Clinicopathological features and prognostic factors of proximal gastric carcinoma in a population with high Helicobacter pylori prevalence: a single-center, large-volume study in Korea.
BACKGROUND
The incidence of gastric cancers has fallen in recent decades. However, a substantial reduction in Helicobacter pylori prevalence and a substantial increase in the incidence of proximal gastric cancer (PGC) have been observed in the West and Japan, but not in other East Asian countries. The purpose of this large-volume study was to analyze prevalence, clinicopathological features, and prognosis of PGC compared with other types of gastric cancer in Korea, where there is high incidence of H. pylori infection.


METHODS
Between 2000 and 2005, a total of 3,193 patients were enrolled. We analyzed clinicopathological features and survival outcomes.


RESULTS
Chronological analysis showed increasing incidence of PGC over the study period. PGC patients were younger and had higher incidence of Bormann types III and IV than did distal gastric cancer (DGC) patients. Also, PGC was associated with a significantly higher proportion of poorly differentiated type, T3 and T4 stage, and positive lymph nodes compared with DGC. Peritoneal and other distant metastases were more common in PGC group than in DGC group. The 5-year survival rate was significantly lower in PGC than in DGC group, regardless of curative resection. Also, the N0 and N1 category significantly influenced the 5-year survival rate. Tumor-node-metastasis (TNM) stage, hepatic metastasis, and curative resection were significant prognostic factors in PGC patients.


CONCLUSIONS
PGC has increased in incidence with the respective decline in H. pylori prevalence in Korea. Survival was worse for patients with PGC than for those with DGC, regardless of curative respectability. PGC is often diagnosed at more advanced stage than other gastric cancers, and therefore early detection is critical for successful treatment.
Park
Jun Chul
JC
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Lee
Yong Chan
YC
Kim
Jie-Hyun
JH
Kim
Yu Jin
YJ
Lee
Sang Kil
SK
Shin
Sung Kwan
SK
Hyung
Woo Jin
WJ
Noh
Sung Hoon
SH
Kim
Choong Bai
CB
D018279:Carcinoma, Signet Ring Cell / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D016481:Helicobacter Infections / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D007723:Korea; D008113:Liver Neoplasms / Q000382:microbiology / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000382:microbiology / Q000556:secondary* / Q000601:surgery; D015995:Prevalence; D011379:Prognosis; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate