Yearly alterations in prognostic factors in gastric cancer during the post-operative period

Prognostic factors in gastric cancer may alter with time after surgery. Ascertaining prognostic factors appropriate for each post-operative year should contribute to the establishment of better therapeutic strategies and ultimately to the improvement of their long-term results.

In the present study, in order to elucidate whether prognostic factors would alter annually, cause of death, recurrence patterns and prognostic factors of gastric cancer by uni- and multivariate analysis were evaluated retrospectively in 833 consecutive patients who underwent potentially curative gastrectomy.

During the first 2 years, the prognostic factors were age, T3-4, pN3, tumor diameter and number of metastatic lymph nodes. During the 3rd and 4th years, they were age, pN2 and number of metastatic lymph nodes; for the fourth year, age and number of metastatic lymph nodes; for the fifth year, age alone. Peritoneal recurrence was predominant throughout the post-operative period, but its incidence decreased gradually with time. The incidence of hematogenous recurrence increased while that of lymphatic recurrence did not change with time.

As prognostic factors change over time, appropriate alterations to therapeutic strategy should be established for each successive period. Particularly, effective therapeutic strategy for peritoneal metastasis should be established in patients with a high number of metastatic lymph nodes during the first five years. Moreover, the treatment of concomitant disease and the evaluation of other malignant disease should be continued after the 5th year.