THE NATIONAL-CANCER-DATA-BASE REPORT ON GASTRIC-CARCINOMA

BACKGROUND. The National Cancer Data Base (NCDB) represents a national electronic registry system now encompassing almost 60% of incident ca ncers in the United States. In combination with other programs of the American College of Surgeons Commission on Cancer, the NCDB offers a w orking example of voluntary, accurate, and cost-effective ''outcomes m anagement'' on a both a local and a national scale. METHODS, For the a ccession years 1985-1993, the NCDB has obtained information on demogra phics, patterns of care, disease stage, treatment, and outcome for a c onvenience sample of 57,407 gastric carcinoma cases (1.6% of total NCD B cases). In addition to describing trends, this report focuses on 5-y ear relative survival for a cohort of 1987-1988 cases staged according to the third edition of the American Joint Committee on Cancer's TNM classification, as well as patterns of care for st cohort of 1992-1993 cases. RESULTS. Stage-stratified 5-year relative survival for the 198 7-1988 cohort was as follows: IA, 71%; IB, 56%; II, 37%; IIIA, 18%; II IB, 11%; IV, 5%. Without noteworthy changes in stage distribution, dem ographics, or other factors, the proportion of patients treated by tot al gastrectomy is increasing slightly, but proximal gastrectomy for pr oximal cancers remains surprisingly popular. The proportion of cases r eceiving postoperative adjuvant treatment has declined slightly. Presu mably because of advanced age and/or medical infirmity, a substantial proportion of U.S. patients with disease at every stage receive no tre atment for cancer. CONCLUSIONS. This analysis of patterns of care has revealed unexplained variations in treatment and opportunities for imp rovement. Treatment of the elderly, infirm patient with gastric carcin oma appears problematic. (C) 1997 American Cancer Society.