title: Risk factors of early proximal gastric carcinoma in Chinese diagnosed using WHO criteria.
abstract: OBJECTIVE
  The incidence of proximal gastric carcinoma (PGC) is rising worldwide for unknown reasons. Herein we compare the risk factors of early PGC with distal gastric carcinoma (DGC) in patients treated at a single tertiary hospital in China.
  
  
  METHODS
  Risk factors of 379 consecutive surgically resected early gastric carcinoma (EGC) diagnosed according to the 2010 World Health Organization criteria were studied by reviewing their medical records and esophagogastroduodenoscopy/biopsy findings and interviewing patients and family members for the patients' history of environmental toxin exposure (ETE), dietary habits, family (FCH) and personal cancer history (PCH) and survival. Differences between PGC (n = 115), DGC (n = 264) and age-matched and gender-matched controls (n = 225) were compared.
  
  
  RESULTS
  Proportion of early PGC in all EGC patients was increased significantly (P < 0.05). The independent risk factors for both PGC and DGC identified by multivariate analysis were intake of preserved food and little fruit, and gastric mucosal intestinal metaplasia and atrophy (all P < 0.05). Advanced age (odds ratio [OR] 9.83, P < 0.01), PCH (OR 5.09, P < 0.05), a high body mass index (>24 kg/m(2) ) (OR 2.79, P < 0.01) and ETE (OR 2.31, P < 0.05) were independent risk factors for PGC, but not male gender, tobacco or alcohol abuse, hiatus hernia, gastroesophageal reflux disease or columnar-lined esophagus. In contrast, FCH (OR 2.34, P < 0.01) and Helicobacter pylori infection (OR 2.81, P < 0.001) were independent risk factors for DGC.
  
  
  CONCLUSIONS
  Independent risk factors for PGC in Chinese patients differ from those of DGC or esophageal adenocarcinoma, supporting the classification of PGC as a separate gastric carcinoma entity in the Chinese populations.
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Fang
authors.affiliation: Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu Province, China.|Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Boston, MA, USA.
authors.forename: Qin
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Rheumatology and Immunology, The Affiliated Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Jiong
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Gui Fang
authors.initials: GF
authors.lastname: Xu
authors.affiliation: Department of Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Boston, MA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Gold
authors.affiliation: Department of Gastroenterology, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Boston, MA, USA.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mashimo
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu Province, China.|Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Xiao Ping
authors.initials: XP
authors.lastname: Zou
mesh_terms: D000368:Aged; D044466:Asian People / Q000208:ethnology; D002277:Carcinoma / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D016208:Databases, Factual; D004032:Diet / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D014944:World Health Organization
keywords: Chinese; early gastric carcinoma; epidemiology; proximal gastric carcinoma; stomach neoplasms