World Journal of Surgery

, Volume 35, Issue 3, pp 617–624 | Cite as

Cancer of the Gastric Cardia is Rising in Incidence in an Asian Population and is Associated with Adverse Outcome

  • Chris Deans
  • Matthew S. W. Yeo
  • Mu Yar Soe
  • Asim Shabbir
  • T. K. Ti
  • Jimmy B. Y. So
Article

Abstract

Background

Tumors arising from the esophagogastric junction (OGJ) are increasing in incidence in the west, but data from Asian populations are conflicting. Singapore has a mixed-Asian population with an international lifestyle. This study was designed to examine the changing trends in incidence of gastric cardia cancer (type III) within this population and to compare the clinicopathological characteristics and outcome of these tumors with gastric tumors.

Methods

Trends in cancer incidence were obtained from the Singapore Cancer Registry. Clinicopathological data were prospectively collected from patients undergoing surgery for gastric cancer who presented to the National University Hospital between 2000 and 2005. Patients underwent surgery with or without (neo)adjuvant therapy. Survival duration was analyzed.

Results

The incidence of cardia tumors has increased each decade since 1968 (1968–1982, 6.3%; 1983–1992, 7.6%; 1993–1997, 8.4%; 1998–2002, 9.1%; 2003–2007, 16.2%). Among the study population (n = 159) cardia tumors were associated with male sex (p < 0.01) and dysphagia (p < 0.01). Although R0 resection rates were similar, systemic recurrence rates were higher among patients with cardia cancer (p = 0.031) and survival was reduced compared with patients with non-cardia gastric cancer (median survival 26 vs. 69 months; p < 0.001). Cardia location of the tumor and metastatic lymph node ratio were identified as independent adverse prognostic indicators on multivariate analysis.

Conclusions

Similar to western societies, the incidence of proximal gastric cancer is increasing in Singapore. Cardia tumors are associated with poorer outcomes, suggesting that cardia cancer is a distinct disease from true gastric cancer requiring different management strategies to improve the outcome for these patients.

References

  1. 1.
    Steevens J, Botterweck AA, Dirx MJ et al (2010) Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 22(6):669–678PubMedGoogle Scholar
  2. 2.
    Blot W, Devesa SS, Kneller RW et al (1991) Rising incidence of adenocarcinoma of the oesophagus and gastric cardia. JAMA 265:1287–1289CrossRefPubMedGoogle Scholar
  3. 3.
    Jankowski JA, Harrison RF, Perry I et al (2000) Barrett’s metaplasia. Lancet 356:2079–2085CrossRefPubMedGoogle Scholar
  4. 4.
    Cameron AJ, Romero Y (2000) Symptomatic gastro-oesophageal reflux as a risk factor for oesophageal adenocarcinoma. Gut 46:745–755CrossRefGoogle Scholar
  5. 5.
    Siewert JR, Stein HJ (1996) Adenocarcinoma of the gastroesophageal junction: classification, pathology and extent of resection. Dis Esoph 9:173–182Google Scholar
  6. 6.
    Siewert JR, Feith M, Werner M et al (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232(3):353–361CrossRefGoogle Scholar
  7. 7.
    Siewert JR, Stein HJ (1998) Classification of carcinoma of the oesophago-gastric junction. Br J Surg 85:1457–1459CrossRefPubMedGoogle Scholar
  8. 8.
    Siewert JR, Feith M, Stein HJ (2005) Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 90(3):139–146CrossRefPubMedGoogle Scholar
  9. 9.
    Peters CJ, Hardwick RH, Vowler SL et al (2009) Generation and validation of a revised classification for oesophageal and junctional adenocarcinoma. Br J Surg 96(7):724–733CrossRefPubMedGoogle Scholar
  10. 10.
    Sobin LH, Gospodarowicz M, Wittekind C (2009) International Union Against Cancer (UICC), TNM classification of malignant tumors, 7th edn. WileyGoogle Scholar
  11. 11.
    Kusano C, Gotoda T, Khor CJ et al (2008) Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. Gastroenterol Hepatol 23(11):1662–1665CrossRefGoogle Scholar
  12. 12.
    Tony J, Kumar SK, Thomas V (2007) Time trends and pathological profile of carcinoma lower oesophagus and gastro-oesophageal junction over the last 20 years—an experience from South India. Trop Gastroenterol 28(3):113–116PubMedGoogle Scholar
  13. 13.
    Zhou Y, Zhang Z, Zhang Z et al (2008) A rising trend of gastric cardia cancer in Gansu Province of China. Cancer Lett 269(1):18–25CrossRefPubMedGoogle Scholar
  14. 14.
    Blaser MJ, Saito D (2002) Trends in reported adenocarcinomas of the oesophagus and gastric cardia in Japan. Eur J Gastroenterol Hepatol 14(2):107–113CrossRefPubMedGoogle Scholar
  15. 15.
    Lee JY, Kim HY, Kim KH et al (2003) No changing trends in incidence of gastric cardia cancer in Korea. J Korean Med Sci 18(1):53–57PubMedGoogle Scholar
  16. 16.
    Chang SS, Lu CL, Chao JY et al (2002) Unchanging trend of adenocarcinoma of the esophagus and gastric cardia in Taiwan: a 15-year experience in a single center. Dig Dis Sci 47(4):735–740CrossRefPubMedGoogle Scholar
  17. 17.
    Hasegawa S, Yoshikawa T, Cho H et al (2009) Is adenocarcinoma of the esophagogastric junction different between Japan and western countries? The incidence and clinicopathological features at a Japanese high-volume cancer center. World J Surg 33(1):95–103CrossRefPubMedGoogle Scholar
  18. 18.
    Look M, Gao F, Low CH, Nambiar R (2001) Gastric cancer in Singapore. Gastric Cancer 4(4):219–222CrossRefPubMedGoogle Scholar
  19. 19.
    National Health Survey (2004) Singapore Ministry of Health, Epidemiology and Disease Control Division. http://www.moh.gov.sg/mohcorp/publications.aspx?id=92
  20. 20.
    Singapore Cancer Registry, National Registry of Disease Office, Singapore, 2010: www.nrdo.gov.sg/page.aspx?id=76
  21. 21.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English Edition. Gastric Cancer 1(1):10–24CrossRefPubMedGoogle Scholar
  22. 22.
    Macdonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730CrossRefPubMedGoogle Scholar
  23. 23.
    Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355(1):11–20CrossRefPubMedGoogle Scholar
  24. 24.
    Association of Upper Gastrointestinal Surgeons, UK (2009) www.augis.org/pdf/audits/nhs-ic-og-clinical-audit_2nd_Annual_Report_2009.pdf
  25. 25.
    Kim JH, Rhee PL, Lee JH et al (2007) Prevalence and risk factors of Barrett’s esophagus in Korea. J Gastroenterol Hepatol 22(6):908–912CrossRefPubMedGoogle Scholar
  26. 26.
    Hongo M (2004) Review article: Barrett’s oesophagus and carcinoma in Japan. Aliment Pharmacol Ther 20(Suppl 8):50–54CrossRefPubMedGoogle Scholar
  27. 27.
    Ti TK (1993) Pattern and surgical treatment of gastric cancer in Singapore. Br J Surg 80(7):886–889CrossRefPubMedGoogle Scholar
  28. 28.
    Brown LM, Silverman DT, Pottern LM et al (1994) Adenocarcinoma of the esophagus and esophagogastric junction in white men in the United States: alcohol, tobacco, and socioeconomic factors. Cancer Causes Control 5(4):333–340CrossRefPubMedGoogle Scholar
  29. 29.
    Saito H, Fukumoto Y, Osaki T et al (2006) Distinct recurrence pattern and outcome of adenocarcinoma of the gastric cardia in comparison with carcinoma of other regions of the stomach. World J Surg 30(10):1864–1869CrossRefPubMedGoogle Scholar
  30. 30.
    Aikou T, Shimaza H (1989) Differences in main lymphatic pathways from the lower esophagus and gastric cardia. Jpn J Surg 19:290–295CrossRefPubMedGoogle Scholar
  31. 31.
    Salvon-Harman JC, Cady B, Nikulasson S et al (1994) Shifting proportions of gastric adenocarcinomas. Arch Surg 129:381–389PubMedGoogle Scholar
  32. 32.
    An JY, Baik YH, Choi MG et al (2010) The prognosis of gastric cardia cancer after R0 resection. Am J Surg 199(6):725–729CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Chris Deans
    • 1
  • Matthew S. W. Yeo
    • 1
  • Mu Yar Soe
    • 2
  • Asim Shabbir
    • 1
  • T. K. Ti
    • 1
  • Jimmy B. Y. So
    • 1
  1. 1.Department of SurgeryNational University HospitalSingaporeSingapore
  2. 2.National University Cancer InstituteNational University HospitalSingaporeSingapore

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