Long-term survival in patients with gastric cancer: a population-based study

Aims - The aim of this study was to determine long term prognostic factors of gastric cancer in a population-based series. Methods - Cut of 1462 gastric cancers diagnosed in the Cote-d'Or area (494 000 residents) over a 20-year period (1976-1995), 649 (44.4%) were resected for cure. Prognostic factors were determined using the actuarial method and relative survival and a multidimensional relative survival model. Results - The 10-year crude survival rate was 8.7% and the corresponding relative survival rate was 14.9%. Age stage and period of diagnosis were independent prognostic factors. After surgery for cure, operative mortality decreased from 18.3% (1976-1979) to 6.6% (1988-1991) and 10-year relative survival increased from 30.8% to 37.2% (NS). After resection for cure (postoperative mortality excluded) the 10-year survival rate remained stable over time. Stage at diagnosis was the main prognostic factor the relative risk of death was more than 10 times higher at stages IIIB and IV than at stage I. Age, site and macroscopic type of growth were prognostic factors independently of stage. Prognosis did not improve over time after resection for cure. Conclusion - Although improving, the overall prognosis of gastric cancer remains poor. Improvement in prognosis was mainly due to decrease in operative mortality. Earlier diagnosis and effective adjuvant treatment represent two ways to improve prognosis.