What is the prognosis for gastric cancer?

Gastric Cancer Prognosis

Gastric cancer carries a poor prognosis with overall 5-year survival rates of 20-25% in unselected patients, primarily because most cases are diagnosed at advanced stages. 1

Stage-Specific Survival Rates

The prognosis varies dramatically by stage at diagnosis:

• Early gastric cancer (T1, limited to mucosa): 5-year survival exceeds 90% with appropriate surgical resection 1, 2
• Localized disease without lymph node involvement: 5-year survival approximately 75% with surgery alone 1
• Advanced/metastatic disease: 5-year survival drops to less than 10% when diagnosed at advanced stages 3
• Stage IV disease: Overall 5-year survival remains 20-25% in the general population 1

Geographic and Detection Differences

Early detection dramatically improves outcomes, explaining superior survival rates in screening populations. 1

• In Japan and South Korea with population-based screening programs, early detection results in significantly improved outcomes compared to Western countries 1
• The United States and Europe have poor early detection rates, contributing to persistently poor survival 1
• Early stage detection can achieve 5-year survival rates exceeding 85% 3

Prognostic Factors

Independent predictors of poor outcome include: 4

• Larger tumor size (≥5 cm)
• Advanced TNM stage
• Proximal tumor location (gastroesophageal junction/cardia)
• Presence of lymph node metastases
• Diffuse histologic type (particularly linitis plastica)
• Inadequate lymph node dissection (<14 nodes examined)

Proximal gastric cancers have significantly worse prognosis than distal tumors (5-year survival: 28% vs 51%, p<0.001) 4

Treatment Impact on Survival

Perioperative chemotherapy substantially improves survival in resectable disease: 5

• Surgery alone: 23% 5-year survival
• ECF regimen (epirubicin, cisplatin, 5-fluorouracil) perioperatively: 36.3% 5-year survival 5
• Adjuvant chemoradiation with 5-FU/leucovorin: 15% absolute improvement in 5-year overall survival 5
• Adjuvant S-1 (oral fluoropyrimidine) after D2 dissection: improved 3-year survival from 70.1% to 81.1% 5

Metastatic Disease Prognosis

For HER2-positive metastatic gastric cancer, trastuzumab plus chemotherapy improves median overall survival: 6

• Chemotherapy alone: 11.0 months median survival
• Trastuzumab plus chemotherapy: 13.5 months median survival (HR 0.73, p=0.0038) 6
• Greatest benefit in IHC3+ tumors: 18.0 months median survival versus 13.2 months with chemotherapy alone 6

Histologic Type and Prognosis

Intestinal-type gastric cancers associated with Lynch Syndrome have better prognosis than diffuse types: 1

• Intestinal-type tumors are more amenable to early endoscopic detection 1
• Diffuse-type gastric cancer (linitis plastica) has particularly poor prognosis and higher diagnostic delay 7
• Small bowel cancer in Lynch Syndrome patients has 5-year survival of only 30-35% 1

Diagnostic Delay Impact

Both patient delay (>3 months before seeking care) and physician delay (>3 months to diagnosis) occur in approximately 25% of cases each, though survival is primarily determined by tumor stage rather than delay duration. 7

Liver Metastasis Prognosis

Gastric cancer with liver metastases has extremely poor prognosis: 1

• 5-year survival rates range from 0% to 37% in highly selected surgical series 1
• Classified as intermediate-risk for hepatic metastasectomy with 5-year survival 15-30% in optimal candidates 1
• Long-term survivors typically have solitary metastasis only 1