Abstracts
1999 Digestive Disease Week

# 2193 ANALYSIS OF 154 ACTUAL 5-YEAR SURVIVORS IN GASTRIC CANCER
Steven N Hochwald, S Kim, D Klimstra, M F Brennan, M Karpeh, Memorial Sloan-Kettering Cancer Ctr, New York, NY

Purpose: Gastric cancer patients in the U.S. have a poor prognosis with a collective crude 5-year survival rate of less than 15%. We identified a subset of actual 5-year survivors (long term survivors, LTS) following curative resection of gastric carcinoma and analyzed clinico-pathologic variables predictive of recurrence and survival beyond the 5 year mark. Methods: A review of our prospective database from 7/85-2/93 revealed 793 patients surgically explored for gastric cancer. Of these, 154 patients were LTS and 280 patients died of disease prior to 5 years (short term survivors, STS), following curative resection (R0). T stage, nodal status, tumor location and median number of positive nodes were compared between the two groups by Chi square analysis. Univariate (Uv) and multivariate (Mv) analysis of disease-free and overall survival beyond 5 years were performed within the LTS group using log rank and Cox regression analysis. Significance was defined as p<0.05. Results: In LTS, 29% were classified as "early gastric cancers" (T1N0-2). The percent of lesions that were T1/T2 (LTS: 60%, STS: 19%, p<0.001), node-negative (LTS: 58%, STS: 15%, p<0.001) or proximal (LTS: 40%, STS: 65%, p<0.001) was significantly different as was the median number of positive nodes (LTS: 0, STS: 5, p<0.001) between the two groups. However, there were still a sizable fraction of advanced T stage (T3/T4, n=62, 40%) or node positive (n=64, 42%) tumors among the LTS group. In the LTS group, the actuarial 10-year overall and disease-free survival were 85% and 81%, respectively (median follow-up: 97 months). Gastric cancer recurred in 23 (median: 49 months) with 13 patients dying of disease after 5 years. In assessing survival after 5 years, only Lauren's classification predicted significantly worse overall and disease-free survival with Diffuse histotypes faring less well. Conclusions: T and N status are powerful prognostic factors of outcome within the first 5 years after curative resection of gastric carcinoma. However, the Lauren's histotype emerges as the dominant predictor of outcome once gastric cancer patients survive 5 years.

LTS: Disease-Free Survival			LTS: Overall Survival
Factor	Uv (p)	Mv (p)	Factor	Uv (p)	Mv (p)
T-stage	0.15	ns	T-stage	0.13	ns
N-stage	0.62	ns	N-stage	0.54	ns
# positive nodes	0.47	ns	#positive nodes	0.19	ns
Lauren's:Diffuse	0.004	0.02	Lauren's:Diffuse	0.02	0.05

Copyright 1996 - 1999, SSAT, Inc.