CHARACTERISTICS AND CLINICAL OUTCOME OF PROXIMAL-3RD GASTRIC-CANCER

Background: It is generally accepted that the prognosis of patients wi th proximal gastric cancer (PGC) is worse than that of patients with m ore distal gastric cancer. Study Design: The aim of this study was to compare the clinical features and outcomes of PGC with those of middle - and distal-third gastric cancers. A total of 646 primary gastric can cers was analyzed as a retrospective study. Results: proximal gastric cancer occurred in 21.8% of the 646 cancers analyzed, and approximatel y 21% of PGCs had esophageal invasion. The 5-year survival rate for pa tients with PGC was significantly lower than that of patients with mor e distal tumors. When the PGC group was divided into patients with eso phageal invasion and without esophageal invasion, patients with esopha geal invasion had significantly worse outcomes. When corrected for dep th of invasion, lesions with esophageal invasion had significantly mor se outcomes than those of other sites in T2 curative cancers. Proximal gastric cancer with esophageal invasion was characterized by a larger tumor, deeper penetration, and a higher incidence of lymph node metas tasis compared with tumors in other sites, and in multivariate analysi s of all curative cases, these variables were independent prognostic f actors for survival. The frequency of positive proximal margins of PGC was higher than those of other sites. Conclusions: The relatively poo r prognosis associated with PGC is mainly from advanced tumor stages o f esophageal invasion. Early detection is the most important strategy to improve the survival of patients with PGC. In addition, aggressive lymph node dissection and chemotherapy for esophageal invasion should be considered even if the tumor invasion is moderate (T2 tumor), and a tumor-free margin is important. (J Am Cell Surg 1998;187:352-357. (C) 1998 by the American College of Surgeons).