Stage-dependent survival in gastric cancer: a Danish nationwide cohort study

Gastric cancer remains a major clinical challenge with poor prognosis. This study investigated survival outcomes based on treatment strategy, tumor stage, and histology in Danish gastric cancer patients.

From January 2013 to December 2021, 2,156 gastric cancers were registered in the Danish Esophagogastric Cancer Group database, covering 99% of national cases. Data were analyzed for patients with intestinal and diffuse-type cancers. Survival was assessed using Kaplan-Meier curves and Cox regression, adjusting for tumor stage, treatment, and demographics.

Median survival was significantly higher with surgery ± perioperative chemotherapy (SCT) than with palliative treatment. For the intestinal-type cancers, SCT resulted in a median survival of 45.2 months (95% CI [35.4-55.1]) versus 5.1 months (95% CI [4.6-5.7]) with palliative treatment. Patients with diffuse type, treated with SCT had a median survival exceeding 128 months, compared with 6.3 months (95% CI [5.2-7.5]) with palliative treatment. Patients receiving epirubicin based CT had a lower risk of death (HR 0.74, p = 0.04) compared with upfront surgery, while FLOT (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel) similarly reduced the risk of death (HR 0.69, p = 0.04). No significant difference was observed between the two CT regimens. Palliative CT and radiotherapy improved survival over best supportive care (p < 0.001). Advanced tumor stage was associated with worse survival, while the histological subtype had no impact on overall survival outcomes.

This study emphasizes the survival benefit of multimodal treatment strategies, especially surgery combined with perioperative CT. Palliative interventions also improved outcomes in advanced disease.