It is well known that stomach cancer is one of the most common malignant tumor and leading cause of death in Korea.
Even though, the clinical applications of various therapeutic modalities the chance for cure of stomach cancer still lies with surgery and despite the advances made in diagnosis, management and surgical technique, less than 10~15% of patients can be expected to live for 5 years after surgery.
Stomach cancer, per se, seemed to be in changing especially in epidemiologic incidence. For past 40 years the stomach cancer is continuously declined in U.S.A. without plausible reasons.
In developed countries the epidemiologic and clinical studies of stomach cancer were already carried out in large numbers of patients more than a decade ago. But we can say that with many reasons of socioeconomic difficulties, the accurate information of stomach cancer in Korea especially to follow up studies after surgery are not yet in our hand. Recently, authors received financial support from Korean Traders Scholarship Foundation to take steps for mass survey of cancer patients in the field of survival time and rate after surgery. This statistical analysis of stomach cancer is a part of the survey.
In addition to postoperative survival time we also attempt to evaluate the influencing factors to survival and data were computed with computer (Type; CDC 3,300) to figure out life table and expecting survival duration after gastric resection in patients of stomach cancer with various clinical conditions which we usually confront at outpatient clinic or ward.
Materials were, of total 3675 cases with stomach cancer who had surgical therapy at surgical department of Catholic Medical Center, Sacred Heart Hospital of Choong Ang Univeristy in Seoul and Gospel Hospital in Pusan between from Jan. 1961 to Dec. 1976.
Results were obtained as follows;
1. The most of all stomach cancer developed over 40 years of age (87.2%) and male to female ratio was 2.3.: 1. The youngest and oldest patient was 21 and 80 years old respectively.
2. Epigastric pain (69.9%) and indigestion (48.3%) were frequent chief complaints.
3. In physical examination, epigastric tenderness (83.2) was the most frequent finding and palpable mass (46.2%), Ascites (12.9%), rectal shelf (2.8%), Virchow´s node (2.7%) are in order.
4. The most patients visited hospital in 6 months after illness (62.7%) and 16.4% of, patients visited hospital, lately over 2 years.
5. Patients with; blood type A -was 39.5% and bloodtype O,B, AB were 27.3%, 23.7%, 9.5% respectively.
6. Gastric acidity below the normal level was 78.0% including achlorhydria (44.9°%).
7. Resectability was 65.6% excluding O&C, (13.6%) and Bypass (20.8%). In resectable cases, plliative resection was done in 40.9% and curative resection was done in 24.7% of patients.
8. Overall survival rate after operation of stomach cancer was 68.0% (6 months), 49.0°0 (1 year), 26.5% (2year), 19.0% (3 year), 9. 1% (4 year), and 4.3 0 (5 year). The survival rate of female was more favorable than male.
9. The level of the hematocrit and serum albumin related with the survival rate after surgery. In patients with anemic and hypoalbuminemic condition 30 months survival rate were 9.8%, 10.7% comparing to that of 14.8%, 20.9% with normal levels.
10. Most of the stomach cancer was located at antrum(65.1%) and/or lesser curvature(72.2%). And that was more favorable than the other part of the stomach in prognosis.
11. The one-year survival rate after curative surgery without lymph node metastasis was 82.3%-and that was 56.4% with lymph node metastasis, 36.7% with palliative resection and 5.7% with O & C or biopsy. Five year survival rate after curative resection without lymph node metastasis
was 28.1% and 7.1% with lymph node metastasis.
12. In relationship between survival rate and percent of lymph node metastasis, patients without lymph node metastasis, 12 months, 30 months, 60months survival rate was 88.1%, 77. 5%, 53.2%.
In patients with more than 75% metastasis, one year survival rate was 20.4% and no survivors- in 30 months and 60 months after surgery.
13. The survival rates in patient with Duke´s A were 85.3% (1 year), 79.4% (30 months), 76.5% (60 months) and that with Duke´s CD were 31.700, 11.4% (1 year), 11.5%, 0% (30, months) respectively.
14. In pathological diagnosis, adenocarcinoma was the most frequent (96.7%) and most of it- was Border´s la &. N (79.9%) in degree of differentiation.
15. Life table was made along the life table method analysis to calculate the periodical expectancy of survival rate after surgical treatment in 1425 patients who were confirmed whether died or survived. The expectancy of survival rate during the first 6 months was calculated 68.0%0. These survivors´ next 6 months expectancy, of survival rate was 73.4%: The 60 months possible-expectency of survival rate can be calculated 78.2% in this table.
The life expectancy after surgery in patients with clinical factors which commonly experienced out patient clinic such as positive lymph node metastasis, over 6 months duration. of illness, cancer of antrum, 31~35% of hematocrit, 10-12 gm % of hemolobin, below 2.5 gm% of serum albumin, ep gastric mass, less than 50% positive node was 56.4% in .6 months and ,38.9%, 18.5 %, 10.6%, 5.6% in increase of each 6 months. In this way the 5-year survival rate in patient with the above condition can be expected 3.0%.
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