The roles of chemotherapy and surgery in gastric carcinoma and the influence of prognostic factors on survival

In this study, we present the results of surgery and chemotherapy and the i mpact of various prognostic factors on survival in patients with gastric ca rcinoma with a follow-up of 6 years. All of the 328 cases were adenocarcino ma histologically and had a median age of 55 years. Median survival was 11 months, and the 5-year survival rate was 18%. Nonmetastatic cases were asso ciated with improved survival as compared with the cases with metastatic di sease (p < 0.001). Patients with gastrectomy had improved survival (p < 0.0 01). Subtotal gastrectomized patients had better survival rates in comparis on to the total gastrectomized patients (p = 0.03). Addition of splenectomy to total gastrectomy and adjuvant chemotherapy did not influence survival rates (p > 0.05). In metastatic patients, we determined beneficial effects of gastrectomy and chemotherapy on survival. The benefit was most predomina nt in chemoresponsive patients (p < 0.001). Higher serum CA 19.9 levels in patients without metastases, higher serum lactate dehydrogenase and carcino embryonic antigen levels in patients with metastases, and lower serum album in levels in both stages were determined as significant predictors of poor survival. On multivariate analysis, only higher serum CA 19.9 level was the independent unfavorable prognostic factor of survival time in nonmetastati c patients (p = 0.008). In metastatic disease, older age (p = 0.03) and mal e gender (p = 0.05) were associated with poorer survival. In conclusion, ga stric cancer is a great health problem, especially in developing countries, and we need more optimal approaches and treatment modalities for gastric c ancer.