Adjuvant Studies in Gastric Cancer in the United States

Abstract

For reasons yet unknown, there has been a steady decrease in the rate of gastric cancer in the United States for the past four decades. Despite this providential decline, however, the estimated 1979 incidence of 23 000 new cases and 14 000 deaths continues to place gastric malignancy high on the list of formidable problems facing American oncologists. The World Health Statistics Manual shows a highly variable worldwide incidence rate, the most prevalent areas of gastric cancer being geographically widely separated countries such as Japan, Chile, Costa Rica, and Hungary. Among the 44 countries from which statistics have been compiled, the United States ranks No. 40 in males and No. 43 in females; and with few exceptions, the incidence in males is considerably higher than in females in the countries surveyed. The overall adjusted 5-year survival rates in the United States remain distressingly low, being 12% in males and 13% in females. However, in those patients with localized disease and hence favorable for surgical resection, the adjusted survival rates are approximately 40% [7]. Unfortunately the symptoms of gastric cancer are nonspecific and all too often appear late in the course of the disease, with only 18% of patients having a localized stage of disease at the time of diagnosis. Even when all obvious malignancy has been removed following surgical resection, appearance of recurrent or persistent disease remains a frequent and discouraging problem. This presentation will be concerned with a review of the clinical trials conducted in the United States in which other modalities of therapy have been combined with surgery in an attempt to prolong and augment the postoperative survival rate.