Results of immunochemo-surgery for gastric carcinoma

Although the therapeutic results of gastric cancer have markedly improved, it still remains the most common cancer death in Korea.

The clinicopathologic characteristics were analyzed for 11,491 consecutive patients who underwent operation for gastric cancer at the Department of Surgery, Seoul National University Hospital from 1971 to 1997. We also evaluated the survival and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The prognostic significance of treatment modality [surgery alone, surgery + chemotherapy, surgery + immunotherapy + chemotherapy (immunochemo-surgery)] were evaluated in stage III gastric cancer.

The 5-year survival rate of overall patients was 55.8%, and that of patients who received curative resection was 64.8%. The 5-year survival rates according to TNM stage were 92.9% for Ia, 84.2% for Ib, 69.3% for II, 45.8% for IIIa, 29.6% for IIIb and 9.2% for IV. Depending on the extent of resection, the 5-year survival rates were 68.7% for STG, 45.4% for TG, 19.6% for combined resection and there was no 5-year survivor in the nonresection group. Regarding adjuvant treatment modality, significant survival difference was observed in stage III patients. The 5-year survival rates were 44.8% for the immunochemo-surgery group, 36.8% for the surgery + chemotherapy group and 27.2% for the surgery alone group.

Curative resection, depth of invasion and lymph node metastasis were the most significant prognostic factors in gastric cancer. Consequently, early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy especially in patients with stage III gastric cancer should be recommended as a standard treatment principle for patients with gastric cancer.