Published online Oct 15, 2020. doi: 10.4251/wjgo.v12.i10.1119
Peer-review started: June 4, 2020
First decision: July 21, 2020
Revised: July 28, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: October 15, 2020
Currently, the morbidity and mortality of gastric cancer (GC) have decreased sharply; however, it is still an important global public health burden. The survival rate of patients with GC in China is higher than those in the United States and some European countries but far lower than those in Japan and South Korea. The morbidity of GC is different geographically even within a country. There are significant geographical distribution clusters of GC in China, and high morbidity is mainly seen in the northern part of China. Because of geographical conditions, dietary habits, economic development, etc., high morbidity and mortality of GC have been seen in Northeast China. Thus, it is necessary to conduct systematic research on the clinical characteristics and survival rate of GC in this densely populated area of China.
A high-capacity data center that collected data from more than 1000 GC surgeries in Northeast China was used in this study. Through analyzing the data from the data center in the past 15 years from 2000 to 2014, this study revealed changes in postoperative clinical characteristics and survival. The results of this study will help people better understand the characteristics and development trends of GC. It may also provide a reference for the diagnosis and prevention of regional GC.
This study performed a comparative analysis of the clinicopathological characteristics and postoperative survival of patients with GC from the Harbin Medical University Cancer Hospital over 15 years starting in 2000. The factors affecting the prognosis of GC are identified based on the time trend.
Student’s t test was used to evaluate the significant differences among the mean values. Categorized variables were evaluated by the Pearson χ2 test. The cumulative survival rate was calculated by the Kaplan-Meier method, and the difference among different groups was evaluated by the long-rank test. A Cox regression model was used for multivariate prognostic analysis.
At the last follow-up visit, a total of 1845 patients survived, and 2899 patients had died. The average 5-year survival rate was 38.9%. Over time, the 5-year survival rate improved significantly in the three periods: Phase I: 24%, Phase II: 36.6%, and Phase III: 43.8%. According to the subgroup analysis by tumor-node-metastasis staging, the 5-year survival rate of patients with stages I + II and III disease was significantly improved compared with the earlier stage. In contrast, the 5-year survival rate of patients with stage IV disease did not change significantly.
Overall, based on our 15 years of experience in treating patients with GC, we have observed that by attaching great importance to the perioperative period, including the improvement in surgical techniques and other techniques, a significant improvement in patient survival was noted.
When patients with GC are diagnosed with a local disease, their prognosis is still not optimistic. Obviously, surgery alone is not enough to achieve the ideal value for survival. We urgently need to develop a multimodal, multidisciplinary, and individualized comprehensive treatment system to achieve better results.