Clinicopathological Features of Upper Third Gastric Cancer during a 21-Year Period (Single Center Analysis)

Abstract

PurposeThe aim of this study was to determine proportions of upper third gastric cancer (UTG) among all gastric cancers and analyze clinicopathological features of the disease.Materials and MethodsThe medical records of 12,300 patients who underwent gastric surgery between 1986 and 2006 at Seoul National University Hospital (SNUH) were retrospectively reviewed. Clinicopathological features of 1,260 patients with UTG and 9,929 patients with middle or lower third gastric cancer (MLG) were compared, and annual proportions of UTG were evaluated.ResultsThe proportion of patients with UTG rapidly increased from 2.6% in 1986 to 12.5% in 1992. However, linear regression analysis showed that the rate of increase was reduced (0.21%/year) after 1992 (12.5% to 14.2% from 1992 to 2006). Compared with the MLG group, the UTG group had a lower proportion of (22.3% vs. 39.7%, P<0.001) and a greater proportion of stage III/IV disease (39.4% vs. 31.7%, P<0.001). The UTG group also had larger tumors than the MLG group in stages I/II and III (3.5 cm/5.3 cm/6.5 cm vs. 3.2 cm/5.0 cm/5.8 cm, P=0.020/0.028 /<0.001), a higher proportion of undifferentiated cancer (63.1% vs. 53.7%, P<0.001), and less intestinal Lauren's type (38.8% vs. 47.4%, P<0.001). The 5-year survival rate of the UTG group was significantly lower than that of the MLG group in stages I/II and III (85.6%/63.1%/34.2% vs. 91.6%/ 69.2%/44.7%, P<0.001/0.028/0.006).ConclusionsThe proportion of UTGs has increased over the last two decades at SNUH, but the rate of increase has been greatly reduced since 1992. The UTG group showed a poorer prognosis compared with the MLG group in stages I/II and III.

Characteristics of proximal early gastric cancer differentiating distal early gastric cancer

“…Several studies included AGC patients as well as EGC that differed from our study population, which may affect the discrepant results from our study in terms of tumor differentiation and Lauren’s classification. A large-scale retrospective Korean study demonstrated that undifferentiated and diffuse type were significantly frequent in the upper third gastric cancer than the middle or distal gastric cancer, which reinforces our study results [37]. We considered that predominance of undifferentiated type, as well as frequent SM invasion, in proximal stomach might be another characteristics of biologic behavior of proximal EGC, because undifferentiated EGCs usually show aggressive histologic findings with deeper invasion depth even in case with relatively small tumor size [38].…”

Comparison on Clinicopathological Features and Prognosis Between Esophagogastric Junctional Adenocarcinoma (Siewert II/III Types) and Distal Gastric Adenocarcinoma

“…Tumors were deeper, with a higher rate of lymph node metastasis in the EGJA group which agrees with other groups. 27 In accordance with the higher proportion of advanced stage, a lower radical degree rate was also observed in the EGJA group. Because of the special locations of cardia and fundus of stomach, EGJA especially Siewert type III tumors were not easy to detect under endoscopy compared with distal lesions.…”

The survival difference between gastric cancer patients from the UK and Japan remains after weighted propensity score analysis considering all background factors

“…A previous study demonstrated that the prognosis of the patients treated by a total gastrectomy was poorer compared to those who were treated by distal gastrectomy [28]. Resection margin status has been reported to have prognostic value in previous studies comparing GC patients from the West and the East [29,30].…”