Survival trends in gastric cancer patients between 1987 and 2016: a population-based cohort study in Finland

Patients

Of the total 22,330 gastric cancer patients, 18,713 (83.8%) had non-cardia cancer and 3617 (16.2%) had cardia cancer during 1987–2016. After exclusion of 797 neuroendocrine tumors, 518 other types of tumors such as squamous cell carcinoma, melanoma, mesenchymal cancer, and gastrointestinal stromal tumor, and 3275 patients without any information on histology available, there were 18,713 histologically confirmed gastric non-cardia adenocarcinomas, and 3617 gastric cardia adenocarcinomas included in the analysis. The number of both cardia and non-cardia adenocarcinoma patients decreased over time. Most gastric adenocarcinomas occurred at the age of 70–79 years. There were more men with gastric non-cardia (52.6%) and cardia adenocarcinoma (70.0%) than women. Most gastric adenocarcinoma patients did not undergo chemotherapy and the majority had advanced cancer stages (Table 1). The demographics in all gastric cancer types were highly similar to histologically confirmed gastric adenocarcinomas. The number of gastric cardia cancer of any histology, however, remained constant over time (Supplementary Table 1).

Table 1 Histologically confirmed gastric non-cardia and cardia adenocarcinoma patients stratified by calendar period, age, sex, CCI, surgical treatment, chemotherapy, and cancer stageSurgery

A total of 9613 (43.0%) gastric adenocarcinoma patients underwent surgical treatment. For gastric non-cardia adenocarcinoma, the proportion of surgical treatment was larger 8293 (44.3%) than for gastric cardia adenocarcinoma (1320, 36.5%, Table 1). The proportion of patients who had undergone surgery decreased from 45.0% to 34.0% for gastric non-cardia adenocarcinoma (Fig. 1a), but remained constant for gastric cardia adenocarcinoma between 1987 and 2016 (Fig. 1b). In the separate analysis of gastric cancers of any histology, the proportion of patients who underwent surgery declined in both gastric cardia and non-cardia cancers (Supplementary Fig. 1).

Fig. 1figure 1

Graphs showing number of histologically confirmed gastric non-cardia adenocarcinoma a and gastric cardia adenocarcinoma b patients diagnosed in Finland between 1987 and 2016. The curves show the number of patients diagnosed (blue line) and proportion of patients undergoing surgery (orange line)

Survival trends in gastric non-cardia cancerAll patients

In all patients with gastric non-cardia adenocarcinoma, the 5-year survival rate decreased from 17% during 1987–1991 to 16% in 2012–2016 (Table 2; Fig. 2a). For gastric cancer patients of any histology, the 5-year survival rate increased from 19% during 1987–1991 to 24% during 2012–2016 (Supplementary Table 2, Supplementary Fig. 2a).

Table 2 One- year-, 3-year-, and 5-year survival in histologically confirmed gastric adenocarcinoma (non-cardia and cardia) stratified by treatment during 1987–2016Fig. 2figure 2figure 2figure 2

Kaplan–Meier survival curves showing 5-year survival rate for histologically confirmed gastric non-cardia adenocarcinoma a and gastric cardia adenocarcinoma b in all patients, for gastric non-cardia adenocarcinoma c and gastric cardia adenocarcinoma d undergoing surgery, and for gastric non-cardia adenocarcinoma e and gastric cardia adenocarcinoma f not undergoing surgery, stratified by 5-year time periods

Surgical patients

The 5-year survival rate in patients who underwent surgical treatment for gastric non-cardia adenocarcinoma improved from 29% during 1987–1991 to 38% during 2012–2016 (Table 2, Fig. 2c). Similarly, increasing survival (31% to 44%) was observed for gastric cancers of any histology (Supplementary Table 2, Supplementary Fig. 2c).

Non-surgical patients

Among the patients without surgical treatment for gastric non-cardia adenocarcinoma, the 5-year survival declined from 7% during 1987–1991 to 4% during 2012–2016 (Table 2, Fig. 2e). The 5-year survival rate increased from 4% during 1987–1991 to 7% during 2012–2016 in those patients undergoing chemotherapy only, whereas the survival rate declined from 6% to 3% in those not going through any treatment (Supplementary Table 3, Supplementary Fig. 3c, 3e). In the analysis of all gastric histological gastric cancer types, the 5-year survival of patients not undergoing surgery increased from 11% during 1987–1991 to 15% during 2012–2016 (Supplementary Table 2, Supplementary Fig. 2e).

Cancer stage

The 5-year survival increased in gastric non-cardia adenocarcinoma patients from 45% to 57% in those with local cancer stage, from 17% to 26% in those with locally advanced cancer stage, and only slightly from 2% to 3% in those with advanced cancer stage between 1987–1991 and 2012–2016 (Table 3, Supplementary Fig. 4a, 4c, 4e).

Table 3 One-year-, 3-year-, and 5-year survival in histologically confirmed gastric adenocarcinoma (non-cardia and cardia) stratified by cancer stage during 1987–2016Survival trends in gastric cardia cancerAll patients

The 5- year survival rate in all patients with gastric cardia adenocarcinoma improved from 10% to 18% between the first and last calendar period (Table 2; Fig. 2b). In the analysis of all gastric cancers, the 5-year survival improved from 11% to 22% (Supplementary Table 2, Supplementary Fig. 2b).

Surgical patients

In patients who underwent surgical treatment for gastric cardia adenocarcinoma, the 5-year survival rate increased from 16% during 1987–1991 to 40% during 2012–2016 (Table 2; Fig. 2d). Similarly, increasing survival over time (18%–45%) was observed in all gastric cancers (Supplementary Table 2, Supplementary Fig. 2d).

Non-surgical patients

Among those who had not undergone surgical treatment for gastric cardia adenocarcinoma, the 5-year survival rate increased from 5% during 1987–1991 to 7% during 2012–2016 (Table 2; Fig. 2f). Similarly, an increase from 6% to 12% was observed in all gastric cancers (Supplementary Table 2, Supplementary Fig. 2f). Among non-surgical patients, the 5-year survival increased from 0% during 1987–1991 to 5% during 2012–2016 in those who underwent chemotherapy only, and from 5% to 9% between 1987–1991 and 2012–2016 in patients who received no treatment (Supplementary Table 3, Supplementary Fig. 3d, 3f).

Cancer stage

The 5-year survival increased in gastric cardia adenocarcinoma patients from 26% to 55% in those with local cancer stage, from 5% to 24% in those with locally advanced cancer stage, and from 1% to 4% in those with advanced cancer stage between 1987–1991 and 2012–2016 (Table 3, Supplementary Fig. 4b, 4d, 4f).

Risk factors for 5-year mortality in gastric non-cardia cancer

In the multivariable cox-regression analysis of all patients with gastric non-cardia adenocarcinoma, earlier calendar periods (HR 1.08, 95% CI 1.02–1.15 in 1987–1991 vs 2012–2016), older age groups (HR 2.92, 95% CI 2.64–3.24, age 90 + vs age > 50), higher comorbidity score (HR 1.22, 95% CI 1.14–1.32, CCI 3 + vs 0), and male sex (HR 1.07, 95% CI 1.03–1.10, male vs female) were observed to be associated with an increased risk of mortality. The risk factors were similar in patients undergoing surgery and not undergoing surgery, with the exception that comorbidity was not a risk factor for mortality in those not undergoing surgery (Table 4). In the analysis of all gastric cancers, the risk factors were the same as in gastric adenocarcinoma, with comorbidity in addition in those not undergoing surgery (Supplementary Table 4).

Table 4 Multivariable cox-regression analysis of risk of mortality during 5-year follow-up in all histologically confirmed gastric non-cardia adenocarcinoma patients and stratified by surgical treatmentRisk factors for 5-year mortality in gastric cardia cancer

In the multivariable cox-regression analysis of all patients with gastric cardia adenocarcinoma, the risk factors of mortality were earlier calendar periods (HR 1.49, 95% CI 1.30–1.71 in 1987–1991 vs 2012–2016), older age groups (HR 2.03, 95% CI 1.59–2.60, age 90 + vs > 50), male sex (HR 1.05, 95% CI 0.97–1.14, male vs female), and high comorbidity score (HR 1.33, 95% 1.14–1.55, CCI 3 + vs 0) (Table 5). The risk factors were similar in patients undergoing surgery and not undergoing surgery, with the exception that male sex was not a risk factor for mortality in those not undergoing surgery. The results were similar in all gastric cancers with the male sex being associated with poor survival in both non-surgical and surgical groups (Supplementary Table 5).

Table 5 Multivariable cox-regression analysis of risk of mortality during 5-year follow-up in all histologically confirmed gastric cardia adenocarcinoma patients and stratified by surgical treatment

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