title: Changing clinical and pathological features of gastric cancer over time.
abstract: BACKGROUND
  The aim of the present multicentre observational study was to evaluate potential changes in clinical and pathological features of patients with gastric cancer (GC) treated in a 15-year interval.
  
  
  METHODS
  A centralized prospective database including clinical, surgical, pathological and follow-up data from 2822 patients who had resection of a primary GC was analysed. The analysis focused on three periods: 1991-1995 (period 1), 1996-2000 (period 2) and 2001-2005 (period 3). Surgical procedure, pathological classification and follow-up were standardized among centres.
  
  
  RESULTS
  The number of resections decreased from 1024 in period 1 to 955 and 843 in periods 2 and 3 respectively. More advanced stages and a smaller number of intestinal-type tumours of the distal third were observed over time. Five-year survival rates after R0 resection (2320 patients) did not change over time (overall: 56·6 and 51·2 per cent in periods 1 and 3; disease-free: 66·8 and 61·1 per cent respectively). Decreases in survival in more recent years were related particularly to more advanced stage, distal tumours and tumours in women. Multivariable analysis showed a lower probability of overall and disease-free survival in the most recent interval: hazard ratio 1·22 (95 per cent confidence interval 1·06 to 1·40) and 1·29 (1·06 to 1·58) respectively compared with period 1. Recurrent tumours were more frequently peritoneal rather than locoregional.
  
  
  CONCLUSIONS
  Overall and disease-free survival rates after R0 resection of GC were unchanged over time.
authors.affiliation: Department of Human Pathology and Oncology, Section of Surgical Oncology, University of Siena, Siena, Italy. marrelli@unisi.it.
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.forename: C
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: P
authors.initials: P
authors.lastname: Morgagni
authors.forename: G
authors.initials: G
authors.lastname: de Manzoni
authors.forename: F
authors.initials: F
authors.lastname: Pacelli
authors.forename: A
authors.initials: A
authors.lastname: Coniglio
authors.forename: A
authors.initials: A
authors.lastname: Marchet
authors.forename: L
authors.initials: L
authors.lastname: Saragoni
authors.forename: S
authors.initials: S
authors.lastname: Giacopuzzi
authors.forename: F
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision / Q000379:methods / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome