Significance of long-term follow-up of early gastric cancer.
BACKGROUND
Therapeutic outcomes for most patients with early gastric cancer are favorable. However, mortality among these patients remains a concern. Improvements in therapeutic outcomes are being sought by studying the timing and causes of death. Here, the results of surgery were evaluated to assess the appropriate treatment and follow-up schedule for early gastric cancer.


METHODS
A total of 1169 patients with early gastric cancer underwent curative gastrectomy between 1992 and 1999. Survival time, prognostic factors, cause of death, and time of death were evaluated retrospectively.


RESULTS
Multivariate analysis of disease-specific survival identified lymph node metastasis as an independent prognostic factor. The anatomical extent of lymph node metastasis and the number of metastatic lymph nodes influenced the rate of recurrence. Multivariate analysis of overall survival identified age as a prognostic factor. A total of 91 patients (7.8%) from the study group died: 56 from comorbid diseases, 21 from gastric cancer, and 14 from other second primary cancers. Death from gastric cancer was frequently observed within 5 years of surgical resection, whereas death from other diseases usually occurred after 5 years. Patients who died as a result of diseases other than gastric cancer tended to be older.


CONCLUSIONS
Appropriate lymph node dissection is necessary for patients with early gastric cancer, particularly those with risk factors associated with lymph node metastasis. Meticulous follow-up protocols that can detect second primary cancers, together with the development of treatments for comorbid diseases, are required to improve survival.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. s0714@med.yokohama-cu.a.cjp
Chikara
C
Kunisaki
Hirotoshi
H
Akiyama
Masato
M
Nomura
Goro
G
Matsuda
Yuichi
Y
Otsuka
Hidetaka
H
Ono
Yutaka
Y
Nagahori
Hideo
H
Hosoi
Masazumi
M
Takahashi
Fumihiko
F
Kito
Hiroshi
H
Shimada
D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis