Analysis of 154 actual five-year survivors of gastric cancer.

Gastric cancer patients in the United States have a poor prognosis with a collective 5-year survival rate of less than 15%. We identified a subset of actual 5-year survivors (long-term survivors) and analyzed clinicopathologic variables predictive of recurrence and survival beyond the 5-year mark. A review of our prospective database from July 1985 to February 1993 revealed 154 patients who were long-term survivors and 280 patients who died of disease prior to 5 years (short-term survivors) following curative resection (R0). Tumor (T) stage, nodal (N) status, tumor location, and median number of positive nodes were compared between the two groups. Univariate and multivariate analysis of disease-free and greater than 5-year disease-specific survival was performed within the long-term survivors. Among the long-term survivors, 29% were classified as "early gastric cancers" (T1NX). The median number of positive nodes (0 vs. 5; P <0.001) and percentage of lesions that were T1/T2 (60% vs. 19%; P <0.001), node negative (58% vs. 15%; P <0.001), or proximal (40% vs. 65%; P <0.001) was significantly different in long-term survivors vs. short-term survivors, respectively. Of the 154 five-year survivors, gastric cancer recurred in 23, and 13 patients (8%) died of the disease at a median of 84 months from the original diagnosis. On univariate and multivariate analysis of prognostic factors in the long-term survivors, only the Lauren histologic classification predicted disease-specific and disease-free survival with diffuse histologic types faring significantly less well. T stage and N status are powerful prognostic factors of outcome within the first 5 years after curative resection of gastric carcinoma. However, the Lauren histologic type emerges as the dominant predictor of outcome once a patient with gastric cancer has survived for 5 years or more.