Distal Stomach Cancer Research Articles

Observation of Early Outcome and Complications among Gastric Cancer Surgery Patients

Background Gastric cancer remains a significant public health challenge in Bangladesh, with a high prevalence of habitual risk factors and late-stage diagnoses. This study aims to evaluate the early outcomes and postoperative complications among gastric cancer surgery patients in a resource-limited setting. Material & Methods: This prospective, cross-sectional observational study was conducted from July 2017 to March 2019 at the Department of Surgical Oncology, National Institute of Cancer Research and Hospital, Dhaka. Forty patients with biopsy-proven operable gastric carcinoma were selected using purposive non-randomized sampling. Data were collected through clinical evaluations, structured interviews, and case record forms, focusing on demographic characteristics, habitual risk factors, tumor-related features, types of surgery, duration of surgery, hospital stay, and postoperative complications. Statistical analyses were performed using SPSS-22. Results: The mean age of participants was 65.16 ± 10.28 years, with a male predominance (70%). Smoking (70%) and beetle leaf consumption (90%) were prevalent habitual risk factors. Distal stomach cancer was more common (65%), with a mean tumor size of 5.00 ± 2.00 cm. Lower radical gastrectomy was performed in 65% of cases. Most surgeries (60%) were completed within 1 to 1.5 hours. Hospital stay durations varied, with 45% staying 11-15 days. Postoperative complications were noted in 52.50% of patients, including wound infections (20%) and urinary tract infections (15%). Conclusions: This study highlights the critical need for improved early detection, risk factor mitigation, and postoperative care in gastric cancer management within Bangladesh. These findings provide a foundation for future research and clinical strategies aimed at enhancing patient outcomes in similar resource-limited settings.

Survival prognostic analysis of laparoscopic D2 radical resection for locally advanced gastric cancer: A multicenter cohort study.

With the development of minimally invasive surgical techniques, the use of laparoscopic D2 radical surgery for the treatment of locally advanced gastric cancer (GC) has gradually increased. However, the effect of this procedure on survival and prognosis remains controversial. This study evaluated the survival and prognosis of patients receiving laparoscopic D2 radical resection for the treatment of locally advanced GC to provide more reliable clinical evidence, guide clinical decision-making, optimize treatment strategies, and improve the survival rate and quality of life of patients. To investigate the survival prognosis and influencing factors of laparoscopic D2 radical resection for locally advanced GC patients. A retrospective cohort study was performed. Clinicopathological data from 652 patients with locally advanced GC in our hospitals from December 2013 to December 2023 were collected. There were 442 males and 210 females. The mean age was 57 ± 12 years. All patients underwent a laparoscopic D2 radical operation for distal GC. The patients were followed up in the outpatient department and by telephone to determine their tumor recurrence, metastasis, and survival. The follow-up period ended in December 2023. Normally distributed data are expressed as the mean ± SD, and normally distributed data are expressed as M (Q1, Q3) or M (range). Statistical data are expressed as absolute numbers or percentages; the χ 2 test was used for comparisons between groups, and the Mann-Whitney U nonparametric test was used for comparisons of rank data. The life table method was used to calculate the survival rate, the Kaplan-Meier method was used to construct survival curves, the log rank test was used for survival analysis, and the Cox risk regression model was used for univariate and multifactor analysis. The median overall survival (OS) time for the 652 patients was 81 months, with a 10-year OS rate of 46.1%. Patients with TNM stages II and III had 10-year OS rates of 59.6% and 37.5%, respectively, which were significantly different (P < 0.05). Univariate analysis indicated that factors such as age, maximum tumor diameter, tumor differentiation grade (low to undifferentiated), pathological TNM stage, pathological T stage, pathological N stage (N2, N3), and postoperative chemotherapy significantly influenced the 10-year OS rate for patients with locally advanced GC following laparoscopic D2 radical resection for distal stomach cancer [hazard ratio (HR): 1.45, 1.64, 1.45, 1.64, 1.37, 2.05, 1.30, 1.68, 3.08, and 0.56 with confidence intervals (CIs) of 1.15-1.84, 1.32-2.03, 1.05-1.77, 1.62-2.59, 1.05-1.61, 1.17-2.42, 2.15-4.41, and 0.44-0.70, respectively; P < 0.05]. Multifactor analysis revealed that a tumor diameter greater than 4 cm, low tumor differentiation, and pathological TNM stage III were independent risk factors for the 10-year OS rate in these patients (HR: 1.48, 1.44, 1.81 with a 95%CI: 1.19-1.84). Additionally, postoperative chemotherapy emerged as an independent protective factor for the 10-year OS rate (HR: 0.57, 95%CI: 0.45-0.73; P < 0.05). A maximum tumor diameter exceeding 4 cm, low tumor differentiation, and pathological TNM stage III were identified as independent risk factors for the 10-year OS rate in patients with locally advanced GC following laparoscopic D2 radical resection for distal GC. Conversely, postoperative chemotherapy was found to be an independent protective factor for the 10-year OS rate in these patients.

Dose-response association between cigarette smoking and gastric cancer risk: a systematic review and meta-analysis.

This study aims at providing an accurate and up-to-date quantification of the dose-response association between cigarette smoking and gastric cancer (GC) risk, overall and by subsite. We conducted a systematic review and meta-analysis of case-control and cohort studies on the association between cigarette smoking and GC risk published up to January 2023. We estimated pooled relative risks (RR) of GC and its subsites according to smoking status, intensity, duration, and time since quitting. Among 271 eligible articles, 205 original studies were included in this meta-analysis. Compared with never smokers, the pooled RR for GC was 1.53 (95% confidence interval; CI 1.44-1.62; n = 92) for current and 1.30 (95% CI 1.23-1.37; n = 82) for former smokers. The RR for current compared with never smokers was 2.08 (95% CI 1.66-2.61; n = 21) for gastric cardia and 1.48 (95% CI 1.33-1.66; n = 8) for distal stomach cancer. GC risk nonlinearly increased with smoking intensity up to 20 cigarettes/day (RR:1.69; 95% CI 1.55-1.84) and levelled thereafter. GC risk significantly increased linearly with increasing smoking duration (RR: 1.31; 95% CI 1.25-1.37 for 20years) and significantly decreased linearly with increasing time since quitting (RR: 0.65; 95% CI 0.44-0.95 for 30years since cessation). The present meta-analysis confirms that cigarette smoking is an independent risk factor for GC, particularly for gastric cardia. GC risk increases with a low number of cigarettes up to 20 cigarettes/day and increases in a dose-dependent manner with smoking duration.

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer.

Objectives This study is aimed at evaluating the efficacy and safety of the big end double-layer uncovered self-expanding metal stents (SEMS) for the treatment of gastric outlet obstruction (GOO) caused by distal stomach cancer. Methods Seventy three patients receiving big end double-layer uncovered SEMS for the treatment of GOO caused by distal gastric cancer will be included in this multicenter prospective clinical trial. The main outcome measures included the functional outcome, the complications, the reinterventional rates, the average treatment charges, and the mean survival time. Monthly telephone calls were needed to assess the food intake until the patients died. Results The technical and the clinical success rates were 98.6%. The stent obstruction caused by tumor ingrowth was observed in one patient (1.4%). The incidence of food impaction was 2.9% (2/70) and the reinterventional rate was 4.3% (3/70). However, stent migration and obstruction caused by overgrowth were not observed. No perforation and severe bleeding were observed. The median cost of endoscopic stenting and total hospitalization (including reinterventions) for the big end double-layer uncovered SEMS in this study was $2945 and $3408, respectively. The mean survival time was 212.5 days. Conclusions The placement of big end double-layer uncovered SEMS is a safe and effective modality and has the potential to be one of the options for the treatment of GOO caused by the distal gastric cancer.

Role of H pylori in GERD- A prospective study

Introduction: The role of Helicobacter pylori in esophageal disease has not been clearly defined. To clarify this issue, we analyzed 120 patients with histologically confirmed esophageal disease. Helicobacter pylori (H. pylori) causes a long-term infection of the human gastric and duodenal mucosa (1). Mucosal colonisation predisposes for peptic ulcer disease, atrophic gastritis and distal (antral) stomach cancer (2), with various effects on gastric acid secretion. Genetic variability of H. pylori is high (3). Several genes have been identified that may play a role in the pathogenicity (4, 5). Most important is the cytotoxin- associated gene A (CagA), which is associated with peptic ulcer disease (6), and intestinal type adenocarcinoma of the stomach (7). Patients with duodenal ulcer often have high basal gastrin levels, high peak acid output and high 24-hour intragastric acidity (8-10). Materials and methods: This investigation was performed at the RL Jalappa Hospital, Tamaka, Kolar in patients who underwent Upper GI Endoscopy. The time of investigation was from January 2016-December 2018. Results: This study included 30 patients with BE out of 120 patients with GERD. The average age of patients in BE group was 52.4 years. (SD } 10.8 yr.) In the GERD group average age was 40.8 years. In all groups included in this study, men were more represented than women. In BE group, H. pylori infection was present in 16.0% of patients. In GERD group, H. pylori infection was present in 42.9%. Conclusion: The prevalence of H. pylori infection in patients with BE was lower in comparison with patients with GERD (p

Comparison of big funnel and individualized stents for management of stomach cancer with gastric outlet obstruction.

Previous studies reported a similar rate of complications, including stent migration and obstruction, between individualized stents and the standard uncovered stents in gastric outlet obstruction (GOO) caused by distal stomach cancer. The objective of this study was to evaluate the efficacy and safety of funnel stents for management of GOO caused by distal stomach cancer. This study was designed as a multicenter, controlled, prospective, and randomized clinical trial involving 4 hospitals. The individualized stent group (44 cases) received cup and funnel covered stents, and the funnel group (44 cases) received only funnel covered stents for management of GOO caused by distal gastric cancer. All patients with GOO were treated with cup and funnel stents according to their assigned groups. The rate of GOO resolution was 100% in the funnel group and 97.7% in the individualized stent group. Stent obstruction caused by tumor ingrowth was observed in 1 patient in the individualized stent group, and proximal partial stent migration was observed in 1 patient in each group. Stent obstruction caused by tumor ingrowth was observed in 1 patient in the individualized stent group. There was no statistical difference in stent migration, obstruction, and survival between groups. Big funnel stents and individualized stents resulted in similar shaping effect and prevention of stent migration and obstruction, suggesting that funnel shaped stents can be used to treat cup or funnel shaped GOO caused by distal stomach cancer.

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis.

Background/AimsTotal gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer.MethodologyA search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis.ResultsTen retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006).ConclusionBased on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed.

Effect of the number of lymph nodes harvested on the long-term survival of gastric cancer patients according to tumor stage and location: a 12-year study of 1,637 cases

BackgroundThe effect of the number of lymph nodes harvested on the long-term survival of gastric cancer according to Tumor, Node, and Metastasis (TNM) stage and tumor location remains unclear. MethodsPatients who underwent gastrectomy for gastric cancer (1998 to 2009) were evaluated retrospectively (1,637 patients). The patients’ clinicopathological variables, overall survival (OS), and progression-free survival (PFS) were recorded. The effect of the number of lymph nodes harvested on survival was analyzed according to TNM stage and tumor location. ResultsHarvest of greater than 30 lymph nodes was associated with significantly better OS and PFS than less than or equal to 14 lymph nodes, but no significant difference was observed between less than or equal to 14 and 15 to 29 lymph nodes harvested. The number of lymph nodes harvested was significantly associated with the OS or/and PFS of late stage cancer (N+, T3 to T4, and stage III to IV), harvest of greater than 30 lymph nodes brought significantly better survival compared with the other 2 groups. A higher number of harvested lymph nodes was associated with significantly better PFS for gastric cancer of the body of stomach, but not for proximal, distal, and whole stomach cancer. When the tumor was located in the body of the stomach, the PFS was better with 15 to 29 lymph nodes than less than 14 lymph nodes; however, the OS and PFS were not significantly different between greater than 30 lymph nodes and 15 to 29 lymph nodes. TNM stage and number of lymph nodes harvested were the independent risk factors affecting the survival. ConclusionTailored lymphadenectomy according to TNM stage and tumor location might be considered for gastric cancer patients.

Individualization of metal stents for management of gastric outlet obstruction caused by distal stomach cancer: a prospective study

The use of various kinds of metal stents has emerged as an effective palliative treatment for malignant gastric outlet obstruction (GOO). However, most of these metal stents were designed for use in the esophagus or intestine and have a high incidence of stent obstruction and stent migration when used elsewhere. To evaluate the efficacy and safety of individualized stents (designed according to the shape and size of the GOO) in order to determine whether such stents could reduce the incidence of stent obstruction and migration. Multicenter, prospective, clinical trial. Two tertiary-care referral centers. Thirty-seven patients who presented with symptomatic unresectable malignant GOO caused by distal gastric cancer between April 2005 and June 2009. Placement of the individualized metal stents. The primary endpoint was to optimize stent resolution of proximal obstruction as determined by a GOO scoring system. Secondary endpoints were success rates, survival rates, and adverse events. Technical and clinical success was achieved in 97.3% and 94.4% of patients, respectively. The rate of resolution of proximal obstruction by a proximal stent was 97.3%. There were no procedure-related perforations or deaths. No stent migration or obstruction by tumor growth were found. The mean survival time was 232 days (range 28-387 days). A single-arm study in tertiary-care centers. Placement of individualized stents is a safe and effective modality for the palliation of malignant GOO caused by distal stomach cancer and can help reduce tumor ingrowth and stent migration.

Helicobacter pylori Seropositivity and Risk of Lung Cancer

Lung cancer is the leading cause of cancer mortality worldwide. Helicobacter pylori (H. pylori) is a risk factor for distal stomach cancer, and a few small studies have suggested that H. pylori may be a potential risk factor for lung cancer. To test this hypothesis, we conducted a study of 350 lung adenocarcinoma cases, 350 squamous cell carcinoma cases, and 700 controls nested within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC) cohort of male Finnish smokers. Controls were one-to-one matched by age and date of baseline serum draw. Using enzyme-linked immunosorbent assays to detect immunoglobulin G antibodies against H. pylori whole-cell and cytotoxin-associated gene (CagA) antigens, we calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between H. pylori seropositivity and lung cancer risk using conditional logistic regression. H. pylori seropositivity was detected in 79.7% of cases and 78.5% of controls. After adjusting for pack-years and cigarettes smoked per day, H. pylori seropositivity was not associated with either adenocarcinoma (OR: 1.1, 95% CI: 0.75–1.6) or squamous cell carcinoma (OR: 1.1, 95% CI: 0.77–1.7). Results were similar for CagA-negative and CagA-positive H. pylori seropositivity. Despite earlier small studies suggesting that H. pylori may contribute to lung carcinogenesis, H. pylori seropositivity does not appear to be associated with lung cancer.

To resect or not resect in metastatic gastric cancer: that is the question!

Last week we discussed 5 patients with gastric cancer at a meeting of our interdisciplinary tumor board. With the evidence we have and the recent publication of multidisciplinary treatment guidelines [1, 2] most decisions were easy to take and we achieved a great consensus with our colleagues from surgery and radiation oncology about our treatment standards. But one case concerned us a lot and we do not know yet if we took the right decision. A 46-year old man, born in Russia who had emigrated to Germany as a child–a freelance carpenter and father of 2 children– presented 5 months ago with a swollen painless lymph node at the right side of the neck. Histopathologic assessment revealed an adenocarcinoma of the intestinal type. Further examination showed a distal stomach cancer infiltrating the duodenum, two borderline enlarged lymph nodes in the mediastinum, and several enlarged lymph nodes along the aorta from the diaphragm down to the iliac bifurcation. These nodes were all positive on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). We treated this patient with docetaxel, 5-fluorouracil, and cisplatin [3]. He tolerated the treatment well but then he developed sensory neuropathy in the fingers and toes during the last cycle and complained about increasing taste disorder and about fatigue. The last computed tomography (CT) scan showed a good response in the lymph nodes. The mediastinum was normal and some enlarged lymph nodes in the retroperitoneum were no longer avid for FDG on the PET-CT. On endoscopy we still found a vital nonobstructing tumor in the distal stomach infiltrating the descending part of the duodenum. The patient had no difficulties in feeding himself and did not complain about

Is cardia cancer aetiologically different from distal stomach cancer?

The coexistence of two aetiologically distinct types of cardia cancer, with distinctive histological characteristics of the neoplastic and nonneoplastic gastric mucosa, may explain the heterogeneous evidence of its association with Helicobacter pylori infection. We compared gastric cardia and noncardia cancers with regard to the frequency of H. pylori infection, the histological characteristics of the nonneoplastic gastric mucosa and the tumour histological type. We evaluated 41 cardia and 339 noncardia cancer cases undergoing gastrectomy, and 380 community controls. H. pylori infection and CagA infection status were assessed by enzyme-linked immunosorbent assay and western blot, respectively. Histological characteristics of the neoplastic and nonneoplastic mucosa were obtained from pathology reports. The association between infection and cancers with different location was quantified in a case-control analysis and cardia and noncardia cancers were further compared. No positive relation was found for H. pylori infection, but CagA-positive strains were associated with an increased risk of noncardia cancer (odds ratio=1.60, 95% confidence interval=1.17-2.18). Twenty-seven (65.8%) cardia cancer cases, predominantly of the intestinal type (66.7%), had nonneoplastic atrophic mucosa and 208 (61.4%) noncardia cancers (56.7% of the intestinal type). Among the cases occurring in nonatrophic patients, the proportion of cancers of the Laurén's intestinal type was 71.4% for cardia and 54.2% for noncardia gastric cancers. Cardia and noncardia cancers were similar with regard to the relation with infection, histological type and condition of the nonneoplastic mucosa, supporting the predominance of cardia cancers determined by H. pylori infection in this European high-risk setting.

Gastroesophageal junction carcinoma multimodal treatment: standards, debate and new therapeutic options

Author for correspondence: Department of Surgery, Ioannina University School of Medicine, Ioannina, TK 451 10, Greece and Personalized Cancer Networks Medicine, Biobank, Ioannina University, Ioannina, TK 451 10, Greece Tel.: +30 265 100 7423 Fax: +30 265 100 7094 droukos@uoi.gr has occurred in the USA and North-West Europe than in Japan and other Asian countries [1,2]. However, an increase in the incidence rate of cancer that anatomically straddles the distal esophagus and proximal stomach, called cardia or GEJ cancer, has been observed [3]. The reasons for this diverse prevalence of cardia and noncardia cancer are unclear. One of the reasons may be the decreasing incidence of noncardia cancer risk factors, such as Helicobacter pylori infection, that may not have a protective effect on GEJ tumors. Another explanation might be an increase in the frequency of gastroesophageal reflux and Barrett’s esophagus, which is thought to increase the risk of adenocarcinoma in the GEJ. Multiple environmental and genetic factors are involved in esophagogastric tumorigenesis, and the molecular mechanisms underlying disease initiation are still poorly understood.

Helicobacter pylori Infection may be Implicated in the Topography and Geographic Variation of Upper Gastrointestinal Cancers in the Taihang Mountain High‐Risk Region in Northern China

Helicobacter pylori infection is prevalent in China. Chronic infection of the bacterial not only causes distal stomach cancer, but also confers risk to gastric cardia adenocarcinoma. Because H. pylori infection is inversely associated with esophageal adenocarcinoma, globally the infection rate is significantly correlated with the ratio of squamous carcinoma to adenocarcinoma of the esophagus. These agree with the topography of upper gastrointestinal cancer observed in the Taihang Mountain high-risk region where both gastric cardia and non-cardia adenocarcinoma coincide with esophageal squamous cancer, but with almost no distal esophageal adenocarcinoma. Moreover, as altitude increases from plain to mountains, we observed progressively increasing incidence rates of gastric adenocarcinomas in recent years in the region. Because H. pylori infection is a definite carcinogen to gastric adenocarcinoma and is more prevalent in the mountain than in plain areas due to undeveloped living conditions, the observation gives the impression as though H. pylori infection is implicated. This article aims to note the role of H. pylori infection in upper gastrointestinal cancer in the Taihang Mountain high-risk region in northern China. First the unique topography and geographic variation of upper gastrointestinal cancer in the region is described to indicate a possible role of H. pylori infection, then we review studies on prevalence of H. pylori infection in the high-risk region and describe difference in socioeconomic development and water hygiene between the plains and the mountains as related to the prevalence of H. pylori infection. Coincidence of gastric cancer in the region and a progressively increasing rate of the cancer from the plain towards the mountains indicate H. pylori infection may be implicated in upper gastrointestinal cancer. International collaboration is needed to study H. pylori and upper gastrointestinal cancer in the region when rapid industrialization is just beginning.

Adenocarcinoma of the Stomach and Esophagus and Drinking Water and Dietary Sources of Nitrate and Nitrite

We conducted a population-based case-control study of adenocarcinoma of the stomach and esophagus in Nebraska, U.S.A. Nitrate concentrations in public drinking water supplies were linked to residential water source histories. Among those using private wells at the time of the interview, we measured nitrate levels in water samples from wells. Dietary nitrate and nitrite were estimated from a food-frequency questionnaire. Among those who primarily used public water supplies (79 distal stomach, 84 esophagus, 321 controls), average nitrate levels were not associated with risk (highest versus lowest quartile: stomach OR=1.2, 95% CI [0.5-2.7]; esophagus OR=1.3, 95% CI [0.6-3.1]). We observed the highest ORs for distal stomach cancer among those with higher water nitrate ingestion and higher intake of processed meat compared with low intakes of both; however, the test for positive interaction was not significant (p=0.213). We did not observe this pattern for esophagus cancer. Increasing intake of nitrate and nitrite from animal sources was associated with elevated ORs for stomach cancer and with a significant positive trend in risk of esophagus cancer (P-trend=0.325 and 0.015, respectively). Larger studies with higher exposures to drinking water sources of nitrate are warranted to further evaluate N-nitroso compound precursors as risk factors for these cancers.

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

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.

Nutrient Intakes and Adenocarcinoma of the Esophagus and Distal Stomach

We studied the relationship between nutrient intakes and adenocarcinoma of the esophagus and distal stomach among 124 esophageal adenocarcinoma cases, 124 distal stomach cancer cases, and 449 controls in a population-based case-control study in eastern Nebraska. The residual method was used to adjust nutrient intake quartiles or tertiles for energy intake. We observed significant inverse associations with risk of esophageal adenocarcinoma for dietary intakes of total vitamin A [highest vs. lowest quartile, multivariate odds ratio (OR) = 0.5, P for trend = 0.05], β-cryptoxanthin (OR = 0.5, P = 0.05), riboflavin (OR = 0.5, P = 0.01), folate (OR = 0.5, P = 0.03), zinc (OR = 0.5, P = 0.05), dietary fiber (OR = 0.5, P = 0.05), protein (OR = 0.5, P = 0.02), and carbohydrate (OR = 0.4, P = 0.02). For distal stomach cancer, only vitamin C (OR = 0.6, P = 0.04), dietary fiber (OR = 0.4, P = 0.007), and carbohydrate (OR = 0.4, P = 0.004) were inversely associated with risk. Our analyses showed significant interaction between dietary fat intake, but not intakes of other nutrients, and respondent type for both cancer sites. Subgroup analyses among self-respondents revealed positive associations between saturated fat intake and risk of esophageal adenocarcinoma (OR = 1.0, 4.1, and 4.6 for intake tertiles, P for trend = 0.02) and risk of distal stomach cancer (OR = 1.0, 1.2, and 3.6, P = 0.03). However, no such associations were found among proxy respondents. Our data suggest that greater intake of dietary fiber, certain carotenoids, and vitamins may decrease the risk of esophageal adenocarcinoma, whereas greater intake of saturated fat may increase the risk of esophageal adenocarcinoma and distal stomach cancer.

Risk of adenocarcinomas of the oesophagus and gastric cardia in patients hospitalized for asthma.

In the first cohort study of the question we followed 92 986 (42 663 men and 50 323 women) adult patients hospitalized for asthma in Sweden from 1965 to 1994 for an average of 8.5 years to evaluate their risk of oesophageal and gastric cardia adenocarcinoma. Standardized incidence ratio (SIR) adjusted for gender, age and calendar year was used to estimate relative risk, using the Swedish nationwide cancer incidence rates as reference. Asthmatic patients overall had a moderately elevated risk for oesophageal adenocarcinoma (SIR = 1.5, 95% confidence interval CI, 0.9–2.5) and gastric cardia cancer (SIR = 1.4, 95% CI, 1.0–1.9). However, the excess risks were largely confined to asthmatic patients who also had a discharge record of gastro-oesophageal reflux (SIR = 7.5, 95% CI, 1.6–22.0 and SIR = 7.1, 95% CI, 3.1–14.0, respectively). No significant excess risk for oesophageal squamous-cell carcinoma or distal stomach cancer was observed. In conclusion, asthma is associated with a moderately elevated risk of developing oesophageal or gastric cardia adenocarcinoma. Special clinical vigilance vis-à-vis gastro-esophageal cancers seems unwarranted in asthmatic patients, but may be appropriate in those with clinically manifest gastro-oesophageal reflux. http://www.bjcancer.com © 2001 Cancer Research Campaign

The influence of cigarette smoking, alcohol, and green tea consumption on the risk of carcinoma of the cardia and distal stomach in Shanghai, China.

The divergent incidence patterns of gastric cardia and distal stomach cancer may suggest different etiologies. This study examined the role of cigarette smoking, alcohol drinking, and green tea consumption as risk factors for carcinoma by anatomic subsite of stomach. Newly-diagnosed stomach carcinoma patients (n = 1124) and frequency-matched population controls (n = 1451) were interviewed in person. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. Excess risks associated with cigarette smoking and alcohol consumption were observed largely among men. The adjusted ORs for all stomach cancer combined were 1.35 (CI: 1.06-1.71) for current smokers, and 1.26 (CI: 0.86-1.84) for ex-smokers. For tumors of the distal stomach, statistically significant positive dose-response trends were found for the number of cigarettes smoked per day, the duration and pack-years of smoking, and inverse trends for years of stopped smoking. For tumors of the gastric cardia, however, a monotonic association was found only for the number of cigarettes smoked per day (P=0.06). Alcohol consumption was not related to the risk of cardia cancer, while a moderate excess risk of distal stomach cancer (OR: 1.55; CI: 1.07-2.26) was observed among heavy alcohol drinkers. Green tea drinking was inversely associated with risk of stomach cancer arising from either subsite, with ORs of 0.77 (CI: 0.52-1.13) among female heavy drinkers, and 0.76 (CI: 0.55-1.27) among male heavy drinkers. Our findings provide further evidence that cigarette smoking and, possibly, alcohol consumption increase the risk of stomach carcinoma, notably of the distal segment. An inverse association with green tea drinking was also observed.