Postresection Prognosis of Gastric Cancer Patients: Comparison of Staging Systems

Abstract

The staging classifications of malignant diseases are important for predicting prognosis as well as for the analysis of surgical results. Three staging systems have been proposed for gastric cancer. To compare the efficacy of these 3 systems, we undertook a retrospective review of 472 patients who underwent gastric cancer resection between 1978 and 1987 at National Taiwan University Hospital. The overall 5-year survival rate in this series was 35.7%. Absolutely curative resection were performed in 265 (56.1%), relatively curative in 150 (31.8%) and noncurative in 57 (12.1%). The 5-year survival rates were 54.4%, 13.7% and 5.3% respectively. The survival curves were analyzed according to the American Joint Committee for Cancer Staging and End Reporting (AJCCS), the Union Internationale Contre le Cancer (UICC), and the Japanese Research Society for the Study of Gastric Cancer (JRSGC) classification. All three systems could predict prognosis. However, disproportionately larger patient number was found in stage III of AJCCS and stage I and III in JRSGC classification. The survival curves of stage II and III of the JRSGC system didn’t differ significantly. On the contrary, patient number distributed evently in each stage of the UICC system with stepwise downward survival rate except that there was no significant difference in survival rates between UICC stages IIIA and IIIB. The prognosis for patients who had gastric cancer beyond UICC stage III was dismal. Aggressive adjuvant therapy should be investigated for these patients following gastric resection. The results of this study demonstrate that the UICC classification is better than the AJCCS and JRSGC classification. We propose that this system should be adopted in multi-institute cooperative study.