[Extended Pathohistological Criteria for Assessment of the Long-Term Prognosis of Gastric Cancer].
BACKGROUND
Gastric cancer is one of the most frequent tumour diseases worldwide. Despite numerous innovations in the diagnostic procedures and treatment the prognosis remains poor as the detection of the disease depends on tumour-associated symptoms which develop rather late in the majority of cases. The treatment outcomes may be improved by a more differentiated and individualised evaluation of the tumour biology. We present a detailed analysis of potentially relevant factors.


METHODS
From 1995 to 2011, data from 923 patients with gastric cancer have been collected in a prospective tumour database. We performed monovariate and multivariate analyses of factors. For the statistical analyses, SPSS software version 19.0 was used. The literature research was performed with Medline.


RESULTS
748 patients underwent surgical exploration. The resection rate was 87 % with a morbidity and mortality of 27 and 9 % (2004 to 2001: 13 and 5 %), respectively. 36 and 29 % of patients survived 5 years or 10 years, respectively. The 5-year and 10-year survival after curative resection was 58 and 46 %, respectively. TNM-associated criteria, tumour size, histological growth pattern, intestinal metaplasia, location of the tumour and classification according to Lauren were of significant influence in the monovariate analyses. In the multivariate analysis, tumour size, curative resection and lymph node involvement were independent prognostic factors. 90 % of the tumour recurrences developed within five years. The median recurrence-free interval was 16 months. Depending on the type of tumour, different survival times were identified. The 228 patients with node-negative curatively resected gastric cancer had a markedly better long-term prognosis. Diffuse type according to Lauren, tumour size, non-tubular histological growth pattern, female sex and proof of serosa infiltration from the primary tumour were prognostic factors in the monovariate analysis. In the multivariate analysis, tumour size was an independent significant prognostic factor (p = 0.05).


CONCLUSIONS
The data analyses showed that the evaluation of gastric cancer may be extended in a sensitive way by factors that have not been previously established. The benefit of an individualised structured treatment and follow-up on the basis of extended criteria should be investigated in future studies.
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland.
Y
Y
Dittmar
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland.
F
F
Rauchfuss
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland.
F
F
Dondorf
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland.
M
M
Ardelt
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland.
H
H
Scheuerlein
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland.
U
U
Settmacher
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016019:Survival Analysis