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10.1245/s10434-008-9877-2
Annals of Surgical Oncology 15:1644-1650 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Differences in the Pattern of Presentation and Treatment of Proximal and Distal Gastric Cancer: Results of the 2001 Gastric Patient Care Evaluation

Neal W. Wilkinson, MD, MPH1, James Howe, MD1, Greer Gay, PhD, MPH2, Lina Patel-Parekh, MHA2, Carol Scott-Conner, MD, PhD1 and John Donohue, MD3

1 Division of Surgical Oncology, University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA
2 National Cancer Data Base, American College of Surgeons, Chicago, IL, USA
3 Department of Surgery, Mayo Clinic, Rochester, MN, USA

Correspondence: Address correspondence and reprint requests to: Neal W. Wilkinson, MD, MPH; E-mail: neal-wilkinson{at}uiowa.edu

Background: While the overall incidence of gastric cancer has declined in the United States of America, the incidence of proximal gastric cancers has increased. The purpose of this analysis was to highlight key differences between proximal and distal gastric cancer as they relate to presentation and treatment.

Methods: Data on 6,099 patients diagnosed with gastric adenocarcinoma were collected as a patient care evaluation under the auspices of the American College of Surgeons Commission on Cancer. The chi-square ({chi}2) test was used for comparisons of proportions across levels of categorical variables by site.

Results: The proximal cancer group included 1,924 patients (87% cardia, 13% fundus) and the distal cancer group included 1,311 patients (85% antrum, 15% pylorus). Proportionately, proximal cancer cases were male (P < 0.01), younger (P < 0.01), and White (P < 0.01); whereas, distal gastric cancer cases were Black (P < 0.01), Hispanic (P < 0.01), and Asian (P = 0.01). Surgery alone (without adjuvant chemotherapy or radiation) was utilized more frequently in distal disease (39.5%) compared to proximal disease (25.7%) (P < 0.01). Pre-operative adjuvant therapy was utilized more frequently in proximal disease (41.7%) compared to distal disease (2.1%) (P < 0.01).

Conclusions: The populations that developed proximal verses distal gastric cancer differed with respect to sex, age, and racial background. Cancer-directed treatments also differed based upon tumor location. Understanding these differences may someday enable us to identify important high-risk populations, prevention strategies, and ultimately best treatment strategies. Long-term survival differences will be explored when follow-up data become available.

Key Words: Gastric adenocarcinoma • Proximal gastric cancer • Distal gastric cancer • Risk factors • Treatment






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