Characteristics of proximal versus distal gastric cancer at the VA: Is there a difference?

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15517 Background: Current literature suggests that proximal gastric cancers differ from distal in terms of biological behavior and prognosis. The aim of this study was to assess the differences in the clinical characteristics, treatment and survival in patients with cancers of the proximal versus distal stomach at the VA. Methods: We searched the Veterans Affairs Central Cancer Registry (VACCR) database for stomach cancer between 1995- 2006 using ICD codes 160–169, classified into proximal (cardia and fundus) and distal. The data then was analyzed using SPSS v.13.0. Results: There were 4,251 (68.5%) and 2,045 (32.5%) patients with cancers of the distal and proximal stomach respectively. Baseline characteristics are summarized in table 1. Both Black and white patients were more likely to have cancer of the distal stomach. (p<0.001) The distribution of cancers of the distal and proximal stomach did not change when the data was compared between 1995–2000 and 2001–2006. Metastatic disease was present in 27.3% of proximal vs. 24.9% in distal stomach cancer. (p=0.09) Patients with distal gastric cancer were more likely to undergo surgery and proximal stomach cancer patients were more likely to undergo chemo or radiotherapy (p<0.001), but there was no difference in the median survival. Cox-regression analysis using variables age, race, stage, treatment, only age, chemotherapy, surgery and the absence of metastatic disease were predictors of survival in distal stomach cancer, while surgery, chemotherapy and the absence of metastatic disease were predictors of survival in proximal stomach. Conclusion: Patients of both races were more likely to have carcinomas of the distal than proximal and this had remained stable over the past decade. The survival outcome was similar and uniformly poor in patients with cancer of the proximal and distal stomach. Further studies are required to study the racial variations and the poor prognosis of gastric cancer. Characteristic Number of patients (N = 6,296) P Value Proximal N = 2,045 Distal N = 4,251 Age (Years) 67.29 69.09 P=0.85 Race Whites 1738 (38.4%) 2789 (61.6%) P<0.001 Blacks 307 (17.4%) 1462 (82.6%) P<0.001 Stage (n = 3,606, 57.3%) Non metastatic 741 (37.2%) 1249 (62.8%) P=0.09 Metastatic 558 (34.5%) 1058 (64.5%) P=0.09 Treatment (n = 4,059, 64.5%) No therapy 623 1614 Surgery 522 (27.4%) 1381 (72.6%) P<0.001 Chemotherapy 219 (30.9%) 489 (69.1%) P<0.001 Radiotherapy 139 (48.4%) 148 (51.6%) P<0.001 Survival (Months) 6.9 5.77 P=0.06 Non metastatic disease 12.13 14.27 P=0.18 Metastatic disease 3.63 2.53 P=0.059 No significant financial relationships to disclose.