Prognosis of Young Survivors of Gastric Cancer in China and the U.S.: Determining Long-Term Outcomes Based on Conditional Survival

Author:

Chen Qi-Yue12,Zhong Qing12,Wang Wei3,Chen Shi4,Li Ping12,Xie Jian-Wei12,Wang Jia-Bing12,Lin Jian-Xian12,Lu Jun12,Cao Long-Long12,Lin Mi12,Tu Ru-Hong12,Huang Ze-Ning12,Lin Ju-Li12,Zheng Hua-Long12,Liu Zhi-Yu12,Zheng Chao-Hui12,Peng Jun-Sheng4,Zhou Zhi-Wei3,Huang Chang-Ming12

Affiliation:

1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China

2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China

3. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangdong, People's Republic of China

4. Department of Esophageal and Gastrointestinal Surgery, The Sixth Hospital Affiliated to Sun Yat-Sen University, Sun Yat-Sen University Research Center of Diagnosis and Treatment of Gastric Cancer, Guangzhou, People's Republic of China

Abstract

Abstract Background Young survivors of gastric cancer (GC) have better prognoses than elderly patients, yet their disease-specific survival (DSS) has received little attention. Patients and Methods Data on young patients (aged ≤40 years) with GC undergoing resections at three Chinese institutions (n = 542) and from the SEER database (n = 533) were retrospectively analyzed. Three-year conditional disease-specific survival (CS3) was assessed. The effects of well-known prognostic factors over time were analyzed by time-dependent Cox regression. Results Overall, young Chinese patients with GC had a better 5-year DSS than U.S. patients (62.8% vs. 54.1%; p < .05). The disease-specific mortality likelihood of the entire cohort was not constant over time, with most deaths occurring during the first 3 years after surgery but peaking at 1 and 2 years in China and the U.S., respectively. Based on 5-year survivorship, the CS3 rates of both groups were similar (90.9% [U.S.] vs. 91.5% [China]; p > .05). Cox regression showed that for Chinese patients, site, size, T stage, and N stage were independent prognostic factors at baseline (p < .05). For U.S. patients, grade, T stage. and N stage significantly affected DSS at baseline (p < .05). In both groups, only T stage continuously affected DSS within 3 years after gastrectomy. However, for both groups, the initial well-known prognostic factors lost prognostic significance after 5 years of survival (all p > .05). Although the 5-year DSS rates of young Chinese patients with T3 and T4a disease were significantly better than those of young U.S. patients, in each T stage, the CS3 of both regions trended toward consistency over time. Conclusion For young patients with GC, the factors that predict survival at baseline vary over time. Although the initial 5-year DSS is heterogeneous, insight into conditional survival will help clinicians evaluate the long-term prognoses of survivors while ignoring population differences.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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