| Objective:Gastric cancer is one of the most common malignancies in China.It is the most serious disease that threatens people’s health,accounting for the first place in digestive tract tumors.About 170,000 people die each year from gastric cancer,which is close to 1/4 of the total number of deaths from cancer.And every year there are more than 20,000 new patients diagnosed with gastric cancer.In line with the general laws of cancer,gastric cancer’s age of onset is mostly between 40 to 60 years old.The ratio of male to female is about 2:1.Gastric cancer can occur in any part of the stomach,but more common in the gastric antrum,especially the small curvature of the stomach.However,as indicated in many researches,the onset of the site gradually migrated to the proximal stomach.With the improvement of early diagnosis and surgical methods,the prognosis of patients with gastric cancer has been improved.However,the factors affecting the prognosis are not entirely clear.The generally accepted opinion is that the prognosis of patients with proximal-third gastric cancer is worse than that of patients with more distal gastric cancer.The aim of our study was to analyze the differences in clinicopathological features and outcomes among the patients with upper-third gastric cancer(cardia or gastric fundus),middle-third gastric cancer(gastric corpus),lower-third gastric cancer(pylorus or gastric antrum)and more than 1/3 gastric cancers.Material and methods:From January 2008 to December 2010,242 patients with gastric adenocarcinoma who underwent gastrectomy were retrospectively enrolled and the patients were stratified into four groups according to their different cancer center locations:upper-third gastric cancer group(group U),middle-third gastric cancer group(group M),lower-third gastric cancer group(group L)and more than 1/3 gastric cancers group(group UML).Results:Clinicopathological features and survival outcomes were compared between the four groups.The study included 152 patients(62.6%)with distal 1/3 of gastric cancer,49(20.2%)with proximal 1/3 of gastric cancer,and 25 patients(10.3%)with 1/3 gastric cancer.In the group U,the size of tumor were significantly larger than in other three groups(p<0.0001),and male predominance was noted in group U in comparison with other groups.In patients with M and UML,T4 staging was more common than L group(p<0.05).In all patients,the cumulative overall survival rate in the UML and M groups was significantlly worse than the other two groups(p<0.0001).The same trend was found in stage Ⅲ patients,but the difference is not statistically significant(p = 0.080).Multivariate analysis showed that tumor site,N staging and recurrence/progression were important factors influencing the survival rate of gastric cancer patients.Conclusions:According to our results,different gastric location of the tumor showed different clinical and pathological features and prognosis.Cox multivariate regression analysis showed that tumor anatomical location,N stage,recurrence/progression were independent factors for the prognosis of patients with stage III gastric cancer.The age,mode of operation,pT,recurrence/progression were factors influencing Ⅰ-Ⅳ gastric adenocarcinoma.Tumor position as an independent risk factor for the prognosis of patients with stage III gastric cancer after operation has a certain significance in guiding treatment and estimating prognosis. |
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