Chronological Changes in the Clinical Features of Gastric Cancer

Lee, Chun Hwan; Lee, Sun Il; Ryu, Keun Won; Mok, Young Jae

Abstract

PURPOSE: Although gastric carcinomas occur throughout the world and the incidence is on the decrease, they remain the most common type of carcinoma in Korea. Significant advancements in the diagnostics and surgical treatment have been achieved during the last three decades. The present retrospective study was undertaken to investigate the chronological changes in the clinical features, including the clinicopathological findings, operative treatment, and the prognosis, of gastric carcinomas.
METHODS
A total of 1973 patients with a primary gastric adenocarcinoma who had been treated surgically during the period from 1983 to 1998 at the Department of Surgery, Korea University College of Medicine, were divided into two groups in order to evaluate the chronological changes: 1,007 patients had been treated during the period from 1983 to 1992 (early period) and 966 patients during the period from 1993 to 1998 (late period). The chronological changes in age, sex, ratio of early gastric cancer (EGC), and resectability were analyzed in all 1973 cases. For the 1755 resected cases, we also studied the chronological changes in the clinicopathological and treatment factors between the early- period (n=894) and the late-period (n=867) groups.
RESULTS
There were significant differences between the two periods with regard to age and ratio of EGC: EGC was more frequent in the late period. Univariate analysis of the resected cases showed that the gross type, tumor size, depth of invasion, UICC stage, and histological type were statistically significant. The analysis of the treatment factors revealed that total gastrectomies and extended lymphadenectomies were more frequent during the late period. The number of lymph nodes dissected was 26.0 12.7 in the early period and 33.4 14.1 in the late period (P<0.01). The 5-year survival rate in all cases was 51.4% in the early period and 55.9% in the late period. The stage-related survival rates (UICC 4th Ed., 1987) in the early vs. the late periods were 92.9% vs. 95.5% in stage IA, 82.1% vs. 91.1% in stage IB, 76.5% vs. 73.1% in stage II, 46.5% vs. 52.1% in stage IIIA, 14.5% vs. 33.6% in stage IIIB, and 2.8% vs. 8.8% in stage IV. There was a statistically significant difference in survival between stage IIIB and IV.
CONCLUSION
These results suggest that the differences in the clinicopathological findings are related primarily to the increased number of early gastric cancer cases in the late period and that the improved survival noted during the late period for stage IIIB and IV cancers might be related to extended surgery.