Background. The aim of the present multicenter observational study was to evaluate potential changes in clinical and pathological features of gastric cancer (GC) patients treated in a 15-yr period. Methods. A centralized prospective database including clinical, surgical, pathological and follow-up data of 2822 patients resected for primary GC was analyzed. The period of treatment was subsetted in: 1991-1995 (period A), 1996-2000 (period B), and 2001-2005 (period C). Surgical procedure, pathological classification and follow-up were standardized among centers. Results. The number of resected patients decreased from 1024 in period A to 955 and 843 in periods B and C, respectively; more advanced stages and lower number of intestinal-type tumors of the distal third were observed overtime. Survival analysis conducted on 2320 patients submitted to R0 resection showed a trend to a lower overall and cancer-related 5-yr survival rates from period A to period C (from 56.6% and 66.8% to 51.2% and 61.1%, respectively). This difference was statistically significant in neoplasms involving the serosa, in distal tumors and in females. Multivariate analysis confirmed the negative prognostic value of most recent time-periods (hazards ratio for overall survival of period C vs. period A: 1.22 (1.06-1.40); cancer-related survival: 1.29 (1.06-1.58)). Conclusion. Even if high survival rates were achieved after R0 resection, a trend to worse results was observed in recent years, mainly due to more advanced stages and fewer intestinal distal tumors. These data indicate that the decreasing incidence of GC may be associated with more aggressive clinical and pathological features of the disease.
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|Titolo:||Changing clinical and pathological features of gastric cancer over time.|
|Appare nelle tipologie:||1.1 Articolo in rivista|