title: Different pathological features and prognosis in gastric cancer patients coming from high-risk and low-risk areas of Italy.
abstract: OBJECTIVE
  To compare clinicopathological features and long-term outcome in gastric cancer patients coming from high-risk and low-risk areas of Italy.
  
  
  BACKGROUND
  Better survival rates have been reported from countries with higher incidence of gastric cancer.
  
  
  METHODS
  Data regarding 829 patients coming from Tuscany (group A) and 143 patients coming from Southern Italy (group B) were analyzed. Mean follow-up time was 56 +/- 57 months; it was 85 +/- 63 months in surviving patients or not tumor-related deaths. Prognostic factors were investigated by multivariate analysis with Cox proportional hazard model after verifying the assumption of proportionality of the risk associated with covariates.
  
  
  RESULTS
  Lauren diffuse-mixed histotype, younger age, extended lymphadenectomy, and advanced stages were more common in group B. Gastric cancer-related 10-year survival probability was 48% in group A versus 29% in group B (log-rank test: P < 0.001). By multivariate analysis, geographic area was confirmed as a significant prognostic factor (hazard ratio for group B vs. group A: 1.52, 95% confidence interval: 1.12-2.06, P = 0.006). The influence of this factor on long-term survival was independent from other clinical, surgical, and pathologic factors, and was notable in neoplasms involving the serosa (10-year survival probability: 15% in group A vs. 3% in group B, log-rank test: P = 0.005).
  
  
  CONCLUSIONS
  Patients coming from low-risk area of Italy showed distinct pathologic features, more advanced stage, and worse prognosis when compared with patients coming from high-risk area. These findings may be indicative of different tumor biology, and may contribute to partly explain worldwide geographic variability in prognosis reported in different series.
authors: Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Siena, Italy. marrelli@unisi.it
authors: Daniele
authors: D
authors: Marrelli
authors: Corrado
authors: C
authors: Pedrazzani
authors: Giovanni
authors: G
authors: Corso
authors: Alessandro
authors: A
authors: Neri
authors: Marianna
authors: M
authors: Di Martino
authors: Enrico
authors: E
authors: Pinto
authors: Franco
authors: F
authors: Roviello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome