[Prognostic factors in resected stomach carcinoma]

Abstract

Between January 1982 and December 1991, 232 consecutive patients (121 male, 111 female) with gastric adenocarcinoma were treated at our clinic. Resection of the tumors (resectability 73.7%) included lymphadenectomy of compartment I (D1 resection). The tumors were classified according to the Borrmann's and Laurén's criteria and according to the TNM system. 171 patients underwent resection of the tumor, 49 palliative surgery and 12 were treated nonsurgically. The operative morbidity in patients with resection and palliative operations was 20.5% and 10.2% respectively, and the mortality rate was 0.6% and 8.2% respectively. Follow-up data (median 6 years postoperatively) were available for 229 out of 232 patients (98.7%). After resection, the five year actuarial survival rate according to the method of Kaplan-Meier was 38.2%. The probability of survival increased to 47.5% after potentially curative resection. An univariate and a multivariate analysis by the proportional hazard model (Cox regression analysis) identified several significant prognostic parameters for survival (in order of their significance): tumor stage (TNM), N-stage, percentage of positive lymph node metastases among removed nodes, Borrmann criteria, T-stage, metastases in five and more lymph nodes, diameter of the tumor, serosal involvement, peritoneal and hepatic metastases, and patient's age. The following parameters did not have a prognostic value in our analysis: grading, Laurén classification, and localization of the tumor. We conclude that the identification of several prognostic factors allows us to estimate the probability of survival for each individual patient. In future these factors may influence decision-making on adjuvant treatment of gastric cancer.