Retrospective Cohort Study
Copyright ©The Author(s) 2020.
World J Gastroenterol. Apr 14, 2020; 26(14): 1613-1627
Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1613
Table 1 Comparison of 18441 gastric cancer patients' characteristics
Characteristics, n (%)No. of PatientsBMI at diagnosis
P valueDrinkers
P valueSmokers
P value
< 18.518.5-22.923-27.4≥ 27.5NeverYesNeverYes
Ex-drinkersCurrent-drinkersEx-smokersCurrent-smokers
No. of patients18441 (100)1193 (6.5)6872 (37.3)7310 (39.6)2196 (11.9)-11578 (62.8)922 (5.0)5202 (28.2)-10244 (55.6)2315 (12.6)5156 (28.0)-
Gender
Male13533 (73.4)758 (63.5)4893 (71.2)5682 (77.7)1667 (75.9)6992 (62.0)874 (95.8)4948 (96.6)5903 (57.6)2220 (95.5)4974 (96.5)
Female4819 (26.1)435 (36.5)1979 (28.8)1628 (22.3)529 (24.1)< 0.0014286 (28.0)38 (4.2)174 (3.4)< 0.0014341 (42.4)95 (4.1)182 (3.5)< 0.001
Age at diagnosis (yr)
mean (SD)58.556.758.259.058.5< 0.00158.660.158.2< 0.00158.062.158.1< 0.001
Younger (≤ 35)653 (3.5)127 (10.7)289 (4.2)152 (2.1)61 (2.8)530 (4.6)13 (1.4)91 (1.8)520 (5.1)22 (1.0)93 (1.8)
Middle-aged (36-65)12119 (65.7)682 (57.2)4604 (67.0)5063 (69.3)1524 (69.4)7373 (63.7)657 (71.3)3887 (74.7)6640 (64.8)1415 (61.1)3872 (75.1)
Older (≥ 66)5235 (28.4)383 (32.1)1976 (28.8)2090 (28.6)609 (27.7)< 0.0013667 (31.7)252 (27.3)1220 (23.5)< 0.0013077 (30.0)877 (37.9)1188 (23.0)< 0.001
Weight loss as % of usual weight
None2858 (15.5)164 (13.8)821 (12.0)813 (11.1)276 (12.6)1629 (14.1)53 (5.8)642 (12.3)1437 (14.0)261 (11.3)625 (12.1)
0-1013814 (74.9)766 (64.2)5217 (75.9)5964 (81.6)1798 (81.9)8830 (76.3)766 (83.1)4030 (77.5)7825 (76.4)1835 (79.3)3980 (77.2)
≥ 101769 (9.6)263 (22.1)834 (12.1)533 (7.3)122 (5.6)< 0.0011119 (9.7)103 (11.2)530 (10.2)< 0.001982 (9.6)219 (9.5)551 (10.7)0.0001
Smoking status
Never smokers10244 (55.6)737 (61.8)3895 (56.7)4084 (55.9)1252 (57.0)9.081 (78.4)124 (13.5)1037 (19.9)---
Smokers7471 (40.5)435 (36.5)2875 (41.8)3128 (42.8)922 (42.0)0.0022488 (21.5)795 (86.2)4159 (80.0)< 0.001----
Current smokers5156 (28.0)339 (28.4)2076 (30.2)2059 (28.2)604 (27.5)1733 (15.0)250 (27.1)3158 (60.7)---
Ex-smokers2315 (12.6)96 (8.1)799 (11.6)1069 (14.6)318 (14.5)< 0.001755 (6.5)545 (59.1)1001 (19.2)< 0.001----
Time since quitting smoking
Short-term (1-9 yr)1505 (8.2)75 (6.3)535 (7.8)678 (9.3)197 (9.0)474 (4.1)422 (45.8)597 (11.5)0 (0.0)1505 (65.0)0 (0.0)
Long-term (≥ 10 yr)810 (4.4)21 (1.8)264 (3.8)391 (5.4)121 (5.5)< 0.001281 (2.4)123 (13.3)404 (7.8)< 0.0010 (0.0)810 (35.0)0 (0.0)< 0.001
No. of cigarettes (per day)
≤ 20 (1 pack)5568 (30.2)338 (28.3)2190 (31.9)2318 (31.7)642 (29.2)1919 (16.6)602 (65.3)3030 (58.3)0 (0.0)1770 (76.5)3798 (73.7)
21-39457 (2.5)22 (1.8)164 (2.4)198 (2.7)62 (2.8)144 (1.2)36 (3.9)276 (5.3)0 (0.0)115 (5.0)342 (6.6)
≥ 40 (≥ 2 packs)708 (3.8)32 (2.7)250 (3.6)302 (4.1)113 (5.2)< 0.001228 (2.0)76 (8.2)400 (7.7)< 0.0010 (0.0)208 (9.0)500 (9.7)< 0.001
Duration of smoking (yr)
1-292805 (15.2)131 (11.0)999 (14.5)1258 (17.2)383 (17.4)927 (8.0)372 (40.4)1497 (28.8)0 (0.0)1230 (53.1)1575 (30.6)
≥ 304037 (21.9)267 (22.4)1652 (24.0)1604 (21.9)449 (20.5)< 0.0011411 (12.2)359 (38.9)2252 (43.3)< 0.0010 (0.0)940 (40.6)3097 (60.1)< 0.001
Alcohol consumption
Never drinkers11578 (62.8)862 (72.3)4520 (65.8)4549 (62.2)1347 (61.3)---9081 (88.7)755 (32.6)1733 (33.6)
Drinkers6124 (33.2)311 (26.1)2247 (32.7)2655 (36.3)821 (37.4)< 0.001----1161 (11.3)1546 (66.8)3408 (66.1)< 0.001
Current drinkers5202 (28.2)272 (22.8)1909 (27.8)2249 (30.8)692 (31.5)---1037 (10.1)1001 (43.2)3158 (61.3)
Ex-drinkers922 (5.0)39 (3.3)338 (4.9)406 (5.6)129 (5.9)< 0.001----124 (1.2)545 (23.5)250 (4.9)< 0.001
Amount of alcohol consumption
Light drinkers (< 15.6 g/d)102 (0.6)3 (0.3)40 (0.6)48 (0.7)11 (0.5)0 (0.0)15 (1.6)87 (1.7)15 (0.2)42 (1.8)45 (0.9)
Moderate drinkers (≥ 15.6 g/d to < 53.5 g/d)660 (3.6)30 (2.5)246 (3.6)311 (4.3)62 (2.8)0 (0.0)77 (8.4)583 (11.2)127 (1.2)201 (8.7)329 (6.4)
Heavy drinkers (≥ 53.5 g/d)3480 (18.9)167 (14.0)1277 (18.6)1488 (20.4)501 (22.8)< 0.0010 (0.0)593 (64.3)2887 (55.5)< 0.001620 (6.1)894 (38.6)1962 (38.1)< 0.001
H. pylori
No1506 (8.2)67 (5.6)561 (8.2)668 (9.1)193 (8.8)837 (7.2)152 (16.5)489 (9.4)734 (7.2)272 (11.8)474 (9.2)
Yes1167 (6.3)56 (4.7)457 (6.7)503 (6.9)134 (6.1)< 0.001692 (6.0)74 (8.0)386 (7.4)< 0.001590 (5.8)169 (7.3)393 (7.6)< 0.001
Histologic type
Well351 (1.9)27 (2.3)107 (1.6)165 (2.3)48 (2.2)214 (1.9)24 (2.6)107 (2.1)185 (1.8)45 (1.9)115 (2.2)
Moderately5514 (29.9)257 (21.5)2004 (29.2)2390 (32.7)758 (34.5)2300 (28.5)288 (31.2)1829 (36.2)2789 (27.2)844 (36.5)1787 (34.7)
Poorly5824 (31.6)374 (31.4)2236 (32.5)2398 (32.8)730 (33.2)3922 (33.9)233 (25.3)1567 (30.1)3643 (35.6)612 (26.4)1475 (28.6)
Undifferentiated, anaplastic3 (0.0)0 (0.0)1 (0.0)2 (0.0)0 (0.0)< 0.0011 (0.0)0 (0.0)2 (0.0)< 0.0013 (0.0)0 (0.0)0 (0.0)< 0.001
pathologicT
p061 (0.3)2 (0.2)22 (0.3)27 (0.4)10 (0.5)41 (0.4)3 (0.3)17 (0.3)35 (0.3)7 (0.3)19 (0.4)
p12778 (15.1)131 (11.0)966 (14.1)1242 (17.0)412 (18.8)1810 (15.6)206 (22.3)721 (13.9)1663 (16.2)347 (15.0)729 (14.1)
p21524 (8.3)83 (7.0)528 (7.7)647 (8.9)243 (11.1)955 (8.3)75 (8.1)462 (8.9)834 (8.1)192 (8.3)467 (9.1)
p33340 (18.1)169 (14.2)1233 (17.9)1459 (20.0)443 (20.2)2051 (17.7)176 (19.1)1093 (21.0)1702 (16.6)497 (21.5)1120 (21.7)
p46545 (35.5)465 (39.0)2605 (37.9)2640 (36.1)708 (32.2)< 0.0014308 (37.2)266 (28.9)1882 (36.2)< 0.0013888 (38.0)812 (35.1)1765 (34.2)< 0.001
pathologicN
p04964 (26.9)274 (23.0)1758 (25.6)2184 (29.9)685 (31.2)3149 (27.2)304 (33.0)1436 (27.6)2785 (27.2)670 (28.9)1434 (27.8)
p12426 (13.2)161 (13.5)905 (13.2)1008 (13.8)313 (14.3)1577 (13.6)116 (12.6)709 (13.6)1357 (13.3)301 (13.0)744 (14.4)
p22549 (13.8)170 (14.3)1018 (14.8)997 (13.6)327 (14.9)1639 (14.2)116 (12.6)758 (14.6)1448 (14.1)316 (13.7)753 (14.6)
p34045 (21.9)226 (18.9)1570 (22.9)1717 (23.5)464 (21.1)< 0.0012633 (22.7)175 (19.0)1193 (22.9)0.0072384 (23.3)545 (23.5)1079 (20.9)0.018
pathologicM
p014785 (80.2)899 (75.4)5563 (81.0)6176 (84.5)1889 (86.0)9438 (81.5)770 (83.5)4373 (84.1)8348 (81.5)1971 (85.1)4273 (82.9)
p12233 (12.1)203 (17.0)943 (13.7)776 (10.6)211 (9.6)< 0.0011460 (12.6)110 (11.9)620 (11.9)< 0.0011332 (13.0)231 (10.0)628 (12.2)< 0.001
pTNM
I3340 (18.1)157 (13.2)1155 (16.8)1490 (20.4)500 (22.8)2139 (18.5)221 (24.0)16 (0.3)1928 (18.8)435 (18.8)922 (17.9)
II2334 (12.7)137 (11.5)843 (12.3)1012 (13.8)320 (14.6)1443 (12.5)147 (15.9)922 (17.7)1210 (11.8)317 (13.7)782 (15.2)
III7712 (41.8)481 (40.3)3005 (43.7)3180 (43.5)917 (41.8)5009 (43.3)312 (33.8)724 (13.9)4456 (43.5)1012 (43.7)2165 (42.0)
IV2233 (12.1)203 (17.0)943 (13.7)776 (10.6)211 (9.6)< 0.0011460 (12.6)110 (11.9)2301 (44.2)< 0.0011332 (13.0)231 (10.0)628 (12.2)< 0.001
Lauren classification
Intestinal2838 (15.4)126 (10.6)988 (14.4)1304 (17.8)388 (17.7)1549 (13.4)250 (27.1)995 (19.1)1279 (12.5)554 (23.9)962 (18.7)
Diffuse2610 (14.2)154 (12.9)1017 (14.8)1095 (15.0)318 (14.5)1660 (14.3)181 (19.6)726 (14.0)1547 (15.1)342 (14.8)680 (13.2)
Mixed1799 (9.8)68 (5.7)646 (9.4)795 (10.9)271 (12.3)< 0.0011010 (8.7)146 (15.8)621 (11.9)< 0.001897 (8.8)295 (12.7)583 (11.3)< 0.001
Linitis plastica
No17321 (93.9)1132 (94.9)6611 (96.2)7059 (96.6)2115 (96.3)11149 (96.3)892 (96.8)5011 (96.3)9844 (96.1)2244 (96.9)4978 (96.6)
Yes181 (1.0)23 (1.9)80 (1.2)59 (0.8)16 (0.7)0.005125 (1.1)9 (1.0)44 (0.9)0.55117 (1.1)18 (0.8)43 (0.8)0.17
Location
Proximal GC6704 (36.4)386 (32.4)2409 (35.1)2856 (39.1)913 (41.6)3870 (33.4)318 (34.5)2447 (47.0)3147 (30.7)1193 (51.5)2298 (44.6)
Distal GC9.992 (54.2)704 (59.0)3966 (57.7)3948 (54.0)1141 (52.0)6884 (59.5)517 (56.1)2417 (46.5)6354 (62.0)933 (40.3)2545 (49.4)
Total GC894 (4.9)56 (4.7)353 (5.1)355 (4.9)104 (4.7)< 0.001558 (4.8)55 (6.0)263 (5.1)< 0.001507 (5.0)127 (5.5)240 (4.7)< 0.001
Type of gastrectomy
Gastrectomy15204 (82.5)930 (78.0)5623 (81.8)6248 (85.5)1885 (85.8)9662 (83.5)773 (83.8)4278 (82.2)8533 (83.3)1961 (84.7)4230 (82.0)
No surgery3146 (17.1)263 (22.1)1246 (18.1)1061 (14.5)311 (14.2)< 0.0011916 (16.6)148 (16.1)924 (17.8)0.0191711 (16.7)353 (15.3)926 (18.0)0.005
Surgical margin
Negative13370 (72.5)791 (66.3)5012 (72.9)5650 (77.3)1730 (78.8)8623 (74.5)684 (74.2)3899 (75.0)7622 (74.4)1755 (75.8)3841 (74.5)
Positive443 (2.4)36 (3.0)163 (2.4)195 (2.7)41 (1.9)< 0.001297 (2.6)21 (2.3)120 (2.3)0.83263 (2.6)67 (2.9)108 (2.1)0.067
Additional therapy
No neo/adjuvant1564 (8.5)82 (6.9)520 (7.6)701 (9.6)241 (11.0)925 (8.0)128 (13.9)484 (9.3)840 (8.2)242 (10.5)456 (8.8)
Neoadjuvant354 (1.9)25 (2.1)158 (2.3)134 (1.8)33 (1.5)192 (1.7)43 (4.7)113 (2.2)171 (1.7)81 (3.5)97 (1.9)
Adjuvant4713 (25.6)244 (20.5)1743 (25.4)2044 (28.0)621 (28.3)3057 (26.4)198 (21.5)1383 (26.6)2782 (27.2)503 (21.7)1354 (26.3)
Neo + adjuvant613 (3.3)37 (3.1)222 (3.2)272 (3.7)77 (3.5)< 0.001353 (3.1)63 (6.8)190 (3.7)< 0.001319 (3.1)136 (5.9)154 (3.0)< 0.001
Table 2 Multivariate survival analysis
Prognostic factorsTotal (n = 18322)1
No surgery (n = 3142)2
Gastrectomy (n = 15180)3
Only curative gastrectomy (n = 13695)4
HR95%CI
P valueHR95%CI
P valueHR95%CI
P valueHR95%CI
P value
LowerUpperLowerUpperLowerUpperLowerUpper
Gender
Male1.001.001.001.00
Female1.051.001.110.061.070.971.190.191.050.991.110.131.040.971.110.25
Age at diagnosis (yr)
Younger (≤ 35)1.001.001.001.00
Middle-aged (36-65)1.070.951.190.260.940.761.150.541.140.991.300.061.151.001.330.05
Older (≥ 66)1.100.981.230.120.890.721.110.301.201.051.380.011.211.051.400.01
BMI (kg/m2) at diagnosis
< 18.51.000.921.090.991.010.871.180.901.000.901.100.931.020.921.140.72
18.5-22.91.001.001.001.00
23-27.40.970.931.020.220.920.841.020.110.990.941.050.730.990.941.050.74
≥ 27.50.990.921.060.720.950.821.100.481.010.931.100.851.020.931.110.74
Weight loss as % of usual weight
None1.001.001.001.00
0-101.141.071.20< 0.0011.161.041.300.011.131.051.2001.111.041.190
≥ 101.241.151.34< 0.0011.221.061.400.011.251.141.38< 0.0011.221.101.340
Smoking status
Never smokers1.001.001.001.00
Current smokers1.020.941.100.661.050.891.230.571.010.921.110.781.030.931.140.58
Ex-smokers0.930.841.030.170.950.761.190.660.930.821.040.200.910.811.030.15
Time since quitting smoking
Short-term (1–9 yr)1.001.001.001.00
Long-term (≥ 10 yr)1.040.911.190.551.020.781.340.871.050.901.220.511.070.911.250.42
No. of cigarettes (per day)
≤ 20 (1 pack)1.001.001.001.00
21-391.070.931.220.361.291.001.660.050.980.841.160.840.990.831.170.87
≥ 40 (≥ 2 packs)1.030.921.160.590.910.721.150.431.090.951.240.221.080.941.240.30
Duration of smoking (yr)
1-291.001.001.001.00
≥ 301.081.001.160.050.940.811.090.401.141.041.2401.131.041.240.01
Alcohol consumption
Never drinkers1.001.001.001.00
Current drinkers0.820.581.180.291.540.713.370.280.750.501.120.160.880.591.320.54
Ex-drinkers0.860.591.240.421.330.632.800.460.750.491.160.190.860.561.320.48
Amount of alcohol consumption
Light drinkers (< 15.6 g/d)1.001.001.001.00
Moderate drinkers (≥ 15.6 g/d to < 53.5 g/d)1.250.861.810.250.970.452.130.951.270.831.940.281.070.701.640.75
Heavy drinkers (≥ 53.5 g/d)1.250.881.790.210.780.371.660.521.370.912.060.131.150.771.730.50
pTNM
I1.001.001.001.00
II1.481.331.66< 0.0013.650.4529.500.231.481.321.65< 0.0011.381.231.56< 0.001
III2.312.122.52< 0.0014.070.5629.790.172.292.102.49< 0.0012.192.002.39< 0.001
IV3.192.863.55< 0.0014.410.6231.180.143.423.043.86< 0.0013.162.793.58< 0.001
Type of gastrectomy
Gastrectomy1.00---
No surgery1.511.401.63< 0.001------------