 0.0008) y 30 vs. 15% (p = 0.2315) respectively. Multivariate analysis showed that age, stage of disease and period of treatment were independent variables.

Conclusion

The global prognosis and that of some stages have improved in recent years with case RGC patients treated with surgery and adjuvant chemotherapy.
Appendix
Available only for authorised users
Literature
1.
go back to reference Parkin DM, Pisani P, Ferlay J: Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer. 1999, 80: 827-841. 10.1002/(SICI)1097-0215(19990315)80:6<827::AID-IJC6>3.0.CO;2-P.CrossRefPubMed Parkin DM, Pisani P, Ferlay J: Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer. 1999, 80: 827-841. 10.1002/(SICI)1097-0215(19990315)80:6<827::AID-IJC6>3.0.CO;2-P.CrossRefPubMed
2.
go back to reference Kelley JR, Duggan JM: Gastric cancer epidemiology and risk factors. J Clin Epidemiol. 2003, 56: 1-9. 10.1016/S0895-4356(02)00534-6.CrossRefPubMed Kelley JR, Duggan JM: Gastric cancer epidemiology and risk factors. J Clin Epidemiol. 2003, 56: 1-9. 10.1016/S0895-4356(02)00534-6.CrossRefPubMed
3.
go back to reference Coleman MP, Gatta G, Verdecchia A, Esteve J, Sant M, Storm H, Allemani C, Ciccolallo L, Santaquilani M, Berrino F, EUROCARE Working Group: EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century. Ann Oncol. 2003, 14 (Suppl 5): v128-v149. 10.1093/annonc/mdg756.CrossRefPubMed Coleman MP, Gatta G, Verdecchia A, Esteve J, Sant M, Storm H, Allemani C, Ciccolallo L, Santaquilani M, Berrino F, EUROCARE Working Group: EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century. Ann Oncol. 2003, 14 (Suppl 5): v128-v149. 10.1093/annonc/mdg756.CrossRefPubMed
4.
go back to reference Sant M, Aareleid T, Berrino F, Bielska Lasota M, Carli PM, Faivre J, Grosclaude P, Hedelin G, Matsuda T, Moller H, Moller T, Verdecchia A, Capocaccia R, Gatta G, Micheli A, Santaquilani M, Roazzi P, Lisi D, EUROCARE Working Group: EUROCARE-3: survival of cancer patients diagnosed 1990–1994: results and commentary. Ann Oncol. 2003, 14 (Suppl 5): v61-v118. 10.1093/annonc/mdg754.CrossRefPubMed Sant M, Aareleid T, Berrino F, Bielska Lasota M, Carli PM, Faivre J, Grosclaude P, Hedelin G, Matsuda T, Moller H, Moller T, Verdecchia A, Capocaccia R, Gatta G, Micheli A, Santaquilani M, Roazzi P, Lisi D, EUROCARE Working Group: EUROCARE-3: survival of cancer patients diagnosed 1990–1994: results and commentary. Ann Oncol. 2003, 14 (Suppl 5): v61-v118. 10.1093/annonc/mdg754.CrossRefPubMed
5.
go back to reference Hundahl SA, Phillips JL, Menck HR: The National Cancer Data Base report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy. Cancer. 2000, 88: 921-932. 10.1002/(SICI)1097-0142(20000215)88:4<921::AID-CNCR24>3.0.CO;2-S.CrossRefPubMed Hundahl SA, Phillips JL, Menck HR: The National Cancer Data Base report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy. Cancer. 2000, 88: 921-932. 10.1002/(SICI)1097-0142(20000215)88:4<921::AID-CNCR24>3.0.CO;2-S.CrossRefPubMed
6.
go back to reference Jemal A, Tiwari RC, Murria T, Ghafoor A, Samuels A, Ward E, Feuer EJ, Thun MJ, American Cancer Society: Cancer Statistics, 2004. CA Cancer J Clin. 2004, 54: 8-29.CrossRefPubMed Jemal A, Tiwari RC, Murria T, Ghafoor A, Samuels A, Ward E, Feuer EJ, Thun MJ, American Cancer Society: Cancer Statistics, 2004. CA Cancer J Clin. 2004, 54: 8-29.CrossRefPubMed
7.
go back to reference Dixon E, Vollmer CM, Sahajpal A, Cattral M, Grant D, Doig C, Hemming A, Taylor B, Langer B, Greig P, Gallinger S: An aggressive approach leads to improved survival in patients with gallbladder cancer. A 12-year study at a North American Centers. Ann Surg. 2005, 241: 385-394. 10.1097/01.sla.0000154118.07704.ef.PubMedCentralCrossRefPubMed Dixon E, Vollmer CM, Sahajpal A, Cattral M, Grant D, Doig C, Hemming A, Taylor B, Langer B, Greig P, Gallinger S: An aggressive approach leads to improved survival in patients with gallbladder cancer. A 12-year study at a North American Centers. Ann Surg. 2005, 241: 385-394. 10.1097/01.sla.0000154118.07704.ef.PubMedCentralCrossRefPubMed
8.
go back to reference Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P: Patient survival after D1 and D2 dissections for gastric cancer: long-term results of the MCR randomised surgical trial. Br J Cancer. 1999, 79: 1522-1530. 10.1038/sj.bjc.6690243.PubMedCentralCrossRefPubMed Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P: Patient survival after D1 and D2 dissections for gastric cancer: long-term results of the MCR randomised surgical trial. Br J Cancer. 1999, 79: 1522-1530. 10.1038/sj.bjc.6690243.PubMedCentralCrossRefPubMed
9.
go back to reference Bonenkamp JJ, Hermans J, Sasako M, Van de Velde CJH: Extended lymph node dissection for gastric cancer. N Engl J Med. 1999, 340: 908-914. 10.1056/NEJM199903253401202.CrossRefPubMed Bonenkamp JJ, Hermans J, Sasako M, Van de Velde CJH: Extended lymph node dissection for gastric cancer. N Engl J Med. 1999, 340: 908-914. 10.1056/NEJM199903253401202.CrossRefPubMed
10.
go back to reference McCulloch P: Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980–1985. Br J Surg. 1994, 81: 417-420.CrossRefPubMed McCulloch P: Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980–1985. Br J Surg. 1994, 81: 417-420.CrossRefPubMed
11.
go back to reference Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA: Chemotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001, 345: 725-730. 10.1056/NEJMoa010187.CrossRefPubMed Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA: Chemotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001, 345: 725-730. 10.1056/NEJMoa010187.CrossRefPubMed
12.
go back to reference Sakamoto J: Adjuvant chemotherapy for gastric cancer in Japan: global and Japanese perspectives. Cancer Chemother Pharmacol. 2004, 54 (Suppl 1): S25-31.PubMed Sakamoto J: Adjuvant chemotherapy for gastric cancer in Japan: global and Japanese perspectives. Cancer Chemother Pharmacol. 2004, 54 (Suppl 1): S25-31.PubMed
13.
go back to reference Grau JJ, Estape J, Fuster J, Filella X, Visa J, Teres J, Soler G, Albiol S, Garcia-Valdecasas JC, Grande L: Randomized trial of adjuvant chemotherapy with mitomycin C plus ftorafur versus mitomycin C alone in resected locally advanced gastric cancer. J Clin Oncol. 1998, 16: 1036-1039.PubMed Grau JJ, Estape J, Fuster J, Filella X, Visa J, Teres J, Soler G, Albiol S, Garcia-Valdecasas JC, Grande L: Randomized trial of adjuvant chemotherapy with mitomycin C plus ftorafur versus mitomycin C alone in resected locally advanced gastric cancer. J Clin Oncol. 1998, 16: 1036-1039.PubMed
14.
go back to reference Grau JJ, Domingo-Domenech J, Morente V, Pera M, Garcia-Valdecasas JC, Fuster J, Bombi A, Mellado B, Albanell J, Gascon P: Low thymidylate synthase expression in the primary tumor predicts favorable clinical outcome in resected gastric cancer patients treated with adjuvant Tegafur. Oncology. 2004, 66: 226-233. 10.1159/000077999.CrossRefPubMed Grau JJ, Domingo-Domenech J, Morente V, Pera M, Garcia-Valdecasas JC, Fuster J, Bombi A, Mellado B, Albanell J, Gascon P: Low thymidylate synthase expression in the primary tumor predicts favorable clinical outcome in resected gastric cancer patients treated with adjuvant Tegafur. Oncology. 2004, 66: 226-233. 10.1159/000077999.CrossRefPubMed
15.
go back to reference Kajitani T: Japanese Research Society for the Study of Gastric Cancer.: The general rules for gastric cancer study in surgery and pathology. Jpn J Surg. 1981, 11: 127-145. 10.1007/BF02468883.CrossRefPubMed Kajitani T: Japanese Research Society for the Study of Gastric Cancer.: The general rules for gastric cancer study in surgery and pathology. Jpn J Surg. 1981, 11: 127-145. 10.1007/BF02468883.CrossRefPubMed
16.
go back to reference American Joint Committee on Cancer: AJCC Cancer Staging Manual. Edited by: Fleming ID, Cooper JS, Henson DE, et al (Eds). 1997, Philadelphia. Lippincott-Raven, 5 American Joint Committee on Cancer: AJCC Cancer Staging Manual. Edited by: Fleming ID, Cooper JS, Henson DE, et al (Eds). 1997, Philadelphia. Lippincott-Raven, 5
17.
go back to reference Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG: Design and analysis of randomized clinical trials requiring prolonged observations on each patient. Br J Cancer. 1976, 34: 585-612.PubMedCentralCrossRefPubMed Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG: Design and analysis of randomized clinical trials requiring prolonged observations on each patient. Br J Cancer. 1976, 34: 585-612.PubMedCentralCrossRefPubMed
18.
go back to reference Kaplan EL, Meier P: Nonparametric estimations from incomplete observations. Am Stat Assoc. 1958, 53: 457-463. 10.2307/2281868.CrossRef Kaplan EL, Meier P: Nonparametric estimations from incomplete observations. Am Stat Assoc. 1958, 53: 457-463. 10.2307/2281868.CrossRef
19.
go back to reference Peto R, Pike MC: Conservatism of the approximation sigma (0-E)2-E in the logrank test for survival data or tumor incidence data. Biometrics. 1973, 29: 279-286. Peto R, Pike MC: Conservatism of the approximation sigma (0-E)2-E in the logrank test for survival data or tumor incidence data. Biometrics. 1973, 29: 279-286.
20.
go back to reference Sasako M, McCulloch P, Kinoshita T, Maruyama K: New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995, 82: 346-351.CrossRefPubMed Sasako M, McCulloch P, Kinoshita T, Maruyama K: New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995, 82: 346-351.CrossRefPubMed
21.
go back to reference Kikuchi S, Sakakibara Y, Sakuramoto S, Kobayashi N, Shimao H, Mieno H, Kato Y, Kadowaki K, Hiki Y, Kakita A: Recent results in the surgical treatment of gastric cancer accordngn to the Japanese and TNM classification. Anticancer Res. 2001, 21: 3589-3594.PubMed Kikuchi S, Sakakibara Y, Sakuramoto S, Kobayashi N, Shimao H, Mieno H, Kato Y, Kadowaki K, Hiki Y, Kakita A: Recent results in the surgical treatment of gastric cancer accordngn to the Japanese and TNM classification. Anticancer Res. 2001, 21: 3589-3594.PubMed
22.
go back to reference McCulloch P, Nita M, Kazi H, Gama-Rodrigues J: Extended versus limited nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2004, CD001964- McCulloch P, Nita M, Kazi H, Gama-Rodrigues J: Extended versus limited nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2004, CD001964-
23.
go back to reference Grau JJ, Martin M, Fuster J, Pera M, Garcia-Valdecasas JC, Bombi JA, Bordas JM, Alcobendas F, Grande L, Estape J: Impact of adjuvant chemotherapy in the long-term outcome of patients with resected gastric cancer. J Surg Oncol. 2003, 82: 234-240. 10.1002/jso.10217.CrossRefPubMed Grau JJ, Martin M, Fuster J, Pera M, Garcia-Valdecasas JC, Bombi JA, Bordas JM, Alcobendas F, Grande L, Estape J: Impact of adjuvant chemotherapy in the long-term outcome of patients with resected gastric cancer. J Surg Oncol. 2003, 82: 234-240. 10.1002/jso.10217.CrossRefPubMed
24.
go back to reference Douglass HO: Gastric cancer: Overview of current therapies. Sem Oncol. 1985, 12 (Suppl 4): 57-62. Douglass HO: Gastric cancer: Overview of current therapies. Sem Oncol. 1985, 12 (Suppl 4): 57-62.
25.
go back to reference Marrelli D, De Stefano A, de Manzoni G, Morgagni P, Di Leo A, Roviello F: Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from prospective multicenter study. Ann Surg. 2005, 241: 247-255. 10.1097/01.sla.0000152019.14741.97.PubMedCentralCrossRefPubMed Marrelli D, De Stefano A, de Manzoni G, Morgagni P, Di Leo A, Roviello F: Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from prospective multicenter study. Ann Surg. 2005, 241: 247-255. 10.1097/01.sla.0000152019.14741.97.PubMedCentralCrossRefPubMed
26.
go back to reference Cunningham D, Allum VH, Stenning SP, Weeden S: Perioperative chemotherapy in operable gastric and lower oesophageal cancer: Final results of a randomised, controlled trial (the MAGIG trial, ISRCTN 93793971. Proc ASCO. 2005, Abstr 4001 Cunningham D, Allum VH, Stenning SP, Weeden S: Perioperative chemotherapy in operable gastric and lower oesophageal cancer: Final results of a randomised, controlled trial (the MAGIG trial, ISRCTN 93793971. Proc ASCO. 2005, Abstr 4001
Metadata
Title
Time-related improvement of survival in resectable gastric cancer: the role of Japanese-style gastrectomy with D2 lymphadenectomy and adjuvant chemotherapy
Authors
Juan J Grau
Ramon Palmero
Maribel Marmol
Jose Domingo-Domenech
Mariano Monzo
Jose Fuster
Oscar Vidal
Constantino Fondevila
Juan C Garcia-Valdecasas
Publication date
01-12-2006
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2006
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-4-53

Other articles of this Issue 1/2006

World Journal of Surgical Oncology 1/2006 Go to the issue