Annals of Surgical Oncology

, 14:348 | Cite as

Evaluation of Intensive Adjuvant Chemotherapy in Gastric Cancer Using Life Expectancy Compared with Log-Rank Test as a Measure of Survival Benefit




The goal of radical cancer surgery with or without adjuvant therapy is to cure disease rather than to delay death. There is concern that the survival benefit of curative treatment may not be properly appreciated by the log-rank test (LRT), which is more sensitive to treatment that delays death than to treatment that achieves cure. To confirm this concern and to evaluate the survival benefit of adjuvant chemotherapy, the data from a previous randomized controlled trial are analyzed using both traditional and new methods.


In this trial, 1410 gastric cancer patients with serosal or subserosal invasion had been classified by nodal and serosal status into four strata and randomized to receive high-dose or low-dose adjuvant regimens (mitomycin and tegafur-uracil) after gastrectomy. The two treatment groups were compared using the LRT as well as the life expectancy (LE) derived from the Boag model and the competing risk model.


The LRT showed no significant difference between the two groups, whereas the LE increased significantly with high-dose chemotherapy (1.4-year gain; 95% CI = 0.1–2.8). A greater gain of 4.4 years occurred exclusively in the serosa-negative node-positive stratum, associated with a 21% increase in cure rate. The gain in LE was particularly greater in younger patients.


Parametric LE analysis offers more relevant information about curative treatment than LRT. It suggests that high-dose chemotherapy may achieve cure in a subset of patients, eradicating residual malignancies left behind after gastrectomy and providing greater survival benefit than expected from LRT.


Log-rank test Life expectancy Gastric cancer Adjuvant chemotherapy Cure rate Boag model 



The authors are indebted to Dr. Inokuchi, former director of the Japanese Foundation for Multidisciplinary Cancer Therapy and Dr. Danno, representative of the T10 Group for providing the data.


  1. 1.
    Goldman AI. The cure model and time confounded risk in the analysis of survival and other timed events. J Clin Epidemiol 1991; 44:1327–1340PubMedCrossRefGoogle Scholar
  2. 2.
    Gamel JW, Vogel R. Comparison of parametric and non-parametric survival methods using simulated clinical data. Stat Med 1997; 16:1629–1643PubMedCrossRefGoogle Scholar
  3. 3.
    Maetani S, Nakajima T, Nishikawa T. Parametric mean survival time analysis in gastric cancer patients. Med Decis Making 2004; 24:131–141PubMedCrossRefGoogle Scholar
  4. 4.
    Gamel JW, Vogel RL, McLean IW. Assessing the impact of adjuvant therapy on cure rate for stage 2 breast carcinoma. Br J Cancer 1993; 68:115–118PubMedGoogle Scholar
  5. 5.
    Gamel JW, Vogel RL. A model of long-term survival following adjuvant therapy for stage 2 breast cancer. Br J Cancer 1993; 68:1167–1170PubMedGoogle Scholar
  6. 6.
    Boag JW. Maximum likelihood estimates of the proportion of patients cured by cancer therapy. J R Stat Soc 1949; B11:15–53Google Scholar
  7. 7.
    Haybittle JL. Life expectancy as a measurement of the benefit shown by clinical trials of treatment for early breast cancer. Clin Oncol 1998; 10:92–94CrossRefGoogle Scholar
  8. 8.
    Wright JC, Weinstein MC. Gains in life expectancy from medical interventions: standardizing data on outcomes. N Engl J Med 1998; 339:380–286PubMedCrossRefGoogle Scholar
  9. 9.
    Tan LB, Murphy R. Shifts in mortality curves: saving or extending lives? Lancet 1999; 554:1378–1381CrossRefGoogle Scholar
  10. 10.
    Gamel JW, Bonaddona G, Valagussa P, Edwards MJ. Refined measurement of outcome for adjuvant breast carcinoma therapy. Cancer 2003; 97:1139–1146PubMedCrossRefGoogle Scholar
  11. 11.
    Gross A, Clark VA. Survival distributions: reliability applications in the biomedical sciences. New York: John Wiley & Sons, 1975.Google Scholar
  12. 12.
    Danno M, Shiroto H, Kuni Y, et al. Study on the intensity of MMC and UFT in postoperative adjuvant chemotherapy for gastric cancer: study report of JFMTC study No. 10. Gan To Kagaku Ryoho 2001; 28:195–203PubMedGoogle Scholar
  13. 13.
    Kajitani T. The general rules for gastric cancer study in surgery and pathology. Jpn J Surg 1981; 11:127–145PubMedCrossRefGoogle Scholar
  14. 14.
    Working committee of the Japanese Society for Gastric Cancer. Japanese classification of gastric carcinoma, 1st ed. Tokyo: Kanehara & Co., 1995Google Scholar
  15. 15.
    Irwin JO. The standard error of an estimate of expectation of life, with special reference to expectation of tumourless life in experiments with mice. J Hygiene 1949; 47:188–189CrossRefGoogle Scholar
  16. 16.
    Simon R. Confidence intervals for reporting results of clinical trials. Ann Int Med 1986; 105:429–435PubMedGoogle Scholar
  17. 17.
    Choi JH, Chung HC, Yoo NC, et al. Gastric cancer in young patients who underwent curative resection. Comparative study with older patients. Am J Clin Oncol 1996; 19:45–48PubMedCrossRefGoogle Scholar
  18. 18.
    Nakajima T, Nashimoto A, Kitamura M, et al. Adjuvant mitomycin and fluorouracil followed by oral uracil plus tegafur in serosa-negative gastric cancer: a randomized trial. Lancet 1999; 354:273–277PubMedCrossRefGoogle Scholar
  19. 19.
    Neri B, de Leonardis V, Romano V. Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicenter randomized study. Br J Cancer 1996; 73:549–552PubMedGoogle Scholar
  20. 20.
    Tsavaris N, Tentas J, Kosmidis P, et al. A randomized trial comparing adjuvant fluorouracil, epirubicin and mitomycin with no treatment in operable gastric cancer. Chemotherapy 1996; 42:220–226PubMedCrossRefGoogle Scholar
  21. 21.
    Earle CC, Maroun JA. Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients. Revisiting a meta-analysis of randomized trials. Eur J Cancer 1999; 35:1059–1064PubMedCrossRefGoogle Scholar
  22. 22.
    Bajetta E, Buzzoni R, Mariani L, et al. Adjuvant chemotherapy in gastric cancer: 5-year results of a randomized study by the Italian Trials in Medical Oncology (ITMO) Group. Ann Oncco 2002; 13:299–307CrossRefGoogle Scholar
  23. 23.
    UICC. TNM Classification of Malignant Tumours. New York: Wiley-Liss, 1997, pp 59–62.Google Scholar
  24. 24.
    Nashimoto A, Nakajima T, Furukawa H, et al. Randomized trial of adjuvant chemotherapy with mitomycin, fluorouracil, and cytosine arabinoside followed by oral fluouracil in serosa-negative gastric cancer: Japan Clinical Oncology Group 9206-1. J Clin Oncol 2003; 21:2282–2297PubMedCrossRefGoogle Scholar
  25. 25.
    Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJH. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999; 340:908–914PubMedCrossRefGoogle Scholar
  26. 26.
    Maetani Y, Murakami M, Kuroda Y, Kobashi Y, Maetani S. Recurrence of advanced gastric cancer presenting bone marrow carcinosis 18 years after surgery: report of a case. Tenri Med Bull 1998; 1:79–88Google Scholar

Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  1. 1.Department of Abdominal SurgeryTenri Institute of Medical Research and Tenri Hospital, TenriJapan
  2. 2.Tenri Institute of Medical ResearchTenriJapan

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