Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy

Abstract

Background. Despite recent advances in diagnosis and treatment, gastric carcinoma remains a major cause of death in the world. Methods. The clinicopathologic profile of 10,000 consecutive patients who underwent primary gastrectomy during 1962‐1989 were reviewed and prognostic factors influencing survival in those with gastric carcinoma were analyzed in 7031 patients. Results. Incidence of gastrectomy for carcinoma has increased steadily and the rate of early carcinoma exceeded that of advanced carcinoma in the recent period of 1985‐1989. Five‐year and 10‐year survival rates were 46.1% and 35.2% in 3868 patients with advanced carcinoma, and 88.8% and 77.3% in 3163 patients with early carcinoma, respectively. In patients with advanced carcinoma, significantly poorer survival rates were noticed for patients older than 70 years of age, those who underwent total gastrectomy, tumors involving the entire stomach or greater than 10 cm in diameter, a macroscopic diffusely infiltrative pattern, adenosquamous histologic type, positive surgical resection margins, or lymph node metastasis. None of the above poor prognostic features were identified in patients with early gastric carcinoma group except for those older than 70 years of age. Although lymph node metastases were present in 10% of early gastric carcinomas, this feature did not impart a poor prognosis. Patients with advanced carcinoma grossly resembling an early carcinoma had an intermediate prognosis, suggesting the existence of a developmentally midstage lesion between early and advanced carcinoma. Conclusions. The study illustrates that the most important role for clinicians treating with gastric carcinoma should be early detection and aggressive surgery for resectable tumors, followed by detailed pathologic examination.