title: Shifting proportions of gastric adenocarcinomas.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  The Section of Surgical Oncology, the New England Deaconess Hospital, Boston, Mass.
  
  
  METHODS
  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.
authors.affiliation: Tufts University School of Medicine, Boston, Mass.
authors.forename: J C
authors.initials: JC
authors.lastname: Salvon-Harman
authors.forename: B
authors.initials: B
authors.lastname: Cady
authors.forename: S
authors.initials: S
authors.lastname: Nikulasson
authors.forename: U
authors.initials: U
authors.lastname: Khettry
authors.forename: M D
authors.initials: MD
authors.lastname: Stone
authors.forename: P
authors.initials: P
authors.lastname: Lavin
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001900:Boston / Q000453:epidemiology; D002423:Cause of Death; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008039:Linitis Plastica / Q000453:epidemiology / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D010166:Palliative Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate