Abstract
Background: Limited evidence exists on the incidence of gastric cancer (GC), and contradictory results exist for the prognosis of GC based on the Lauren classification. We analyzed the incidence and survival of GC based on the Lauren classification.Methods: The Surveillance, Epidemiology, and End Results (SEER) database from 1975 through 2015 was used to identify all patients with surgically resected, histologically diagnosed intestinal or diffused-type GC. Propensity score matching was used to analyze the association between the Lauren classification type and prognosis.Results: The trend of total GC incidence showed an obvious decrease (APC = −1.51, 95% CI: −2.31 to −1.01) as well as that of the intestinal type (APC = −1.43, 95% CI: −2.01 to −1.12). However, we found that the relative incidence of the diffused type was increased (APC = 0.6, 95% CI: 0.41–0.82). The trend of the total incidence of GC (APC = −1.31, 95% CI: −1.91 to −1.03) and that of the intestinal type (APC = −1.11, 95% CI: −1.53 to −0.98) was decreased in 40–49-year-olds, but that of the diffused type was increased (APC = 1.5, 95% CI: 1.2–1.72). We found that trends in GC incidence exhibited a similar pattern in the regional and distant stages and showed a decrease from 1975 through 2015. However, the incidence rate of the local stage was increased, with an APC of 0.5 (95% CI: 0.3–0.7). We identified 15,989 GC cases from the SEER database, including 13,852 intestinal-type and 2,138 diffused-type cases. The 1,336 intestinal-type cases were matched with 1,336 diffused-type cases using propensity score matching (PSM), and patients with the diffused type had a better prognosis than patients with the intestinal type (HR = 0.56, 95% CI: 0.45–0.78). However, we found that patients with diffused-type GC had worse survival than patients with intestinal-type GC in the cohort from Renji Hospital (P < 0.001).Conclusion: The total incidence of GC and that of the intestinal-type GC decreased, but the incidence of diffused-type GC increased in 40–49-year-olds. Diffused types of GCs may have a different prognosis compared to intestinal-type GCs in different patient cohorts. Nevertheless, these results should be interpreted with caution in assessing the prognosis in combination with other factors.
Highlights
Global cancer statistics reveal that gastric cancer (GC) is the fifth most common cancer, with more than 1,000,000 new cases diagnosed and an estimated 783,000 deaths in 2018; GC has a greater impact in Eastern Asian countries, such as Mongolia, Japan, and Korea, compared to Northern America and Europe [1]
The incidence of the intestinal type decreased with an annual percentage changes (APCs) value of −1.43
In contrast to the total change, we found that the relative incidence of the diffused type was increased because the APC was 0.6
Summary
Global cancer statistics reveal that gastric cancer (GC) is the fifth most common cancer, with more than 1,000,000 new cases diagnosed and an estimated 783,000 deaths in 2018; GC has a greater impact in Eastern Asian countries, such as Mongolia, Japan, and Korea, compared to Northern America and Europe [1]. Some data showed that Hp eradication reduced the incidence of GC, especially in Asian countries, including China and Japan [6, 7]. Endoscopic screening greatly aids in the detection of early GC and prevents the progression of GC by removing precursor lesions, such as high-grade or low-grade dysplasia [9]. Despite this background, there is little evidence on whether the incidence of GC and other epidemiological characteristics were altered over the past several decades. Limited evidence exists on the incidence of gastric cancer (GC), and contradictory results exist for the prognosis of GC based on the Lauren classification. We analyzed the incidence and survival of GC based on the Lauren classification
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