Clinical Prognostic Factors in Gastric Cancer in Chinese Patients:

Experience from the Cancer Hospital/Institute,

Chinese Academy of Medical Sciences

Yuankai Shi, M.D.

Department of Medical Oncology,

Cancer Hospital/Institute,

Chinese Academy of Medical Sciences (CAMS)

Background

4th most common cancer, 2nd most common cause of death,

2/3 patients in developing countries, 42% of them in China

Gastric cancer worldwide in 2002:

Parkin DM, et al. CA Cancer J Clin. 2005;55:74

5-year overall survival: 15%-54%

Parkin DM, et al. CA Cancer J Clin. 2005;55:74

Gastric cancer in China in 2005Gastric cancer in China in 2005

Incidence: Incidence:

376,000 new cases376,000 new cases

Third most common cancer Third most common cancer

Mortality: Mortality:

24.71/1024.71/105

Third Third cause of death from cancer from cancer

Behind Lung cancer and Liver cancerBehind Lung cancer and Liver cancer

http://www.moh.gov.cn

Objective

To evaluate the therapeutic effects and

prognostic factors in patients with operable

gastric cancer

To construct a prognostic model

Materials and methodsMaterials and methods

Identify prognostic factors with data from 1043 pts treated with combinIdentify prognostic factors with data from 1043 pts treated with combin

ed modality therapy based on gastrectomy, between 1999 and 2002, ied modality therapy based on gastrectomy, between 1999 and 2002, i

n the Cancer Hospital, CAMS n the Cancer Hospital, CAMS

Construct prognostic model with data from 1284 pts with combined mConstruct prognostic model with data from 1284 pts with combined m

odality treatment based on gastrectomy, between 1999-2006, in the Codality treatment based on gastrectomy, between 1999-2006, in the C

ancer Hospital, CAMSancer Hospital, CAMS

Statistical analysisStatistical analysis

Life Table, Cox hazard proportional model, Logistic regression modelLife Table, Cox hazard proportional model, Logistic regression model

ResultsResults5-year

39%

15%

5-year OS

100%

91%

84%

61%

33%

19%

5%

Median survival: 39.5 mo

median relapse-free survival: 22.7 mo

5-y OS: 39%

5-y RFS: 15%

1043 pts with operable gastric cancer

median follow-up: 51.6 mo

Univariate analysis in 1043 pts

Univariate analysis in 1043 pts

Independent prognostic factors

Allpts

n=1284

Trainingsamplen=963

Testingsamplen=321

Randomized

Prognostic equationPrognostic index

Prognostic model

Construct

Validate

Fig. Overall survival (OS) and relapse-free survival (RFS) for 1284 patients.

0 24 48 72 96 1200

20

40

60

80

100

OS

RFS

Time (months)

Sur

viva

l (%

)

Overall survival and relapse-free survival

Median follow-up: 35.7 mo

5-y OS: 40%

5-y RFS: 12%

Univariate analysis in 1284 pts

Univariate analysis in 1284 pts

Independent prognostic factors of OS in training sample

Prognostic modelPrognostic model

LNM: Lymphonode metastases; PCI: peritoneal cavity involvement.

FactorsFactors ScoreScore

Age>60y Age>60y 11

ProximalProximal 11

Stage Stage Ⅲ/ⅣⅢ/Ⅳ 22

LNM LNM ratio>1/3ratio>1/3

22

PCI PCI 22

Risk groupRisk group ScoreScore

Low risk (L)Low risk (L) 0-10-1

Low intermediate Low intermediate

(LI)(LI)

2-32-3

High intermediate High intermediate

(HI)(HI)

4-54-5

High risk (H)High risk (H) 6-86-8

Risk model defined by prognostic index

Risk model in age group

5-year OS

82%

60%

27%

7%

5-y OS

81%

48%

20%

0

P<0.001

P<0.001

5-y OS

82%

60%

27%

7%

Risk model in stage

Survival curve according to risk model

LI

L

L

LI

Risk model in treatment

Discussion

Lagarde SM, et al. J Clin Oncol, 2006, 24:4347

AuthorAuthor TimeTime NN PatientsPatients Independent prognostic factorsIndependent prognostic factors

ZhanZhan 20052005 497497 curativecurative Stage, Size, Perioperative chemotherapyStage, Size, Perioperative chemotherapy

YolotaYolota 20022002 697697 operableoperable Site, T category, LNMSite, T category, LNM

SchwarzSchwarz 20072007 13771377 operableoperable

IIIA-IVIIIA-IV

Age, Site, Number of LNM,Age, Site, Number of LNM,

T category, SexT category, Sex

The presentThe present

studystudy

10431043 operableoperable Age, Site, Size, Stage, Ratio of LNM,Age, Site, Size, Stage, Ratio of LNM,

PCI, Curative resection, Combined therapyPCI, Curative resection, Combined therapy

Comparison in gastric cancer prognostic factors

Zhan YQ, et al. Ai Zheng 2005,24:596; Yokota T, et al. Anticancer Res 2002,22:3673;

Schwarz RE et al. Ann Surg Oncol 2007,14:317

ConclusionConclusion

This risk model could identify various outcomes This risk model could identify various outcomes

in pts with the same stage from IB to IVin pts with the same stage from IB to IV

This risk model also could identify different This risk model also could identify different

outcomes in pts with the same treatment statusoutcomes in pts with the same treatment status

Prospective study are warranted to validate Prospective study are warranted to validate

these findings.these findings.

Acknowledgements Acknowledgements Dept. of Abdominal Surgical OncologyDept. of Abdominal Surgical Oncology Zhi-xiang ZhouZhi-xiang Zhou Hai-zeng Zhang Hai-zeng Zhang Yi ShanYi Shan Ping ZhaoPing Zhao Xiang Wang Xiang Wang Jian-xiong Wu Jian-xiong Wu Yong-fu ZhaoYong-fu Zhao

Dept. of Medical OncologyDept. of Medical Oncology Jing WangJing Wang Jin-wan WangJin-wan Wang Hong-gang Zhang Hong-gang Zhang Yu-sheng LiYu-sheng Li Jing HuangJing Huang Xiao-hui HeXiao-hui He Xiao-hong HanXiao-hong Han

Dept. of PathologyDept. of Pathology Xun ZhangXun Zhang Yan SongYan Song Shang-mei LiuShang-mei Liu

Dept. of Imaging DiagnosisDept. of Imaging Diagnosis Chun-wu ZhouChun-wu Zhou Li-ming Jiang Li-ming Jiang Zhu WangZhu Wang

Thank you for your attention!