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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 Gastric cancer worldwide in 2002: 4th most common cancer, 2nd most common cause of death, 2/3 patients in developing countries, 42% of them in China 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 2005 Incidence: 376,000 new cases Third most common cancer Mortality: 24.71/105 Third cause of death from cancer Behind 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 methods Identify prognostic factors with data from 1043 pts treated with combined modality therapy based on gastrectomy, between 1999 and 2002, in the Cancer Hospital, CAMS Construct prognostic model with data from 1284 pts with combined modality treatment based on gastrectomy, between 1999-2006, in the Cancer Hospital, CAMS Statistical analysis Life Table, Cox hazard proportional model, Logistic regression model Results 5-year 39% 15% 1043 pts with operable gastric cancer Median survival: 39.5 mo median relapse-free survival: 22.7 mo 5-y OS: 39% 5-year OS 100% 91% 5-y RFS: 15% 84% 61% 33% 19% 5% median follow-up: 51.6 mo Univariate analysis in 1043 pts Univariate analysis in 1043 pts Independent prognostic factors Construct Randomized Training sample n=963 Prognostic equation Prognostic index All pts n=1284 Testing sample n=321 Prognostic model Validate Overall survival and relapse-free survival Survival (%) 100 Median follow-up: 35.7 mo 80 5-y OS: 40% 60 5-y RFS: 12% 40 OS 20 RFS 0 0 24 48 72 96 120 Time (months) Fig. Overall survival (OS) and relapse-free survival (RFS) for 1284 patients. Univariate analysis in 1284 pts Univariate analysis in 1284 pts Independent prognostic factors of OS in training sample Prognostic model Factors Score Risk group Score Age>60y 1 Low risk (L) 0-1 Proximal 1 Stage Ⅲ/Ⅳ 2 Low intermediate (LI) 2-3 High intermediate (HI) 4-5 High risk (H) 6-8 LNM ratio>1/3 2 PCI 2 LNM: Lymphonode metastases; PCI: peritoneal cavity involvement. Risk model defined by prognostic index Risk model in age group 5-y OS 81% 48% 20% 0 P<0.001 5-year OS 5-y OS 82% 82% 60% 60% 27% 27% 7% 7% P<0.001 Risk model in stage Survival curve according to risk model L LI L LI Risk model in treatment Discussion Lagarde SM, et al. J Clin Oncol, 2006, 24:4347 Comparison in gastric cancer prognostic factors Author Time N Patients Independent prognostic factors Zhan 2005 497 curative Stage, Size, Perioperative chemotherapy Yolota 2002 697 operable Site, T category, LNM Schwarz 2007 1377 operable IIIA-IV Age, Site, Number of LNM, T category, Sex 1043 operable Age, Site, Size, Stage, Ratio of LNM, PCI, Curative resection, Combined therapy The present study 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 Conclusion This risk model could identify various outcomes in pts with the same stage from IB to IV This risk model also could identify different outcomes in pts with the same treatment status Prospective study are warranted to validate these findings. Acknowledgements Dept. of Abdominal Surgical Oncology Zhi-xiang Zhou Hai-zeng Zhang Yi Shan Ping Zhao Xiang Wang Jian-xiong Wu Yong-fu Zhao Dept. of Pathology Xun Zhang Yan Song Shang-mei Liu Dept. of Medical Oncology Jing Wang Jin-wan Wang Hong-gang Zhang Yu-sheng Li Jing Huang Xiao-hui He Xiao-hong Han Dept. of Imaging Diagnosis Chun-wu Zhou Li-ming Jiang Zhu Wang Thank you for your attention!