title: Strategies to improve treatment outcome in gastric cancer: a retrospective analysis of patients from two high-volume hospitals in Korea and China.
abstract: China has high incidence of gastric cancer (GC). However, the treatment outcomes of China were unsatisfactory compared to those of Korea. We performed this study to compare tumour characteristics, treatment parameters, and survival outcomes of GC patients between Korea and China based on the databases of two high-volume hospitals, with the aim of identifying indicators of GC prognosis. Data of patients undergoing gastrectomy for GC from 2006 to 2010 were analysed retrospectively. Subgroup survival analyses, stratified by clinicopathologic factors and multivariable analyses, were performed. The interactive roles of chemotherapy and D2 lymphadenectomy for overall survival were also investigated. Among 1365 Chinese and 4981 Korean patients, the proportion of early cancer detection in Chinese patients was much lower relative to that of Korean patients. There were no significant differences between countries in terms of surgical morbidity and mortality. The overall 5-year survival rates were 54.3% and 81.4%; when stratified by clinicopathologic factors, the survival were generally statistically higher in Korean patients. Gender, age, T stage, N stage, extent of lymphadenectomy, radicality of surgery, resection type, and chemotherapy were independently associated with survival in patients without metastasis. Survival rates for stage II and III GC differed significantly between the two countries, but this difference was eliminated among patients who underwent D2 lymphadenectomy or received chemotherapy. These treatments were given to patients with advanced-stage diagnoses (approximately 20% and 80% of patients, respectively). Treatment type was selected as independent prognostic factors in stage I-III and D2/D2+, with chemotherapy resulting in the best prognosis. Many differences in GC tumour characteristics exist between two countries. Early cancer detection and standardized treatment in Korea contribute to superior survival rates. Promotion of an early screening program, training and dissemination of standard D2 lymphadenectomy, and appropriate applications of chemotherapy would improve survival outcomes.
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|Department of Surgery, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.|Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Kun
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Wei-Han
authors.initials: WH
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xin-Zu
authors.initials: XZ
authors.lastname: Chen
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Mi Kyung
authors.initials: MK
authors.lastname: Song
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jinae
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Zhi-Xin
authors.initials: ZX
authors.lastname: Chen
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.|Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jia-Ping
authors.initials: JP
authors.lastname: Chen
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Cheong
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Zong-Guang
authors.initials: ZG
authors.lastname: Zhou
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.|Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.|Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jian-Kun
authors.initials: JK
authors.lastname: Hu
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D002681:China; D004358:Drug Therapy / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: D2 lymphadenectomy; chemotherapy; gastrectomy; gastric cancer; tumour characteristics