Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram Journal Article


Authors: Strong, V. E.; Song, K. Y.; Park, C. H.; Jacks, L. M.; Gonen, M.; Shah, M.; Coit, D. G.; Brennan, M. F.
Article Title: Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram
Abstract: Objective: To compare disease-specific survival (DSS) between the US and Korea following R0 resection for gastric carcinoma (GC). Summary background data: Many studies have described decreased 5-year survival after curative gastrectomy for GC in the West compared with the East. Although clinicopathological presentations of GC are known to vary widely between Eastern and Western countries, including histology, tumor location, and stage at presentation, it remains unclear whether these factors account for differences in survival. Methods: All patients undergoing curative intent resections (R0) for GC (1995-2005) were evaluated in 2 independent, single-institution prospectively maintained databases from the US (711 patients) and Korea (1646 patients). Patients receiving neoadjuvant chemotherapy were excluded from this analysis. Patient, surgical and pathologic variables were compared. DSS was determined via multivariate analysis using prognostic variables from an internationally validated GC nomogram that estimates the probability of 5-and 9-year survival. Results: Age and body mass index were significantly higher in US patients. Location of tumors was more often proximal in the United States (39% vs. 9%, P < 0.0001) and distal in Korea (54% vs. 33%, P < 0.0001). Korean patients had more early stage tumors (42% vs. 28% stage Ia, P < 0.0001) with a higher number of lymph nodes identified (97% vs. 79%, ≥15 lymph nodes, P < 0.0001). The 5-year DSS was higher in Korea than in the United States. After multivariate analysis, applying factors used in the nomogram, DSS of Korean GC patients remained significantly better than that of US patients (HR = 1.3, 95% CI; 1.0-1.6, P = 0.008). Conclusion:S This study demonstrates better survival for GC patients in Korea compared with the US as determined by multivariate analysis with a validated gastric cancer nomogram. Multiple possibilities can explain this difference. Copyright © 2010 by Lippincott Williams & Wilkins.
Keywords: adolescent; adult; cancer survival; controlled study; aged; aged, 80 and over; disease-free survival; middle aged; survival rate; young adult; major clinical study; united states; cancer staging; lymph node excision; lymphadenectomy; adenocarcinoma; tumor localization; neoplasm recurrence, local; validation study; body mass; nomograms; lymph node; clinical evaluation; esophagus resection; gastrectomy; intermethod comparison; stomach cancer; stomach adenocarcinoma; stomach carcinoma; stomach neoplasms; nomogram; korea
Journal Title: Annals of Surgery
Volume: 251
Issue: 4
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2010-04-01
Start Page: 640
End Page: 646
Language: English
DOI: 10.1097/SLA.0b013e3181d3d29b
PUBMED: 20224369
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: ANSUA" - "Source: Scopus"
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MSK Authors
  1. Murray F Brennan
    980 Brennan
  2. Mithat Gonen
    824 Gonen
  3. Manish Shah
    177 Shah
  4. Vivian Strong
    189 Strong
  5. Daniel Coit
    495 Coit
  6. Lindsay Jacks
    37 Jacks