title: Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome.
abstract: BACKGROUND
  Tumors arising from the esophagogastric junction (OGJ) are increasing in incidence in the west, but data from Asian populations are conflicting. Singapore has a mixed-Asian population with an international lifestyle. This study was designed to examine the changing trends in incidence of gastric cardia cancer (type III) within this population and to compare the clinicopathological characteristics and outcome of these tumors with gastric tumors.
  
  
  METHODS
  Trends in cancer incidence were obtained from the Singapore Cancer Registry. Clinicopathological data were prospectively collected from patients undergoing surgery for gastric cancer who presented to the National University Hospital between 2000 and 2005. Patients underwent surgery with or without (neo)adjuvant therapy. Survival duration was analyzed.
  
  
  RESULTS
  The incidence of cardia tumors has increased each decade since 1968 (1968-1982, 6.3%; 1983-1992, 7.6%; 1993-1997, 8.4%; 1998-2002, 9.1%; 2003-2007, 16.2%). Among the study population (n = 159) cardia tumors were associated with male sex (p < 0.01) and dysphagia (p < 0.01). Although R0 resection rates were similar, systemic recurrence rates were higher among patients with cardia cancer (p = 0.031) and survival was reduced compared with patients with non-cardia gastric cancer (median survival 26 vs. 69 months; p < 0.001). Cardia location of the tumor and metastatic lymph node ratio were identified as independent adverse prognostic indicators on multivariate analysis.
  
  
  CONCLUSIONS
  Similar to western societies, the incidence of proximal gastric cancer is increasing in Singapore. Cardia tumors are associated with poorer outcomes, suggesting that cardia cancer is a distinct disease from true gastric cancer requiring different management strategies to improve the outcome for these patients.
authors.affiliation: Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
authors.forename: Chris
authors.initials: C
authors.lastname: Deans
authors.forename: Matthew S W
authors.initials: MS
authors.lastname: Yeo
authors.forename: Mu Yar
authors.initials: MY
authors.lastname: Soe
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
authors.forename: T K
authors.initials: TK
authors.lastname: Ti
authors.forename: Jimmy B Y
authors.initials: JB
authors.lastname: So
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D017677:Age Distribution; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D002299:Cardia / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012846:Singapore / Q000453:epidemiology; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis