Gastric adenocarcinoma: review and considerations for future directions.
OBJECTIVE
This update reviews the epidemiology and surgical management, and the controversies of gastric adenocarcinoma. We provide the relevance of outcome data to surgical decision-making and discuss the application of gene-expression analysis to clinical practice.


BACKGROUND
Gastric cancer mortality rates have remained relatively unchanged over the past 30 years, and gastric cancer continues to be one of the leading causes of cancer-related death. Well-conducted studies have stimulated changes to surgical decision-making and technique. Microarray studies linked to predictive outcome models are poised to advance our understanding of the biologic behavior of gastric cancer and improve surgical management and outcome.


METHODS
We performed a review of the English gastric adenocarcinoma medical literature (1980-2003). This review included epidemiology, pathology and staging, surgical management, issues and controversies in management, prognostic variables, and the application of outcome models to gastric cancer. The results of DNA microarray analysis in various cancers and its predictive abilities in gastric cancer are considered.


RESULTS
Prognostic studies have provided valuable data to better the understanding of gastric cancer. These studies have contributed to improved surgical technique, more accurate pathologic characterization, and the identification of clinically useful prognostic markers. The application of microarray analysis linked to predictive models will provide a molecular understanding of the biology driving gastric cancer.


CONCLUSIONS
Predictive models generate important information allowing a logical evolution in the surgical and pathologic understanding and therapy for gastric cancer. However, a greater understanding of the molecular changes associated with gastric cancer is needed to guide surgical and medical therapy.
Dicken
Bryan J
BJ
Department of Surgery, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
Bigam
David L
DL
Cass
Carol
C
Mackey
John R
JR
Joy
Anil A
AA
Hamilton
Stewart M
SM
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery*; D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D020869:Gene Expression Profiling; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020411:Oligonucleotide Array Sequence Analysis; D010529:Peritoneal Cavity; D011237:Predictive Value of Tests; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery*; D016896:Treatment Outcome