Interest in leading prognostic determinants of proximal gastric adenocarcinoma (PGA) in comparison with distally located adenocarcinoma (DLA) of the stomach led to an analysis of data from 506 patients with PGA and 484 patients with DLA operated on between 1 April 1982 and 31 October 1984 and participating in a multicentre observational study to validate tumour node metastasis (TNM) stage groupings. The proportion of men with PGA was slightly higher than that of men with DLA (69 versus 63 per cent). Men more often had cardia carcinomas than women (14 versus 9 per cent); 74 per cent of these men but only 43 per cent of the women were less than 65 years old. Evaluation of data by a log-linear model indicated a strong partial association (P less than 0.001) between age and site; patients younger than 65 years more often had PGA than older patients. Advanced tumour stage and the intestinal type of carcinoma were more frequently seen in the elderly. More than twice as many patients with PGA in comparison with those with DLA (35 versus 15 per cent) had palliative surgery (moderate association, P less than 0.05). This may have resulted from different stages at different sites; advanced carcinomas (TNM stages IIIb and IV) were more often diagnosed in patients with PGA than in those with DLA (60 versus 38 per cent). Residual tumour left after surgery was associated with deeper infiltration (P less than 0.001). No difference between PGA and DLA groups with respect to histological type of carcinoma was established, but residual tumour was more frequently associated with a diffuse type carcinoma (P less than 0.01). An overall tendency to poorer long-term prognosis in PGA was seen for all TNM stages, with and without residual tumour, except for TNM stage II with residual tumour, even though patients with PGA were younger than those with DLA. These differences in long-term prognosis, however, are based primarily on poorer short-term survival for PGA, particularly for TNM stages Ib and II without residual tumour. A significant risk of surgical management, particularly for early-stage tumours situated in the upper part of the stomach, has therefore been recognized. Surgeons should appreciate the higher surgical mortality rate for patients with PGA when curative treatment requires more risky surgical techniques.
This multicenter observational study examined the survival of 1420 patients with histologically proven carcinoma of the stomach. From April 1982 through October 1984, 1360 (95%) patients underwent surgery, 988 (72%) had resections, and 372 (28%) minor surgical procedures. The percentage of patients who have been followed until death or 3 to 5 years was 99.4%. Patients were staged preoperatively and intraoperatively and by pathologists using the old (1978) and new (1987) TNM stage groupings and 5-year survival was analyzed. Subgroups of patients who changed their stage group according to the new stage definitions were analyzed separately. Only age was an important prognostic factor for survival in Stage IA (P less than 0.05) and Stage IB (P less than 0.01). Residual tumor after surgery was most important for survival in Stage II (P less than 0.01) and Stage IIIA (P less than 0.001). This indicates that improvements of stage definitions for individual prognosis can only be achieved by adding data concerning the presence or absence of residual tumor (R classification).
of life in gastric cancer. Karnofsky's scale and Spitzer's index in comparison at the time of surgery in a cohort of 1081 patients. Scand J Gastroenterol 1987, 22(suppl Karnofsky's performance status scale (KS) and Spitzer's quality of life index (QLI)were used to assess the quality of life of 1081 patients with histologically proven gastric cancer who entered the German multicentre observational field study for the validation of the TNM system for gastric cancer. Age and sex distribution and interscale correlation were examined to obtain information about the validity of the KS and the quality of life of gastric cancer patients. Age and sex distributions revealed two trends: men seemed to have better KS and QLI values than women, and old patients had worse QLI values than young patients. The interscale correlation gave a good -0.72 Spearman's rank correlation coefficient ( p < 0.001). These results showed that KS and QLI had comparable age and sex distributions among gastric cancer patients. Together with the good interscale correlation this means a mutual confirmation of both concepts and of the first contributions for the validation of KS.
98 consecutive patients (40 men, 58 women; mean age 49 [17-83] years) who had been referred for outpatient gastroscopy or colonoscopy were questioned beforehand regarding their anxiety about the procedure, its causes and how it could be dispelled. Two thirds of them (67%) stated that they felt anxiety about the investigation; almost half of them (46%) felt very great or "terrible" anxiety. 55% of the patients had been fully informed about the nature of the procedure. 69% of the women and 48% of the men had previously experienced gastroscopy or colonoscopy. The reasons for their anxiety were varied. One quarter of those questioned (24%) had had unpleasant experiences during previous endoscopies; others had been alarmed by rumours about endoscopy (22%), and some were less worried about the procedure itself than about what it might reveal (24%). Almost two thirds (63%) wanted a tranquilizing injection. Other methods for dispelling anxiety, such as detailed information about the procedure (21%), a calm, relaxed atmosphere (19%) or the presence of a relative at the endoscopy (7%) were claimed for in a limited way. However, 37% very much wanted to watch the endoscopy on the television monitor. The findings show that the number of patients who experience anxiety before undergoing endoscopy is alarmingly great, and that more energetic measures are necessary to relieve their fears and worries.
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