Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry

Abstract

The Japanese Gastric Cancer Association (JGCA) started a new nationwide gastric cancer registry in 2008. Approximately 50 data items, including surgical procedures, pathological diagnoses, and survival outcomes, for 12004 patients with primary gastric cancer treated in 2001 were collected retrospectively from 187 participating hospitals. Data were entered into the JGCA database according to the JGCA Classification of gastric carcinoma, 13th edition and the International Union Against Cancer (UICC) TNM Classification of malignant tumors, 5th edition by using an electronic data collecting system. Finally, data of 11261 patients with gastric resection were analyzed. The 5-year follow-up rate was 83.5%. The direct death rate was 0.6%. TNM 5-year survival rates (5YSRs)/JGCA 5YSRs were 91.8/91.9% for stage IA, 84.6/85.1% for stage IB, 70.5/73.1% for stage II, 46.6/51.0% for stage IIIA, 29.9/33.4% for stage IIIB, and 16.6/15.8% for stage IV. The proportion of patients more than 80 years old was 7.0%, and their 5YSR was 48.7%. Compared to the JGCA archived data, though the follow-up rate needs to be improved, these data suggest that the postoperative results of patients with primary gastric carcinoma have improved in those with advanced disease and in the aged population in Japan.

Fig. 1

Geographical distribution of the registered patients

Fig. 2

Hospital volumes in the 187 participating hospitals

Fig. 3

Kaplan–Meier survival for all 12004 patients with primary gastric cancer. 5YSR 5-year survival rate

Fig. 4

Kaplan–Meier survival for resected cases and unresected cases

Fig. 5

Kaplan–Meier survival of the resected cases stratified by sex

Fig. 6

Kaplan–Meier survival of the resected cases stratified by age

Fig. 7

Kaplan–Meier survival of the resected cases stratified by tumor location. W whole stomach, M middle third, L lower third, U upper third of stomach

Fig. 8

Kaplan–Meier survival of the resected cases stratified by macroscopic type

Fig. 9

Kaplan–Meier survival of the resected cases stratified by depth of tumor invasion. M mucosa or muscuralis mucosa, SM submucosa, MP muscularis propria, SS subserosal, SE serosa, SI adjacent structures

Fig. 10

Kaplan–Meier survival of the resected cases stratified by pT classification

Fig. 11

Kaplan–Meier survival of the resected cases stratified by lymph node metastasis

Fig. 12

Kaplan–Meier survival of the resected cases stratified by Japanese Gastric Cancer Association (JGCA) stage

Fig. 13

Kaplan–Meier survival of the resected cases stratified by TNM stage

Fig. 14

Kaplan–Meier survival of the resected cases stratified by curative potential of gastric resection. Resection A, no residual disease with high probability of cure satisfying all of the following conditions: T1 or T2; N0 treated by D1, 2, 3 resection or N1 treated by D2, 3 resection; M0, P0, H0, CY0, and proximal and distal margins >10 mm; Resection B, no residual disease but not fulfilling criteria for “Resection A”; Resection C, definite residual disease