Stage-dependent survival in gastric cancer: a Danish nationwide cohort study

BACKGROUND: Gastric cancer remains a major clinical challenge with poor prognosis. This study investigated survival outcomes based on treatment strategy, tumor stage, and histology in Danish gastric cancer patients.

METHODS: From January 2013 to December 2021, 2,156 gastric cancers were registered in the Danish Esophagogastric Cancer Group database, covering 99% of national cases. Data were analyzed for patients with intestinal and diffuse-type cancers. Survival was assessed using Kaplan-Meier curves and Cox regression, adjusting for tumor stage, treatment, and demographics.

RESULTS: Median survival was significantly higher with surgery ± perioperative chemotherapy (SCT) than with palliative treatment. For the intestinal-type cancers, SCT resulted in a median survival of 45.2 months (95% CI [35.4-55.1]) versus 5.1 months (95% CI [4.6-5.7]) with palliative treatment. Patients with diffuse type, treated with SCT had a median survival exceeding 128 months, compared with 6.3 months (95% CI [5.2-7.5]) with palliative treatment. Patients receiving epirubicin based CT had a lower risk of death (HR 0.74, p = 0.04) compared with upfront surgery, while FLOT (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel) similarly reduced the risk of death (HR 0.69, p = 0.04). No significant difference was observed between the two CT regimens. Palliative CT and radiotherapy improved survival over best supportive care (p < 0.001). Advanced tumor stage was associated with worse survival, while the histological subtype had no impact on overall survival outcomes.

CONCLUSION: This study emphasizes the survival benefit of multimodal treatment strategies, especially surgery combined with perioperative CT. Palliative interventions also improved outcomes in advanced disease.