Sequential changes in conditional survival of patients undergoing curative gastrectomy for gastric cancer

Abstract

Background

Long-term data on the prognosis of patients who survived >5 years after gastrectomy for gastric cancer (GC) remain scarce. This study aimed to investigate sequential changes in conditional survival (CS) in patients with stage I–III GC who underwent R0 gastrectomy.

Methods

Of 1129 patients with stage I to III GC who underwent R0 gastrectomy, the causes of death were assessed, and sequential changes in conditional overall survival (cOS), conditional disease-specific survival (cDSS), and conditional non–disease-specific survival (cNDSS) were calculated and compared. In a subgroup of 709 patients who survived >5 years, the associations between cOS, cDSS, cNDSS, and clinicopathologic factors were analyzed.

Results

Over a median follow-up of 63 months, 203 patients (18.0%) died of GC, and 132 patients (11.7%) died of non-GC causes. The 5-year cDSS consistently increased over 10 years after gastrectomy for stage II and III GC. The cDSS and cNDSS intersected at 7 years after gastrectomy for stage II GC, whereas these measures crossed at 8 years after gastrectomy for stage III GC. In the 709 5-year survivors, multivariate analysis identified disease stage as being significantly associated with cOS and cDSS. Moreover, age ≥ 75 years, male sex, and preoperative comorbidities were associated with lower cNDSS.

Conclusion

Surveillance for GC relapse was crucial during the first 7 and 8 years after gastrectomy for stages II and III, respectively. Conversely, surveillance for second primary cancers and benign diseases became relatively more important 0, 7, and 8 years after gastrectomy for stages I, II, and III, respectively. In 5-year survivors, age ≥ 75 years, male sex, and preoperative comorbidities were associated with mortality unrelated to GC.