Although many studies of the prognostic factors in patients with gastric carcinoma have been reported, only a few have examined the prognosis of FGC patients. Therefore, we analyzed the clinicopathologic features of FGC patients undergoing curative resection and their surgical outcomes.
The incidence of gastric carcinoma is known to be higher for men than for women.1
Chandanos and Lagergren reported that the incidence of gastric carcinoma shows a male dominance, with a male-to-female ratio of about 2:1. They suggested that the male dominance in the incidence of gastric carcinoma can at least be partly explained by a protective effect of estrogen in women.10
In agreement with their result, the male-to-female ratio in the present study was 1.9:1.
There was a difference in histologic differentiation between FGC and MGC patients. Poorly differentiated histology was more common in FGC patients than in MGC patients, as in Yu and Zhao's11
report. However, the use of histologic differentiation as a prognostic factor is another controversial subject, although several studies have examined the prognostic relevance of histologic grade in patients with gastric carcinoma. Furthermore, our study showed that histologic differentiation had no statistical significance as a prognostic factor.
Traditionally, the depth of invasion and the presence or absence of lymph node metastasis are the most important clinicopathologic factors influencing the prognosis of patients with gastric carcinoma.12
In the present study, multivariate analysis showed that three factors were independent, statistically significant parameters associated with survival: serosal invasion, lymph node metastasis, and operative type.
Lymph node metastasis is thought to be an important prognostic factor in carcinoma of the stomach. In this study, the lymph node metastasis was an important prognostic factor in FGC patients. Bonezziti et al.2
found that female patients with negative nodes at pT1 or pT2 had better survival. Bando et al.15
also reported that sex should be taken into account as well as clinicopathological variables related to lymph node metastases when determining appropriate therapy for early gastric carcinoma. Schafmayer et al.16
reported that the extent of lymphadenectomy influenced long-time survival in female patients with gastric carcinoma.
In gastric carcinoma, the depth of wall invasion is another important prognostic factor in addition to lymph node metastasis. Moriguchi et al.12
and Adachi et al.14
demonstrated that the depth of wall invasion provides useful prognostic information in patients with gastric carcinoma.
Some studies have suggested that the extent of gastric resection was a significant independent predictor of survival in patients with node-positive gastric carcinoma. Kim et al.17
found that patients who had a distal gastrectomy showed a significantly better long-term prognosis than did patients who underwent total gastrectomy. They interpreted their results in terms of indications for total gastrectomy and the relative risks for more distant and extensive lymph node metastasis.
Several studies have reported a better prognosis for women than for men.2
Similar to these results, we observed a positive significant effect of female gender on survival outcome in our study. Our results showed that the overall 5-year survival rate of the FGC patients was significantly higher than that for MGC patients (53.4% vs. 47.6%; p=0.010). When FGC patients were divided into those with early and those with advanced carcinoma, the overall 5-year survival rate of the early FGC patients was significantly higher than that of the MGC patients (94.3% vs. 86.1%; p=0.0462). However, the overall 5-year survival rates of advanced FGC and MGC patients with curative resection did not differ statistically (41.63% vs. 37.4%; p=0.0766) in this study. This suggests that early detection is important to achieve better survival rates. With regard to long-term survival, Schafmayer et al.16
reported that no significant difference could be shown between men and women. However, splenectomy had a significant effect on long-term survival between the two groups. When the spleen was preserved, women showed a significantly improved survival rate compared with men with preserved spleens. Therefore, those authors proposed that gender differences should be taken into account when analyzing the long-term data of oncological patients.16
Kim et al.8
proposed that sex hormones such as estrogens contribute to the survival differences between men and women with gastric carcinoma.
In conclusion, serosal invasion, lymph node metastasis, and type of operation were statistically significant parameters associated with survival. Also, we found that the overall 5-year survival rate of FGC patients with curative resection (53.4%) was higher than that of MGC patients. In advanced cases, however, no significant difference was observed in the overall 5-year rate between the FGC and MGC patients. Therefore, early detection is more important for improving the prognosis of female patients with gastric cancer than for male patients.