Abstract
In Medical Oncology, a Chinese high-volume hospital’s experience typically represented the changes of surgical management for gastric cancer in mainland China [1]. Since the interim of first decade of twenty-first century, several Chinese surgeon communities of gastric cancer, such as gastric cancer committee in Chinese Anti-Cancer Association (CACA), made a great effort to spread standard gastric cancer surgery and advance the quality of radical D2 surgery in mainland China. Consequently, we found a dramatic increase in proportion of D2 surgery between two periods 2000–2005 and 2006–2010 [1]. Likewise, the average of harvested lymph nodes was obviously increased along with the promotion of technical quality [1]. Similar changes could be seen in other Chinese high-volume medical institutes nationwide, and the standard D2 surgery became the preferred treatment for resectable gastric cancer, including early gastric cancer (EGC). The promising alteration led to improvement in overall outcome of surgical patients with gastric cancer in mainland China. In Japan and Korea, also high-incidence countries of gastric cancer, standard D2 surgery is generally advocated. However, their overall survival outcome of gastric cancer appears superior to that in China, although the stage-specific survival rates are not apparently different [1]. Based on Globocan 2012 data set from International Agency for Research on Cancer (IARC), mortality-to-prevalence ratios (MPRs) are 0.04, 0.07 and 0.33 in Japan, Korea and China, respectively. MPR is a sensitive epidemiological parameter to estimate the difference in overall survival outcome among populations [2]. The high MPR in China indicates that the global efficacy of screening and management of gastric cancer is still weak, despite the likely comparability of surgical technique to Japan and Korea. Therefore, the shortage in overall survival outcome in China has to largely attribute to the lower proportion of EGC among all gastric cancer patients. According to Japanese and Korean reports, the proportion of EGC has been 50–60% among surgical patients, and additionally many eligible EGC patients are selected for endoscopic treatment, especially in Japan. In contrast, our experience in the Chinese high-volume hospital mentioned above demonstrates that the proportion of EGC was only 8–11% during 1994–2001 and 11–19% during 2002–2012, respectively (Fig. 1a). The average of EGC proportion is still very limited (14.5%) in west China, although it has already increased to some extent (Fig. 1b). Among surgical patients with EGC, 22.1% of them had lymph node metastasis, who were unfit for endoscopic treatment. It is the reason why endoscopic treatment cannot become popular in mainland China by now. Additionally, 30.8% of those patients with node-positive EGC had no less than 3 metastatic nodes, as unfit for limited surgery and sentinel node navigation despite of superficial infiltration. Most Chinese gastrointestinal surgeons personally prefer standard D2 surgery for EGC yet. The lower proportion of EGC and relatively advanced status of EGC make either surgical or endoscopic treatment pattern different between China and Japan or Korea. Factually, high mortality of gastric cancer has been a great part of increasing healthcare burden for 40 years in mainland X.-Z. Chen (&) W.-H. Zhang J.-K. Hu (&) Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang 37, Chengdu 610041, Sichuan Province, China e-mail: chen_xz_wch_scu@126.com
Published Version
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