Clinicopathological Characteristics and Prognosis of Proximal and Distal Gastric Cancer during 1997–2017 in China National Cancer Center

Abstract

Background. The prognostic relevance of gastric tumor location has been reported and debated. Our study was conducted to examine the differences in clinicopathological features, prognostic factors, and overall survival (OS) between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC). Patients and Methods. Patients with PGC or DGC were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) during 1997–2017. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models. Results. We reviewed 16,119 cases of gastric cancer patients, including 6,479 of PGC and 9,640 of DGC. PGC patients presented as older patients (61.5 versus 56.4 years, P<0.001) and more males (82.9% versus 68.2%, P<0.001). Compared with DGC, PGC was more likely to be in later pT stage (pT3 and pT4, 65.0% versus 52.8%, P<0.001) and lymph node metastasis (54.8% versus 50.9%, P<0.001). In univariate analysis, PGC patients had a worse survival outcome in stage I (Hazard ratio [HR] = 2.04, 95% CI: 1.42-2.94) but a better prognosis in stage IV (HR = 0.85, 95% CI: 0.73-0.98) when compared to DGC patients. However, multivariate analysis demonstrated that PGC was not an independent predictor for poor survival (HR = 1.07, 95% CI: 1.00-1.14). Results from multivariate analysis also revealed that pT4, lymph node metastasis, distant metastasis, no gastrectomy, and Borrmann IV were independent predictors associated with poor survival for both PGC and DGC patients. Additional prognostic factors for PGC patients included underweight (BMI < 18.5) (HR = 1.29, 95% CI: 1.06-1.58), linitis plastica (HR = 2.13, 95% CI: 1.25-3.65), and overweight (23 ≤ BMI <27.5) (HR = 0.80, 95% CI: 0.71-0.90). During the 20-year study period, the 5-year OS increased significantly for both PGC and DGC, with the increase rate of 91.7% and 67.7%, respectively. Conclusion. In China, PGC significantly differed from DGC in clinicopathological characteristics and prognostic factors. However, there was no significant relationship between survival outcome and gastric tumor location.

Is cardia cancer a special type of gastric cancer? A differential analysis of early cardia cancer and non-cardia cancer

“…The two main sites of gastric cancer are proximal gastric (cardia) and distal gastric (non-cardia) 10 . Although the incidence rate of non-cardia cancer has declined in Western countries, that of cardia cancer has been increasing since 1970s 11 , 12 .…”

Serum level of interleukin‐35 as a potential prognostic factor for gastric cancer

“…Gastric cancer (GC) ranks among the world's leading cancer‐related deaths, especially in East Asia 1,2 . Although the prognosis of patients with early stage of GC has been improved significantly owing to the early diagnosis via endoscopy, most of advanced or recurrent GC patients have poor clinical outcome, and the 5‐year overall survival rate was determined to be 30‐35% 3 . An incomplete understanding of the molecular mechanisms of GC carcinogenesis and development may be part of the reasons for the poor prognosis.…”

“…1,2 Although the prognosis of patients with early stage of GC has been improved significantly owing to the early diagnosis via endoscopy, most of advanced or recurrent GC patients have poor clinical outcome, and the 5-year overall survival rate was determined to be 30-35%. 3 An incomplete understanding of the molecular mechanisms of GC carcinogenesis and development may be part of the reasons for the poor prognosis. Thus, reliable prognostic biomarkers and therapeutic targets for GC are still needed to be identified to guide treatment strategies and improve clinical outcome.…”

Ethnic disparities in demographic, clinicopathologic and biological behaviours and prognosis of gastric cancer in northwest China

“…The 5-year OS rate for GC is above 50% in Japan and Korea but only approximately 20% in China. [4][5][6] Factors including older age, advanced TNM stage, poor differentiation and lymphatic metastasis have all been shown to be unfavourable for the prognosis of GC patients among different racial or ethnic groups. [7][8][9] Some other factors, including environmental, as well as genetic background due to diversity in race/ethnicity, were also indicated to affect an individual's cancer spectrum.…”

“…Despite improvements in endoscopic, surgical and systemic treatments, the overall survival (OS) rates and prognosis of GC patients are still dismal. The 5‐year OS rate for GC is above 50% in Japan and Korea but only approximately 20% in China 4‐6 . Factors including older age, advanced TNM stage, poor differentiation and lymphatic metastasis have all been shown to be unfavourable for the prognosis of GC patients among different racial or ethnic groups 7‐9 .…”