title: The relationship between improved prognosis in gastric cancer patients in the last 25 years and changing methods of surgical and combined treatment.
abstract: BACKGROUND
  Poland is among the countries with the high morbidity and mortality rates for gastric carcinoma (GC). The differences of GC biology depending on the geographical regions were suggested. In the literature, there are no reports from detailed clinicopathologic studies carried out in large series of GC patients in Poland.
  
  
  METHODS
  Based on the prospectively collected data of 3696 GC patient treated surgically between 1977-1999, potentially significant prognostic factors were analyzed to assess their prognostic value, and their time related distribution during the over 20-year period of the study.
  
  
  RESULTS
  The mean age of the patients was 59.0 (SD 11.6) years and ranged from 20 to 93 years. The male-to-female ratio was 2.3. Overall cumulative 5-year survival was 0.28 (for early GC 0.85) and significantly increased over the period of study. Among factors analyzed the depth of invasion, lymph nodes status, tumor size, age, UICC-R classification and rate of involved to removed lymph nodes are of statistically significant and most important prognostic value. In the over 20-year period of study the rate of diffuse type carcinoma acc. to Lauren increased but the tumor locations did not changed significantly. The rate of early GC did not change throughout the period of study but number of most advanced cases decreased. Chemo- and chemotherapy improved outcomes in some groups of patients.
  
  
  CONCLUSIONS
  The basic clinicopathologic profile of Polish patients is similar to the reported in Western Europe and Japan, except for significantly higher early GC occurrence in Japan. According to the obtained results the prognosis of GC depends clearly upon the stage of the disease at the time of surgery. The improvement of outcomes during over 20 years of GC study in Poland was due to introducing better diagnosis and routine multimodal treatment.
authors.affiliation: 1st Department of General and GI Surgery, Jagiellonian University, Krakow, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Popiela
authors.forename: J
authors.initials: J
authors.lastname: Kulig
authors.forename: P
authors.initials: P
authors.lastname: Kołodziejczyk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
chemical_list: D001500:BCG Vaccine; D016685:Mitomycin; D005047:Etoposide; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil