Investigation and analysis of 3-year survival and influencing factors in patients with primary gastric cancer

Abstract

BACKGROUND

This study explores the 3-year survival outcomes and associated influencing factors in patients with primary gastric cancer treated via laparoscopic surgery, providing meaningful guidance for clinical management.

AIM

To evaluate and analyze the 3-year survival outcomes and associated risk factors in patients with primary gastric cancer who underwent laparoscopic surgery.

METHODS

A total of 100 patients with primary gastric cancer who underwent laparoscopic surgery at our hospital between January 2019 and December 2021 were enrolled. These patients were monitored for 3 years, and their survival statuses were recorded. Patients were categorized into survival and non-survival groups based on their outcomes. Data on sex, age, American Society of Anesthesiologists classification, tumor size, depth of invasion, postoperative adjuvant radio-chemotherapy, postoperative carcinoembryonic antigen (CEA) levels, and other clinical parameters were collected and contrasted across groups to identify factors impacting 3-year survival.

RESULTS

After a 3-year follow-up, the survival rate was 73.00% (73 of 100 patients). No significant differences were observed in sex, tumor location, alcohol consumption, smoking status, tumor differentiation, histological type, intraoperative blood loss, or surgical outcomes between patients with varying prognoses (P > 0.05). However, notable disparities were found in age, American Society of Anesthesiologists classification, tumor-node-metastasis (TNM) stage, tumor size, depth of invasion, lymph node metastasis, lymph node dissection, postoperative adjuvant radio-chemotherapy, postoperative CEA levels, surgical duration, extent of gastric resection, and postoperative complications (P < 0.05). Multivariate logistic regression analysis identified age, TNM stage, tumor size, depth of invasion, lymph node metastasis, lymph node dissection, postoperative adjuvant radio-chemotherapy, postoperative CEA levels, surgical duration, extent of gastric resection, and postoperative complications as independent predictors of 3-year survival in patients with primary gastric cancer following laparoscopic surgery (P < 0.05).

CONCLUSION

The 3-year survival outcome for patients undergoing laparoscopic surgery for primary gastric cancer was 73.00%. Key determinants of survival included age, TNM stage, tumor size, depth of invasion, and lymph node metastasis. This analysis of 3-year survival and its influencing factors offers novel perspectives for optimizing clinical interventions in patients with primary gastric cancer treated via laparoscopic surgery.

Key Words: Primary gastric cancer; Laparoscopic surgery; Survival; Influencing factors; Carcinoembryonic antigen

Core Tip: This study analyzed the 3-year survival rate and influencing factors of primary gastric cancer patients after laparoscopic surgery, offering guidance for clinical management. A retrospective study of 100 patients (2019-2021) showed a 73.00% survival rate. Multivariate analysis found key survival factors: Age, tumor-node-metastasis stage, tumor size, depth of invasion, and lymph node metastasis. These findings provide new perspectives to improve the prognosis of primary gastric cancer patients after laparoscopic surgery and emphasize the importance of multidisciplinary teamwork and individualized treatment plans in enhancing patients’ survival rates and quality of life.

INTRODUCTION

Primary gastric cancer, arising from gastric mucosal cells, is a highly prevalent malignant tumor within the digestive system. It predominantly affects individuals aged 50-70 years, with common clinical manifestations including weight loss, fatigue, upper abdominal pain, and hematemesis. In some cases, patients may present with gastric bleeding or perforation[1,2]. According to 2022 statistics, the top five causes of cancer-related deaths in China are lung, liver, gastric, colorectal, and esophageal cancers, with gastric cancer contributing to approximately 260400 fatalities[3]. Surgery remains a conventional therapeutic approach for primary gastric cancer and has demonstrated efficacy in extending patient survival. Laparoscopic surgery, known for its minimal invasiveness and high safety profile, has gained prominence in the management of primary gastric cancer. This technique reduces intraoperative trauma to normal tissues, preserves gastric tissue, and enhances surgical success rates through precise laparoscopic assistance[4,5].

Despite these advantages, primary gastric cancer retains a risk of postoperative recurrence following laparoscopic surgery, which may lead to reduced 3-year survival rates and adversely affect patient outcomes. Recently, postoperative survival in patients with primary gastric cancer has garnered significant attention. Several studies have explored postoperative survival and its influencing factors to implement targeted interventions aimed at improving patient prognosis. Consequently, this study sought to investigate and analyze the 3-year postoperative survival and associated influencing factors by evaluating 100 patients with primary gastric cancer who underwent laparoscopic surgery.

MATERIALS AND METHODS

General information

We selected 100 patients with primary gastric cancer who underwent laparoscopic surgery at our hospital between January 2019 and December 2021. There were 53 males and 47 females, with ages ranging from 39 to 79 years and an average age of (59.63 ± 5.26) years. The inclusion criteria were as follows: (1) Diagnosis of primary gastric cancer according to relevant standards and histopathological examination; (2) Patients who received laparoscopic surgical treatment; (3) Patients who were followed-up for 3 years; (4) Patients with complete clinical information; and (5) Patients who, along with their families, provided informed consent to participate in the study. The exclusion criteria were as follows: (1) Endocrine and metabolic diseases; (2) Other gastrointestinal diseases, such as appendicitis and duodenal ulcers; (3) Coagulation disorders; (4) Other malignant tumors, such as lung cancer; and (5) Lymph node metastasis.

Methods

Collection of clinical information: Clinical data were gathered from patient medical records and questionnaires, including general characteristics and treatment details. A 3-year follow-up was conducted to collect relevant follow-up information. The data collected encompassed sex, age, American Society of Anesthesiologists classification, tumor location, alcohol consumption, smoking habits, tumor differentiation, tumor-node-metastasis (TNM) stage, histological type, tumor size, depth of invasion, lymph node metastasis, lymph node dissection, postoperative adjuvant radio-chemotherapy, postoperative carcinoembryonic antigen (CEA) levels, surgical duration, intraoperative blood loss, extent of gastric resection, surgical outcomes, and postoperative complications.

Follow-up procedures: Patients underwent a 3-year postoperative follow-up via outpatient visits, telephone calls, and WeChat. The follow-up recorded 3-year survival rates, concluding in December 2024 or at the time of patient death.

Observational parameters: (1) 3-year survival analysis: A 3-year follow-up was conducted to document survival and mortality rates among the selected patients, categorizing them into survival and non-survival groups; (2) Comparison of clinical data: Clinical parameters between the survival and non-survival groups, such as age, sex, alcohol consumption, smoking status, and tumor differentiation, were compared; and (3) Factors influencing survival: Multivariate logistic regression analysis was employed to identify factors affecting the 3-year survival of patients with primary gastric cancer following laparoscopic surgery.

Statistical analysis

Statistical analyses were performed using SPSS 22.0. Categorical data (%) were analyzed using the χ² test. Continuous data (mean ± SD) adhering to a normal distribution were assessed with a t-test, while ordinal data were evaluated using the Z-test. A significance level of P < 0.05 was established for all analyses.

RESULTS

Analysis of 3-year survival outcomes

Among the 100 patients with primary gastric cancer who underwent laparoscopic surgery and were included in this study, a 3-year follow-up revealed a survival rate of 73.00% (73 patients survived, while 27 did not).

Comparison of clinical characteristics

No significant differences were observed in sex, tumor location, alcohol consumption, smoking status, tumor differentiation, or histological type between the survival and non-survival groups (P > 0.05). However, statistically significant differences were found in age, American Society of Anesthesiologists grade, TNM stage, tumor size, depth of invasion, lymph node metastasis, lymph node dissection, postoperative adjuvant radio-chemotherapy, postoperative CEA levels, surgical duration, extent of gastric resection, and postoperative complications (P < 0.05) (Table 1).

Table 1 Comparison of the clinical data between the two groups, n (%).

Index		Survival group (n = 73)	Death group (n = 27)	χ2/Z	P value
Sex	Male	38 (52.05)	15 (55.56)	0.097	0.755
	Female	35 (47.95)	12 (44.44)
Age (year)	< 60	60 (82.19)	14 (51.85)	9.430	0.002
	≥ 60	13 (17.81)	13 (48.15)
ASA	I-II	58 (79.45)	15 (55.56)	5.710	0.017
	≥ III	15 (20.55)	12 (44.44)
The located of tumor	Sinuses ventriculi	21 (28.77)	9 (33.33)	0.273	0.785
	Corpora ventriculi	30 (41.10)	10 (37.04)
	Preventriculus	22 (30.14)	8 (29.63)
Drink	Yes	26 (35.62)	14 (64.38)	2.165	0.141
	No	47 (51.85)	13 (48.15)
Smoke	Yes	23 (31.51)	10 (37.04)	0.273	0.602
	No	50 (68.49)	17 (62.96)
The degree of tumor differentiation	Tall	14 (19.18)	4 (14.81)	1.288	0.198
	Centre	26 (35.62)	6 (22.22)
	Below	33 (45.21)	17 (62.96)
TNM	Phase 1	36 (49.32)	5 (18.52)	3.847	< 0.001
	Phase 2	29 (39.73)	7 (25.93)
	Phase 3	8 (10.96)	15 (55.56)
Pathology type	Adenocarcinoma	39 (53.42)	15 (55.56)	0.343	0.731
	Mucinous adenocarcinoma	16 (21.92)	7 (25.93)
	Signet ring cell cancer	18 (24.66)	5 (18.52)
Tumor diameter	≤ 5 cm	44 (60.27)	10 (37.04)	4.284	0.038
	> 5 cm	29 (39.73)	17 (62.96)
Infiltration depth	T1 + T2	41 (56.16)	9 (33.33)	4.110	0.043
	T3 + T4	32 (43.84)	18 (66.67)
Lymphatic metastasis	Yes	20 (27.40)	15 (55.56)	6.870	0.009
	No	53 (72.60)	12 (44.44)
Nodal dissection	Yes	50 (68.49)	12 (44.44)	4.838	0.028
	No	23 (31.51)	15 (55.56)
Postoperative adjuvant chemoradiation therapy	Yes	52 (71.23)	11 (40.74)	7.862	0.005
	No	21 (28.77)	16 (59.26)
Postoperative CEA level	< 5 ng/mL	45 (61.64)	10 (37.04)	4.822	0.028
	≥ 5 mL	28 (38.36)	17 (62.96)
Operation time	≥ 3.5 hours	22 (30.14)	16 (59.26)	7.095	0.008
	< 3.5 hours	51 (69.86)	17 (40.74)
Intraoperative bleeding	≥ 200 mL	31 (42.47)	12 (44.44)	0.031	0.859
	< 200 mL	42 (57.53)	15 (55.56)
Gastrectomy range	Total gastrectomy	24 (32.88)	15 (55.56)	4.261	0.039
	The stomach was excised in large parts	49 (67.12)	12 (44.44)
Surgical effect	Complete remission	22 (30.14)	9 (33.33)	0.464	0.642
	Partial remission	29 (39.73)	8 (29.63)
	Stable disease	20 (27.40)	6 (22.22)
	Progression disease	2 (2.74)	4 (14.81)
Postoperative complications	Yes	22 (30.14)	14 (51.85)	4.034	0.045
	No	51 (69.86)	13 (48.15)

ASA: American Society of Anesthesiologists; TNM: Tumor-node-metastasis; CEA: Carcinoembryonic antigen.

Identification of factors impacting 3-year survival

Statistically significant single factors were selected as independent variables, with 3-year survival status serving as the dependent variable. These factors were dichotomized (coded as “0” for absence and “1” for presence) and included in a multivariate logistic regression model (Table 2). The analysis demonstrated that age, TNM stage, tumor size, depth of invasion, lymph node metastasis, lymph node dissection, postoperative adjuvant radio-chemotherapy, postoperative CEA levels, surgical duration, extent of gastric resection, and postoperative complications were independent predictors of 3-year survival in patients with primary gastric cancer following laparoscopic surgery (P < 0.05) (Table 3).

Table 2 Variable assignment methods for multivariate logistic regression analysis.

Variable	Value
Age	0: < 60, 1: ≥ 60
ASA	0: I-II, 1: ≥ III
TNM	0: I, 1: II, 2: III
Tumor diameter	0: I-II, 1: ≥ III
Infiltration depth	0: ≤ 5 cm, 1: >5 cm
Lymphatic metastasis	0: Yes, 1: No
Nodal dissection	0: Yes, 1: No
Postoperative adjuvant chemoradiation therapy	0: Yes, 1: No
Postoperative CEA level	0: < 5 ng/mL, 1: ≥ 5 ng/mL
Operation time	0: ≥ 3.5 hours, 1: < 3.5 hours
Gastrectomy range	0: Total gastrectomy, 1: The stomach was excised in large parts
Postoperative complications have occurred	0: Yes, 1: No

0: Absence; 1: Presence; ASA: American Society of Anesthesiologists; TNM: Tumor-node-metastasis; CEA: Carcinoembryonic antigen.

Table 3 Analysis of factors influencing survival at 3 years after laparoscopic surgery in patients with primary gastric cancer.

Variable	β	SD	Wald χ2	P value	OR	95%CI
Age	1.141	0.216	6.878	0.004	0.579	0.501-0.874
ASA	0.710	0.436	5.437	0.112	2.114	1.704-5.413
TNM	0.844	0.325	6.258	0.003	2.103	1.687-5.144
Tumor diameter	0.541	0.623	3.145	0.022	1.479	1.198-2.369
Infiltration depth
Lymphatic metastasis	1.204	0.211	10.782	< 0.001	2.009	1.325-5.697
Nodal dissection	1.397	0.159	9.456	0.002	0.789	0.514-0.988
Postoperative adjuvant chemoradiation therapy	1.114	0.279	9.887	< 0.001	0.611	0.514-0.892
Postoperative CEA level	1.354	0.778	9.146	< 0.001	1.556	1.045-2.984
Operation time	0.571	0.246	6.445	0.012	1.687	1.014-2.778
Gastrectomy range	0.556	0.214	5.336	0.029	1.781	1.146-2.842
Postoperative complications have occurred	1.145	0.789	2.114	0.006	0.148	0.026-1.234

OR: Odds ratio; CI: Confidence interval; ASA: American Society of Anesthesiologists; TNM: Tumor-node-metastasis; CEA: Carcinoembryonic antigen.

DISCUSSION

Primary gastric cancer is caused by a combination of various factors, including common causes such as Helicobacter pylori infection, precancerous lesions, genetic factors, and environmental factors. Additionally, poor or unhealthy diet can increase the risk of disease. Common treatment methods for primary gastric cancer include surgery, chemotherapy, and radiotherapy, among which surgery is the most important because it can remove pathological tissues and extend the patient’s survival period. In recent years, with the development of minimally invasive surgery, laparoscopic surgery has been gradually applied in the treatment of primary gastric cancer. It is characterized by minimal trauma, rapid postoperative recovery, and the ability to expand the surgical field under laparoscopic assistance, reducing damage to normal blood vessels during surgery, and more precise and meticulous lymph node dissection in the abdominal cavity, thereby further improving surgical outcomes[6,7]. However, mortality among patients with primary gastric cancer after laparoscopic surgery and the 3-year survival rate remain relatively low, affecting patient prognosis. In this study, the 3-year survival rate of 100 selected patients with primary gastric cancer who underwent laparoscopic surgery was only 73.00%, which confirms this hypothesis. To improve the 3-year survival rate of patients with primary gastric cancer after laparoscopic surgery, it is necessary to clarify the factors affecting patient survival to provide reasonable preventive and treatment measures.

Using univariate and multivariate logistic regression analysis, it was found that age, TNM stage, tumor diameter, invasion depth, lymph node metastasis, lymph node dissection, postoperative adjuvant chemotherapy, postoperative CEA level, operation time, gastric resection range, and postoperative complications were independent risk factors for the 3-year survival rate after laparoscopic surgery in patients with primary gastric cancer (P < 0.05).

Age

With an increase in age, the physical function of patients declines, and the body’s recovery ability and immune function also decline. Elderly patients are often accompanied by diabetes, hypertension, and other diseases. With age, the body’s tolerance to surgery declines, leading to a decrease in the 3-year survival rate of patients with primary gastric cancer after laparoscopic surgery[8]. TNM stage with tumor diameter and depth of invasion. TNM staging of malignant tumors is evaluated according to tumor size and lymphatic involvement, serving as an indicator of disease severity. In stage I, which represents the early stage of the disease, the tumor diameter is relatively small, infiltration depth is relatively low, and treatment difficulty is relatively low. After surgical treatment, the prognosis of patients is relatively good, and the 3-year survival rate is relatively high.

Lymphatic metastasis

Primary gastric cancer patients after cancer cell proliferation can exhibit diffusion to a certain extent, and diffusion mainly includes blood circulation and the lymphatic system. If cancer cells through lymph metastasis can affect the function of the organs in patients, it will not only increase the difficulty of treatment, but it will also affect the prognosis of patients, leading to decreased prognosis effect and 3 years survival rate after surgery[9]. With the progression of primary gastric cancer, tumor cell spread occurs, which increases the difficulty of treatment and affects the patient’s prognosis[10]. Lymph node dissection can effectively reduce the risk of tumor recurrence and metastasis, improve patient prognosis, and improve the 3-year survival rate. Radiation radiotherapy is a commonly used treatment for malignant tumors. It kills cancer cells by using high-energy radiation and suppresses their growth and spread of cancer cells. Cancer cells from patients with primary gastric cancer can spread to other parts of the body. Although laparoscopic surgery can remove the primary tumor, small lesions may remain. Radiotherapy after laparoscopy for primary gastric cancer can kill residual cancer cells, achieve a better prognostic effect, and improve the 3-year survival rate of patients after surgery.

Postoperative CEA level

CEA is a polysaccharide-rich protein complex commonly used clinically as a broad-spectrum tumor marker to aid in the diagnosis of malignant tumors[11,12]. Although CEA levels can be increased in various tumors, when its concentration is significantly increased, the body is at risk of developing digestive tract tumors[13]. For example, in gastric cancer, malignant tumors can be diagnosed early by detecting CEA levels and combining them with imaging information[14,15]. In addition, patients with primary gastric cancer still need to regularly monitor CEA levels after laparoscopic surgery. CEA levels indicate the risk of recurrence and poor prognosis, which may affect the 3-year survival rate of patients[16,17].

In addition to traditional treatment approaches, such as surgery and radio-chemotherapy, emerging therapies, such as immunotherapy and targeted therapy, have shown significant promise in improving survival outcomes in gastric cancer. Immunotherapy, particularly with immune checkpoint inhibitors (for example, programmed death 1/programmed death-ligand 1 inhibitors), has demonstrated efficacy in advanced gastric cancer by enhancing the body’s immune response against cancer cells[18]. For instance, studies involving pembrolizumab and nivolumab have reported improved progression-free survival and overall survival in patients with advanced gastric cancer, particularly those with programmed death-ligand 1-positive tumors[19]. Targeted therapies, such as trastuzumab for human epidermal growth factor receptor 2-positive gastric cancer, have also shown benefits in extending survival by specifically targeting the molecular pathways involved in tumor growth. These therapies offer new avenues for improving postoperative survival, reducing the risk of recurrence, complementing traditional treatments, and providing a more comprehensive approach for managing gastric cancer. Further research is needed to explore the integration of these therapies into clinical practice and their potential impact on the 3-year survival rate of patients undergoing laparoscopic surgery.

Operation time and extent of gastrectomy

Prolonged operative time in patients with primary gastric cancer is associated with increased stimulation and trauma to the intra-abdominal organs, thereby increasing the risk of intra-abdominal infection and adversely affecting the postoperative survival rate. The extent of gastrectomy is a critical factor. In the absence of gastric resection, patients with primary gastric cancer may experience damage to the diaphragm, increased risk of pulmonary complications, and increased damage to normal tissue of the body, which may affect the 3-year survival rate.

Postoperative complications have occurred

Common complications after laparoscopy in patients with primary gastric cancer include postoperative bleeding, anastomotic fistula, and adhesive intestinal obstruction. First, if the patient has a postoperative bleeding phenomenon, it indicates that surgery may damage the normal blood vessels of the body, which will affect the prognosis of the patient. Second, anastomotic fistulas can lead to severe pain and bleeding. If timely symptomatic treatment is not received, it may affect the patient’s life. Adhesion-type ileus is mainly due to compression of the intestinal tube in the abdominal cavity, which disrupts the normal intestinal function. Pre-development of adhesive intestinal obstruction can present with symptoms such as abdominal pain and distension. If treatment is not administered in a timely manner, patient survival may be shortened.

The present study has several limitations. First, the study period was from January 2019 to December 2021; given the rapid advancements in cancer treatment, including emerging therapeutic approaches such as immunotherapy, the inclusion of more recent data would have strengthened the study’s relevance to current clinical practice. Second, while the study highlights the importance of surgical and oncological interventions, it does not fully explore the benefits of a multidisciplinary approach. Collaborations with nutritionists, psychologists, and palliative care specialists were not incorporated, which might have provided a more comprehensive patient care model and potentially improved survival outcomes. These limitations should be considered when interpreting the study results and applying them in clinical settings.

CONCLUSION

This investigation found that the 3-year survival rate of primary gastric cancer was only 73.00%. The risk factors affecting postoperative survival were mainly age, TNM stage, tumor diameter, infiltration depth, lymph node metastasis, lymph node dissection, postoperative adjuvant radiotherapy and chemotherapy, postoperative CEA level, operation time, gastric resection range, postoperative complications, and effective prevention and control measures to improve the patient prognosis.