Changing patterns of gastric carcinoma over the past two decades in a single institution: clinicopathological findings in 1557 patients.
BACKGROUND
Reported differences in clinicopathological patterns of gastric carcinoma (GC) suggest the presence of time-related changes of cancer biology. The aim of this study was to analyse any fluctuations of GC biology in a large series of patients from Poland, where morbidity and mortality rates for GC are relatively high.


METHODS
Based on the prospectively collected data of 1557 GC patients treated surgically between 1977 and 1999, we analysed the differences in clinicopathological patterns for two consecutive periods: 1977-88 (group I) and 1989-99 (group II). Moreover, time-related trends of GC biology were assessed.


RESULTS
The mean age of the patients was 59.1 years (range 20-93) and increased from 58.1 years in group I to 59.9 years in group II (P < 0.05). Early GC occurred in 6.2% of cases in group I and in 13.7% in group II (P < 0.001). The incidence of stage IV carcinomas according to the UICC classification significantly decreased from 70.9% to 53.6% (P < 0.001). The proportion of tumours located in the distal part of the stomach declined from 44.1% in group I to 37.6% in group II (P < 0.05). Analysis did not reveal differences in histological type (according to the Lauren classification) between groups; nevertheless, a significant trend toward lowering incidence of intestinal type GC was observed (P < 0.05). Overall, 5-year survival was 27.2% and increased over the period of study from 18.6% to 30.4% (P < 0.001).


CONCLUSIONS
The patterns of GC stage, location and histology have changed during the analysed period of time. Observed differences are probably related to fluctuations in carcinogenic factors and have diagnostic as well as therapeutic implications.
Popiela
T
T
First Dept of General and GI Surgery, Jagiellonian University, Kraków, Poland. mspopiel@cyf-kr.edu.pl
Kulig
J
J
Kołodziejczyk
P
P
Sierzega
M
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011044:Poland / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology; D016019:Survival Analysis; D013997:Time Factors