title: Differences in the pattern of presentation and treatment of proximal and distal gastric cancer: results of the 2001 gastric patient care evaluation.
abstract: 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). Preoperative 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.
authors.affiliation: Division of Surgical Oncology, University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA. neal-wilkinson@uiowa.edu
authors.forename: Neal W
authors.initials: NW
authors.lastname: Wilkinson
authors.forename: James
authors.initials: J
authors.lastname: Howe
authors.forename: Greer
authors.initials: G
authors.lastname: Gay
authors.forename: Lina
authors.initials: L
authors.lastname: Patel-Parekh
authors.forename: Carol
authors.initials: C
authors.lastname: Scott-Conner
authors.forename: John
authors.initials: J
authors.lastname: Donohue
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology