Pathology and prognosis of carcinoma of the stomach

Abstract

The pathology and prognosis of 205 patients treated by total or partial gastrectomy for carcinoma of the stomach during the years 1951-5 have been evaluated. One hundred and sixteen patients (61 per cent) had a partial gastrectomy and 74 (39 per cent) had a total gastrectomy. The overall postoperative mortality was 25 per cent and this was greater for total than for partial gastrectomy. The crude survival rate was 19.4 per cent at 5 years and 11.4 per cent at 10 years. Carcinoma of the cardia had a worse prognosis than tumours at other sites. There were no 5-year survivors among patients with the linitis plastica type of carcinoma of the stomach. Tumours classified as poorly differentiated or anaplastic carcinoma had a poorer prognosis than well-differentiated adenocarcinomas. The amount of lymphocytic and plasma-cell infiltration of the tumour has a very significant effect on prognosis. Five out of the 7 patients with a heavy infiltrate of such cells survived over 5 years. Lymph-node involvement is the feature having the greatest influence on prognosis. There was a 40 per cent 5-year survival rate in the absence of node involvement and an 11 per cent 5-year survival rate with involved nodes. Patients with involved nodes surviving over 5 years had, on the average, fewer positive glands than those with involved nodes who survived for less than 5 years. No benefit follows from total rather than partial gastrectomy provided the cancer and regional lymph-nodes can be removed with the simpler procedure. Four case reports are presented to illustrate the difficulties in assessing the prognosis of gastric cancer.