Early carcinoma of the gastric cardia in Japan - Is it different from thatin the West?

BACKGROUND, The incidence of adenocarcinoma of the gastric cardia has incre ased recently in the West. However, in Japan, most patients with gastric ca rcinoma have disease that is situated in the body and the distal stomach. T he objectives of this study were to compare the clinicopathologic findings of patients with early gastric carcinoma (EGC) arising at the cardia and th ose wit carcinoma in more distal parts of the stomach, then comparing the f indings with those from patients with carcinoma of the gastric cardia in th e West. METHODS. Three thousand one hundred forty-four patients with EGC who underw ent surgical resection between 1962 and 1997 at the National Cancer Center Hospital in Tokyo were studied. Seventy patients with EGC at the cardia wer e compared with those who had lesions in the middle and lower parts of the stomach. The body mass index (BMI), smoking, and drinking were evaluated us ing all patients with cardia EGC and 344 patients in a matched cohort in th e latter group. RESULTS, Seventy patients had an EGC located just at the cardia, whereas 27 96 patients had lesions in the lower two-thirds of the stomach. The former lesions were different from those in the distal two-thirds of the stomach: More often, they were of an elevated type (34% vs. 14%, respectively, they were histologically well differentiated in 89% (vs. 59%), and there were mo re submucosal tumors (53% vs. 41%). The BMI, smoking, and drinking in the t wo groups were not different. The incidence of Barrett esophagus and gastro esophageal reflux disease (GERD) in patients with EGC were 2.9% (2 of 70 pa tients) and 5.7% (4 of 70 patients), respectively. CONCLUSIONS. There were many significant differences in clinicopathologic c haracteristics between patients with carcinoma of the cardia and patients w ith carcinoma of the distal stomach in Japan. The incidence of early cardia carcinoma was very low in Japan, and obesity, smoking, drinking, Barrett e sophagus, or GERD were not related to its occurrence, in contrast to report s in the West. Cancer 2000; 89:2555-9. (C) 2000 American Cancer Society.