Shifting proportions of gastric adenocarcinomas
J. C. Salvon-Harman, B. Cady, S. Nikulasson, U. Khettry, M. D. Stone and P. Lavin
Tufts University School of Medicine, Boston, Mass.
OBJECTIVES: To substantiate reports of increasing proportions of gastric
adenocarcinoma of diffuse histologic type and in the proximal portion of
the stomach, to better understand the prognostic features that govern
survival, and to determine whether alterations of operative strategy might
improve the surgical results. DESIGN: Retrospective analysis of 289
consecutive patients with gastric adenocarcinoma operated on by general
surgeons over a 26-year period. Records were reviewed for location,
histologic type, resection, operative mortality, lymph node status, and
outcome. SETTING: The Section of Surgical Oncology, the New England
Deaconess Hospital, Boston, Mass. MAIN OUTCOME MEASURES: Survival rate,
length of life of the patients who died, and operative mortality. RESULTS:
A marked and significant shift of gastric adenocarcinoma to a proximal
location (54% between 1985 and 1990) occurred over 26 years (P = .0075)
with a significant stage improvement at presentation (P = .0235).
Percentages of cancers that were of the diffuse, poorly differentiated
histologic type increased to 48%. More curative operations were performed
in the last period (61%), and this upward trend from 37% was significant.
Proximal gastric cancers had a poorer prognosis with more operative deaths,
more lymph node metastases, and worse survival rates than distal cancers.
Poor survival rates occurred even when comparing patients with negative
lymph nodes or favorable histologic features with patients with similar
distal cancers. CONCLUSIONS: Despite significant increases in the
proportion of proximal cancers, survival rates have improved only slightly.
Nodal status plays a less prognostic role than does location or histologic
type but does provide prognostic information for individual locations.
Survival rates for diffuse histologic cancer were consistently worse than
those for intestinal histologic cancer, which emphasizes the underlying
disease biology controlling outcome. Radical lymphadenectomy for gastric
adenocarcinoma would not improve surgical outcome in the United States.
