Short and long-term survival from gastric cancer. A population-based study from a county hospital during 25 years

Figures & data

Table I.  30-days mortality related to treatment.

Treatment	Total no. of patients (%)	No. of patients dead <31 days (%)	No. dead (%) in hospital (%)
Total gastrectomy	63 (18)	2 (3)	7 (11)
Subtotal gastrectomy	21 (6)	0	1 (5)
Billroth-II resection	45 (13)	0	4 (9)
Billroth-I resection	15 (4)	1 (7)	2 (13)
Resection of the cardia	6 (2)	1 (17)	1 (17)
Other resections	4 (1)	1 (25)	1 (25)
Palliative gastroenterostomy	16 (4)	3 (19)	4 (25)
Exploratory laparotomy only	31 (9)	8 (26)	12 (39)
Exploratory laparoscopy only	1 (0.3)	0	0
Endoscopic stenting	11 (3)	3 (27)	3 (27)
No surgery	143 (40)	43 (30)	54 (39)
Total	356	62 (17)	89 (25)

Table II.  Adjusted odds ratio for risk of in-hospital mortality for different risk factors (logistic regression analysis of 356 patients)

Risk factor	No.of patients	No.(%)died in-hospital	Odds ratio	95% C.I.
ASA group
1–2	212	37 (18%)	1
3	125	29 (23%)	1.4	(0.8–2.6)
4	19	8 (42%)	3.2	(1.1–9.2)
Treatment
R0, R1 resection	113	9 (8%)	1
R2 resection	41	6 (15%)	2.7	(0.7–6.4)
Bypass or stent	27	2 (7%)	0.8	(0.2–4.2)
Exploratory laparotomy	32	11 (34%)	6.5	(2.4–18)
No operation	143	46 (32%)	5.1	(2.4–11)

Figure 1.  Kaplan Meier curves of the overall survival distributed by R-type of resection.

Figure 2.  Kaplan Meier curves of the overall survival distributed by the four main stages.

Table III.  Survival analysis using Cox's Proportional Hazards Model (analysis of 356 patients)

Risk factor	No.of patients	Estimated mean survival in years (95% C.I) (Kaplan-Meier analysis)	Relative hazard (95% C.I.)	p-value
Stage (UICC)
IA	13	16 (11–20)	1
IB	20	9.7 (5.3–14)	2.8 (0.9–8.8)	0.07
II	27	4.6 (2.3–7.0)	5.9 (2.0–17)	0.001
IIIA	31	3.0 (1.6–4.4)	8.2 (2.8–24)	<0.001
IIIB	14	1.2 (0.74–1.6)	14 (4.5–46)	<0.001
IV	164	0.43 (0.36–0.57)	13 (4.2–42)	<0.001
Unstaged	87	0.46 (0.36–0.57)	11 (3.3–35)	<0.001
R
0	97	6.6 (4.9–8.4)
1	16	0.94 (0.34–1.5)	2.8 (1.5–5.3)	0.001
All other	243	0.41 (0.35–0.47)	3.6 (2.0–6.7)	<0.001

Figure 3.  Kaplan Meier curves of the overall survival distributed by the duration of symptoms.

Table IV.  Survival analysis using Cox's Proportional Hazards Model (analysis of 354 patients)

Risk factor	No.of patients	Estimated mean survival in years (95% C.I) (Kaplan-Meier analysis)	Relative hazard (95% C.I.)	p-value
Symtoms duration at admission (months)
< 2	134	1.2 (0.6–1.9))	1
2–6	136	1.9 (1.2–2.6)	0.65 (0,50–0,84)	0.001
> 6	70	3.8 (2.0–5.5)	0.52 (0.38–0.71)	<0.001
Unknown	14		0.86 (0.46-1.60)	0.63
Dysphagia
No	278	2.6 (1.9–3.3)	1
Yes	76	0.8 (0.4–1.1)	1.9 (1.4–2.6)	<0.001
Fatigue
No	166	3.1 (2.1–4.2)	1
Yes	188	1.2 (0.7–1.7)	1.5 (1.2–1.9)	0.001
Weight loss
No	124	3.6 (2.3–4.9)	1
Yes	230	1.2 (0.8–1.6)	1.5 (1.2–2.0)	0.001
Palpable tumor
No	278	2.6 (1.9–3.4)	1
Yes	76	0.4 (0.3–0.6)	1.9 (1.4–2.5)	<0.001
Ascites
No	332	2.3 (1.7–2.9)	1
Yes	22	0.2 (0.1–0.2)	3.3 (2.1–5.3)	<0.001
Anaemia
No	256	2.5 (1.8–3.2)	1
(Hb < 10g%) Yes	22	1.1 (0.6–1.7)	1.4 (1.1–1.8)	0.015

Table V.  Post-operative mortality and 5-year survival in different studies.

Reference	Year	Country	Number of Patients	Type of R-resection	Year of Treatment	a) 30-days postoperative mortality * b) In-hospital mortality ** c) a + b ***	Total 5-year Survival
Arak & Kull [8]	1994	Estonia	406	R0	1978-1987	5.9% *	46.1%
Arak et al. [9]	1996	Finland	88	R0	1983–1987	10.2% *	45.5%
Barchielli et al. [3]	2001	Italy	1017	R0/ R2(?)	1985–1987	8.0% ***	29.7%
Borch et al. [10]	2000	Sweden	450	R0	1974–1991	6.9% *** (?)	19–36%
Cunningham et al.[4]	2005	USA	264	R0	1984–2002	2.5% *	33%
Damhuis et al. [5]	2002	Netherlands	1978	R0/R1	1987–1997	7.9% *	–
Degiuli et al. [11]	2004	Italy	191	R0	1994–1996	3.1% **	55.0%
Edwards et al. [12]	2004	England	118	R0	1996–2002	7.6% *	32% (D1)/59% (D2)
Hansson et al. [13]	2000	Sweden	508	R0/R1	1989–1995	7.1% **	–
Hartgrink et al. [7]	2004	Netherlands	711	R0	1989–1993	6.6% (4% D1/ 10% D2) ***ca.	47%
Haugstvedt et al.[14]	1993	Norway	532	R0	1982–1984	–	40%
Jagoditsch et al. [15]	2001	Austria	521	R0	1984–1998	2.3% *	48.5%
Park et al. [16]	2005	S. Korea	646	RO/R1	2002	0.6% **	–
Sano et al. [17]	2004	Japan	523	R0	1995–2001	0.8% **	50–62%
Siewert et al. [18]	1998	Germany	1182	R0	1986-1989	4.8% *	45%
Viste et al. [19]	2004	Norway	213	R0	1991–2002	3.9% ***	37%

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