Stage I gastric cancer with high-risk factors after surgery — adding herbal medicine raised 5-year survival from 55.5% to 81.4%

Across the papers in our ongoing "Cancer herbal medicine" series, the type of cancer differs but the conclusion is largely the same: adding herbal medicine to standard treatment helps survival. This gastric cancer study, however, starts from a slightly different angle. Its subjects are patients with stage I (early) gastric cancer — usually thought of as "surgery is enough" — but who carry high-risk factors that worsen the prognosis.

Stage I gastric cancer is not always something to take lightly

Gastric cancer (胃癌, gastric cancer) is the world's third-leading cause of cancer death and is common in Korea as well. Fortunately, stage I gastric cancer generally shows good survival with curative surgery (curative surgery) alone. But not for everyone. Patients with so-called high-risk factors — older age, high tumor grade, large tumor size — have a markedly worse prognosis even at the same stage I. Indeed, the 5-year survival of some early gastric cancers with high-risk factors has been reported to fall to around 50%.

For this reason, adjuvant treatment is considered for high-risk patients rather than surgery alone. So how much can herbal medicine help the survival of this high-risk group? This study addressed exactly that question head-on.

What 127 real-world medical records revealed

Published in 2023 in the international journal Journal of Traditional Chinese Medicine, this multicenter real-world study analyzed the medical records of 127 patients with stage I gastric cancer who underwent surgery at six hospitals in Yangzhou, China, between 2012 and 2020. It compared overall survival (overall survival, OS) and disease-free survival (disease-free survival, DFS) between 48 patients who took herbal medicine for 3 or more months after surgery and 79 who did not.

The results were clear. The 1-, 3-, and 5-year survival rates were 100%, 97.6%, and 81.4% in the herbal-medicine group — higher at every time point than the 91%, 64.5%, and 55.5% of the non-users, with the gap widening over time (P=0.006). Median disease-free survival was also longer in the herbal group at 49.7 months versus 36.5 months (P=0.001). In a multivariable analysis adjusting for multiple factors, herbal medicine was the only independent protective factor lowering the risk of death (overall-survival hazard ratio 0.28, disease-free-survival hazard ratio 0.34).

The benefit was greater when high-risk factors were present

The study also analyzed which factors worsened survival. It found that female sex, stage Ib, and blood vessel invasion (blood vessel invasion) were independent risk factors that raised the risk of death. Strikingly, it was in this very high-risk group that the benefit of adding herbal medicine was greatest.

Among female patients, median survival was 57.9 months in the herbal group — nearly double the 28.5 months of the non-users (P<0.0001). In stage Ib patients, too, the difference was clear at 51.3 versus 29.9 months (P=0.001). And among patients who did not receive chemotherapy, the gap was even larger: 59.7 months in the herbal group versus 19.3 months without (P=0.006). In other words, the worse a patient's expected prognosis, the clearer the benefit of continuing herbal medicine alongside standard care.

Which herbal medicines were used, and why did they help?

Most of the herbal medicine prescribed in this study was decoctions. What each prescription aimed at was not to attack the tumor directly but to restore the digestive function, immunity, and physical strength that decline after surgery.

This is the two-way strategy of "fu zheng qu xie" (扶正祛邪) — keeping the cancer in check while raising the body's own capacity to resist disease. The study also observed a trend toward lower mortality risk among patients who took herbal medicine for 6 or more months, though this was not statistically confirmed because of the small sample size.

Active herbal-medicine care after surgery

The message of this study is clear. Even for stage I gastric cancer, if high-risk factors are present, surgery is not the end — the care that follows to recover and maintain the body can shape survival. It is worth remembering that the benefit was greatest precisely in the high-risk group whose prognosis is of most concern. If you have had surgery for gastric cancer or are about to begin treatment, we close by encouraging you to consult thoroughly with a Korean-medicine specialist and steadily continue an herbal medicine prescription suited to you.