Stomach cancer natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
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Overview
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.
Natural History
Metastasis occurs in 80-90% of individuals with stomach cancer. without treatment, 63 percent of patients with early gastric cancer will progress to advanced stage disease within five years [73].
Complications
- Ascites
- Gastrointestinal bleeding
- Spread of cancer to other organs or tissues
- Weight loss
- Recurrence:
In a Japanese series, 58 of 633 patients (9.2 percent) with early gastric cancers had synchronous cancers, defined as a second cancer found within the first year [94]. the overall incidence of metachronous cancers was 8.2 percent, the majority of which were able to be resected endoscopically. the cumulative incidence of metachronous early gastric cancers was 9.5 percent at five years, 13.1 percent at seven years, and 22.7 percent at 10 years [92].
Prognosis
5-Year Survival
The prognosis of patients with gastric cancer is related to tumor extent and includes both nodal involvement and direct tumor extension beyond the gastric wall.[8,9]
The overall five-year survival rate for treated early gastric cancer in most modern era series is over 90 percent: nearly 100 percent for mucosal tumors, and 80 to 90 percent for submucosal tumors [75-78]. early-stage disease accounts for only 10% to 20% of all cases diagnosed in the United States.
The remaining patients present with metastatic disease in either regional or distant sites.
The overall survival rate in these patients at 5 years ranges from almost no survival for patients with disseminated disease to almost 50% survival for patients with localized distal gastric cancers confined to resectable regional disease. Even with apparent localized disease, the 5-year survival rate of patients with proximal gastric cancer is only 10% to 15%. Although the treatment of patients with disseminated gastric cancer may result in palliation of symptoms and some prolongation of survival, long remissions are uncommon.
Survival rates are similar between patients who undergo endoscopic resection and those who undergo surgical resection (five-year survival of 96 and 94 percent in one study)[1]
The recurrence rate after surgery is approximately 1 to 5 percent in reports from Korea[2]
and Japan and 5 to 15 percent in studies from Western centers.[3]
These variable recurrence rates partially reflect differences in length of follow-up, but may also be due to differences in the pathologic diagnosis of malignancy[4]. Among patients undergoing endoscopic resection, recurrence rates have been reported to be between 0 and 30%.[5]
Higher recurrence rates are seen with those who have piecemeal or incomplete resections.
Prognosis with lymph node involvement[6]
The literature suggests that up to 10 percent of mucosal early gastric cancers and 20 to 30 percent of submucosal early gastric cancers will have lymph node metastases
long-term survival was 95 percent in patients with no lymph node involvement, 88 percent in those with one to three nodes involved, and 77 percent in those with more than three nodes involved[7]
- Between 2004 and 2010, the 5-year relative survival of patients with stomach cancer was 29%.[8]
- When stratified by age, the 5-year relative survival of patients with stomach cancer was 31.4% and 26% for patients <65 and ≥ 65 years of age respectively.[8]
- The survival of patients with stomach cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of stomach cancer:[8]
| Stage | 5-year relative survival (%), (2004-2010) |
| All stages | 28.3% |
| Localized | 64.1% |
| Regional | 28.8% |
| Distant | 4.2% |
| Unstaged | 20.2% |
- Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of stomach cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[8]
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References
- ↑ Choi IJ, Lee JH, Kim YI, Kim CG, Cho SJ, Lee JY; et al. (2015). "Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection". Gastrointest Endosc. 81 (2): 333–41.e1. doi:10.1016/j.gie.2014.07.047. PMID 25281498.
- ↑ Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S (2010). "Recurrence after curative resection of early gastric cancer". Ann Surg Oncol. 17 (2): 448–54. doi:10.1245/s10434-009-0772-2. PMID 19904573.
- ↑ Percivale P, Bertoglio S, Muggianu M, Aste H, Secco GB, Martines H; et al. (1989). "Long-term postoperative results in 54 cases of early gastric cancer: the choice of surgical procedure". Eur J Surg Oncol. 15 (5): 436–40. PMID 2792394.
- ↑ Schlemper RJ, Itabashi M, Kato Y, Lewin KJ, Riddell RH, Shimoda T; et al. (1997). "Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists". Lancet. 349 (9067): 1725–9. doi:10.1016/S0140-6736(96)12249-2. PMID 9193382.
- ↑ Hiki Y, Shimao H, Mieno H, Sakakibara Y, Kobayashi N, Saigenji K (1995). "Modified treatment of early gastric cancer: evaluation of endoscopic treatment of early gastric cancers with respect to treatment indication groups". World J Surg. 19 (4): 517–22. PMID 7676693.
- ↑ Ohashi S, Okamura S, Urano F, Maeda M (2007). "Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer". Gastric Cancer. 10 (4): 241–50. doi:10.1007/s10120-007-0442-7. PMID 18095080.
- ↑ Kim JP, Hur YS, Yang HK (1995). "Lymph node metastasis as a significant prognostic factor in early gastric cancer: analysis of 1,136 early gastric cancers". Ann Surg Oncol. 2 (4): 308–13. PMID 7552619.
- ↑ 8.0 8.1 8.2 8.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.