title: Gastric cancer: decreasing incidence but stable survival in the Netherlands.
abstract: BACKGROUND
  Gastric cardia and non-cardia cancer exhibit differences in biological and epidemiological features across the world. The aims of this study were to analyze trends in incidence, stage distribution, and survival over a 20-year period in the Netherlands, separately for both types of gastric cancer.
  
  
  METHODS
  Data on all patients with a diagnosis of gastric cancer in the period 1989-2008 were obtained from the nationwide Netherlands Cancer Registry. Time trends in incidence [analyzed as European Standard Rate per 100 000 (ESR)] and relative survival were separately analyzed for cardia and non-cardia gastric cancer.
  
  
  RESULTS
  A total of 47 295 patients were included. Incidence rates per 100 000 for cardia cancer declined from 5.7 to 4.3 for males and remained stable for females (1.2). For non-cardia cancer, the incidence in males declined from 25 to 14 and in females from 10 to 7. Proportional incidence in stage IV cardia and non-cardia cancer increased in 2004-2008 (cardia 32-42%, non-cardia 33-45%). Five-year survival rates for stage I-III and X (unknown) remained stable (cardia cancer: 20%, non-cardia gastric cancer: 31%). Five-year survival for stage IV disease was 1.9% and 1.0% for cardia and non-cardia gastric cancer.
  
  
  CONCLUSIONS
  The incidence of gastric cancer in the Netherlands markedly decreased over the past decades, in particular of non-cardia cancer. Survival remained dismal. Improvement of survival remains a challenge for the multidisciplinary team involved in gastric cancer treatment.
authors.affiliation: Jeroen Bosch Hospital, Department of Surgery , Hertogenbosch , The Netherlands.
authors.forename: Anneriet E
authors.initials: AE
authors.lastname: Dassen
authors.forename: Johan L
authors.initials: JL
authors.lastname: Dikken
authors.forename: Koop
authors.initials: K
authors.lastname: Bosscha
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Annemieke
authors.initials: A
authors.lastname: Cats
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Coebergh
authors.forename: Valery E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000556:secondary; D000368:Aged; D002299:Cardia / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors