Stomach

--Reid-Lombardo, K.M., Gay, G., Patel-Parekh, L., Ajani, J.A., Donohue, J.H., and Gastric Patient Care Evaluation Group from the Comission on Cancer (2007).  Treatment of Gastric Adenocarcinoma May Differ Among Hospital Types in the US, a Report from the National Cancer Data Base.  Journal of Gastrointestinal Surgery 2007 April 11(4);410-420.

--Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy. Cancer 2000; 88:921-932. (!)

--Hundahl SA, Menck HR, Mansour EG, Winchester DP. The national cancer data base report on gastric carcinoma. Cancer 1997; 80:2333-41. (!)

--Wanebo HJ, Kennedy BJ, Winchester DP, Stewart AK, Fremgen AM. Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on longterm survival. J Am Coll Surg 1997; 185:177-84. (!)

--Wanebo HJ, Kennedy BJ, Winchester DP, Fremgen AM, Stewart AK. Gastric carcinoma: Does lymph node dissection alter survival? J Am Coll Surg 1996; 183:616-624. (!)

Among the 3,804 patients having curative resection in the long-term study with more than a 5-year follow up, 695 had dissection of the nodes along the celiac axis, hepatic artery, or splenic artery (N2 nodes); 1,529 patients had removal of the adjacent nodes (N1 nodes); and 903 patients had no nodes identified in the resection specimen (essentially N0 nodes removed). For patients having a dissection of N2 nodes, the median survival time was 19.7 months with a 5-year survival rate of 26.3 %. The median survival time for patients having a dissection of N1 nodes was 24.8 months, with a 5-year survival rate of 30%. Among patients having no nodes removed, the median survival time was 29.5 months with a 5-year survival rate of 35.6%.

--Lawrence W, Menck HR, Steele GD, Winchester DP. The National Cancer Data Base report on gastric cancer. Cancer 1995; 75:1734-1744.

Three Calls for Data provided a total of 16,992 case reports of gastric cancer for 1985, 1986, and 1991, from hospital cancer registries across the U.S. Gastric cancer was the 15th most frequent cancer reported to the NCDB. The proportion of all reported cancers that were gastric in the 2 time intervals studied were essentially the same. In 1991, 20.8% of the cases were reported in minorities. Only 46% of gastric cancer cases were staged by the American Joint Committee on Cancer (AJCC) system from 1985 to 1986, compared to 77% in 1991. More advanced stages were reported for younger patients, but less advanced stages were noted in the Asian population. Of all patients reported, 41.4% had no reported cancer-directed surgery, 41.1% had partial or hemigastrectomy, and 6.7% had total gastrectomy. More extensive surgery was associated with patients with stage III disease than with stages I and II, as might be expected. Survival after treatment remained poor (5-year relative survival; 43% for stage I, 37% for stage II, 18% for stage III, and 20% for stage IV).

--Lawrence W, Menck HR: Gastric cancer. In: Steele GD, Winchester DP, Osteen RT, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1994. Atlanta, GA: American Cancer Society, 1994.

Data were received on 4,109 gastric cancer cases from 464 hospitals in 1985, 4,372 cases from 474 hospitals in 1986, and 8,511 cases from 937 hospitals in 1991. These data represent approximately 17%, 18%, and 36% of all stomach cancers in the United States in 1985, 1986, and 1991, respectively. Various social factors were studied from the standpoint of the incidence of gastric cancer, but there were no apparent differences compared with other cancers and no trends observed in terms of geographic areas in the United States, rural versus urban living, or income group. However, there was a trend toward an increasing proportion of Hispanic and Asian patients with gastric cancer in 1985and 1986 compared to 1991. No conclusions specific to gastric cancer can be drawn from this information regarding national trends, since the ethnic distribution of patients in the hospitals recruited to do the study and the hospital characteristics in the second time period could easily have led to this disparity. In the United States, the predominant anatomic sub-site for gastric cancer has steadily shifted from the distal gastric area to proximal sites, but the site distribution did not change appreciably between the 2 data collection periods. The trend toward earlier stage at diagnosis in the higher-income groups might easily be explained by better access to the health care system for this population, but the similar trend of earlier stage in the small Asian population in this study is particularly interesting. Gastric cancer arising in this group may involve a less aggressive disease process than that generally observed in the U.S. white population. This hypothesis had been advanced in the past to help explain the superior treatment results reported in Japan compared with institutional reports on end results from the United States.

--Wanebo HJ, Kennedy BJ, Chmiel JS, Steele GD, Winchester DP, Osteen RT. Cancer of the stomach: A patient care study by the American College of Surgeons. Ann Surg 1993; 218:583- 592. (*)

A total of 18,365 (11,264 treated in 1982 and 7,101 treated in 1987) patients stomach cancer participated in this study. The median ages were 68.4 years in males and 71.9 years in females, and 25% of the patients had a history of gastric ulcer. Lesions were located in the upper third (31%), middle third (14%), distal third (26%), and entire stomach (10%). The extent of gastric resection varied according to location. For lower third lesions, patients were treated with subtotal gastrectomy (55%), extended resection (21%), and total gastrectomy (6%). For proximal lesions 29% of patients had subtotal gastrectomies, 4.6% had total, 41% had extended gastrectomies (including esophagus), and 13.6% had dissection of the celiac nodes. The disease-specific survival rate was 26%. The survival rate after resection was 19%, 21% for lower and mid-third cancer, 10% for upper-third cancers, and 4% if the entire stomach was involved. The stage-related survival rates ranged from 50% (stage I) to 3% (stage IV). Among patients with pathologically clear margins, the survival rate was 35% versus 13% in those with microscopically involved margins, and it was 3% in those with grossly involved margins.

 

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