7065 Early cancer of the gastric cardia in japan; is it different from that in the west?

Abstract

The incidence of adenocarcinoma of the gastric cardia has shown an increase in recent years in the West, and obesity has been reported to have relation to its increased risk. In Japan, however, the majority of gastric cancer are situated in the body and distal stomach which appear to have a different etiology, and cardia cancer is recognized as extemely rare. The purpose of the study is to evaluate the relation of body mass index (BMI) between patients with cardia and distal cancer at an early stage, and to compare clinico-pathological findings of each cancer. A total of 3144 patients with early gastric cacner (EGC) were examined, who underwent surgery in the period from 1962 to 1997 at National Cancer Center Hospital Tokyo (NCCH). Among these, only 70 cases (2%) were adenocarcinoma of gastric cardia, which were located within 20mm from esophagogastric junction, and 2949 cases (94%) were early distal cancer. 34.3 percent of the early cardia cancer showed the macroscopically elevated type, and this occurs in less than 13.7% of the distal cancer. Eight nine percent (62/70) cardia cancer revealed differentiated adenocarcinoma histologically. The male:female ratio of cardia cancer cases was about 2.7:1, which was much higher than that in patients with distal cancer. Proportion of submucosal invasion (53%) was significantly higher in cardia cancer than distal cancer. When BMI of the patients with cardia cancer were compared with 344 cohorts matched for age and sex selected from the patients with early distal cancer, there was no difference in BMI. Conclusions- There were several singnificant differences in clinicopathological characteristics between cardia cancer and distal cancer at an early stage. However, the incidence of early cardia cancer was very low in Japan, and obesity would not relate to its occurrence as reported in the West.