Abstract
The overall 5-year survival of patients with gastric cancer is only 23% in the US compared with 60% in Japan. For Western patients, detecting the disease earlier and applying treatment quality control could substantially improve clinical outcome. For the treatment of gastric cancer, complete tumor resection, whenever feasible, is the standard treatment. Resection of the primary tumor (partial or total gastrectomy) is based on standardized criteria of the tumor, such as location, stage, histology, and surgical margins. The extent of regional lymphadenectomy required, however, has been a matter of considerable debate. Emerging evidence from the latest randomized controlled trials show that extended (D2) lymphadenectomy is safe and able to cure 20% of patients with N2-disease compared with 0% treated with limited D1 dissection, provided that the optimal surgical technique is used. Estimates suggest that this N2-specific subgroup advantage reflects a potential absolute overall survival benefit of 3–6%. Postoperative decisions about adjuvant chemotherapy and radiotherapy are based on pathologic staging, the extent of surgery performed (D0/D1 vs D2/D3) and the risk–benefit ratio. Recurrence-risk and mortality-risk reduction is achievable with a carefully planned relapse-prevention guided therapeutic strategy. Patient-related factors (tumor features and expected recurrence-risk magnitude) and treatment-related factors (surgical experience, adjuvant treatment risk–benefit ratio) should be considered on an individual basis. In future, genomic-based approaches will help to provide a more personalized therapeutic approach and improve patient outcome.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Parkin DM et al. (2001) Cancer burden in the year 2000. The global picture. Eur J Cancer 37 (Suppl 8): S4–S66
Jemal A et al. (2004) Cancer Statistics, 2004. CA Cancer J Clin 54: 8–29
Sasako M (2003) Principles of surgical treatment for curable gastric cancer. J Clin Oncol 21 (Suppl): S274–S275
Fujii M et al. (1999) State of the art in the treatment of gastric cancer: from the 71st Japanese Gastric Cancer Congress. Gastric Cancer 2: 151–157
Roukos DH (2000) Current status and future perspectives in gastric cancer management. Cancer Treat Rev 26: 243–255
Bonenkamp JJ et al. (1993) Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients. World J Surg 17: 410–415
McCulloch PG et al. (1995) Comparison of the molecular genetics of c-erb-B2 and p53 expression in stomach cancer in Britain and Japan. Cancer 75: 920–925
Noguchi Y et al. (2000) Is gastric carcinoma different between Japan and the United States? Cancer 89: 2237–2246
Bonenkamp JJ et al. (1999) Extended lymph-node dissection for gastric cancer. Dutch Gastric Cancer Group. N Engl J Med 340: 908–914
Cuschieri A et al. (1999) Patient survival after D1 and D2 resection for gastric cancer: long-term results of the MRC randomised surgical trial. Surgical Co-operative Group. Br J Cancer 79: 1522–1530
Nashimoto A et al. (2003) Randomized trial of adjuvant chemotherapy with mitomycin, fluorouracil and cytosine arabinoside followed by oral fluorouracil in serosa-negative gastric cancer: Japan Clinical Oncology Group 9206-1. J Clin Oncol 21: 2282–2287
Degiuli M et al. (2004) Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol 30: 303–308
Wu CW et al. (2004) Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 91: 283–287
Sano T et al. (2004) Gastric cancer surgery: Morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–Japan Clinical Oncology Group Study 9501. J Clin Oncol 22: 2767–2773
Hartgrink HH et al. (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22: 2069–2077
Hundahl SA et al. (2000) The National Cancer Data Base Report on poor survival of US gastric carcinoma patients treated with gastrectomy: fifth edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer 88: 921–932
Macdonald JS et al. (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345: 725–730
Kappas AM et al. (2004) Is it time to change surgical strategy for gastric cancer in the United States? Ann Surg Oncol 11: 727–730
Roukos DH and Kappas AM (2001) Limitations in controlling risk of recurrence after curative surgery for advanced gastric cancer are now well-explained by molecular-based mechanisms. Ann Surg Oncol 8: 620–621
Chambers AF et al. (2002) Dissemination and growth of cancer cells in metastatic sites. Nat Rev Cancer 2: 563–572
Roukos DH et al. (2001) Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: a prospective with quality control 10-year follow-up study. Br J Cancer 84: 1602–1609
Roukos DH (2004) Early-stage gastric cancer: a highly treatable disease. Ann Surg Oncol 11: 127–129
Kappas AM et al. (2003) Evidence-based approach: Is it time to change funding, research policy and treatment strategy of gastric cancer in the western world? Gastric Breast Cancer 2: 24–27
Greene FL et al. (2002) AJCC Cancer Staging Handbook, edn 6. New York: Springer-Verlag.
Japanese Gastric Cancer Association (1998) Japanese classification of gastric cancer, 2nd English Edn. Gastric Cancer 1: 8–24
Lordick F et al. (2004) Neoadjuvant therapy for oesophagogastric cancer. Br J Surg 91: 540–551
Mochiki E et al. (2004) Evaluation of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography for gastric cancer. World J Surg 28: 247–253
Dehdashti F and Siegel BA (2004) Neoplasms of the esophagus and stomach. Semin Nucl Med 34: 198–208
Kappas AM and Roukos DH (2002) Quality of surgery determinant for the outcome of patient with gastric cancer. Ann Surg Oncol 9: 828–830
Siewert JR et al. (1998) Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 228: 449–461
Siewert JR et al. (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232: 353–361
Gunderson LL and Sosin H (1982) Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 8: 1–11
Wanebo HJ et al. (1993) Cancer of the stomach: A patient care study by the American College of Surgeons. Ann Surg 218: 583–592
Bozzetti F et al. (1999) Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg 230: 170–178
Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5: 1–5
Yokota T et al. (2003) Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol 4: 423–428
Allum WH et al. (2002) Guidelines for the management of oesophageal and gastric cancer. Gut 50 (Suppl 5): S1–S23
Maruyama K et al. (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11: 418–425
Gall FP and Hermaneck P (1985) New aspects in the surgical treatment of gastric carcinoma–a comparative study of 1,636 patients operated on between 1969 and 1982. Eur J Surg Oncol 11: 219–225
Harrison LE et al. (1998) Total gastrectomy is not necessary for proximal gastric cancer. Surgery 123: 127–130
Padera TP et al. (2002) Lymphatic metastasis in the absence of functional intratumor lymphatics. Science 296: 1883–1886
Iriyama K et al. (1994) Results of combined resection of invaded organs in patients with potentially curable, advanced gastric cancer. Eur J Surg 160: 27–30
Martin RC II et al. (2002) Achieving R0 resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg 194: 568–577
Bunt AM et al. (1995) Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol 13: 19–25
Roukos DH et al. (1998) Evidence of survival benefit of extended (D2) lymphadenectomy in western patients with gastric cancer based on a new concept: a prospective long-term follow-up study. Surgery 123: 573–578
Lorenz M et al. (2002) Preservation vs resection of the spleen for gastric cancer. Gastric Breast Cancer 1: 33–39
Birkmeyer JD et al. (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349: 2117–2127
Panzini I et al. (2002) Adjuvant chemotherapy in gastric cancer: a meta-analysis of randomized trials and a comparison with previous meta-analyses. Tumori 88: 21–27
Bajetta E et al. (2002) Adjuvant chemotherapy in gastric cancer: 5-year results of a randomised study by the Italian Trials in Medical Oncology (ITMO) Group. Ann Oncol 13: 299–307
Goldhirsch A et al. (2003) Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 21: 3357–3365
Spira A and Ettinger DS (2004) Multidisciplinary management of lung cancer. N Engl J Med 350: 379–392
Ott K et al. (2003) Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II study. Gastric Cancer 6: 159–167
Allum W et al. (2003) Perioperative chemotherapy in operable gastric and lower oesophageal cancer: A randomized, controlled trial (the MAGIC trial, ISRCTN 93793971) [abstract]. Proc Am Soc Clin Oncol 22: a998
Ajani JA et al. (2004) Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol 22: 2774–2780
Yu W (2003) Impact of perioperative intraperitoneal chemotherapy on the treatment of primary gastric cancer. Surg Oncol Clin N Am 12: 623–634
Glehen O et al. (2004) Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol 5: 219–228
Xu DZ et al. (2004) Meta-analysis of intraperitoneal chemotherapy for gastric cancer. World J Gastroenterol 10: 2727–2730
Gschwind A et al. (2004) The discovery of receptor tyrosine kinases: targets for cancer therapy. Nat Rev Cancer 4: 361–370
Weiss MM et al. (2003) Genomic profiling of gastric cancer predicts lymph node status and survival. Oncogene 22: 1872–1879
Kim MC et al. (2004) Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg 239: 383–387
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Roukos, D., Kappas, A. Perspectives in the treatment of gastric cancer. Nat Rev Clin Oncol 2, 98–107 (2005). https://doi.org/10.1038/ncponc0099
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/ncponc0099
This article is cited by
-
Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship
World Journal of Surgical Oncology (2017)
-
Integration of radiotherapy and chemotherapy for abdominal lymph node recurrence in gastric cancer
Clinical and Translational Oncology (2017)
-
Postoperative chemoradiotherapy versus chemotherapy for R0 resected gastric cancer with D2 lymph node dissection: an up-to-date meta-analysis
World Journal of Surgical Oncology (2016)
-
Gastrokine 1 mRNA in human sera is not informative biomarker for gastric cancer
Journal of Negative Results in BioMedicine (2016)
-
Predictive factors for survival and recurrence rate in patients with node-negative gastric cancer—a European single-centre experience
Langenbeck's Archives of Surgery (2015)