Abstract
The records of 1,710 patients with adenocarcinoma of the stomach treated at Charity Hospital over a 35-year period were reviewed to note any trends which might help in understanding the decreasing incidence and poor prognosis of the disease.
The yearly number of gastric cancer patients has dropped from 234/100,000 in the 1950's to 195/100,000 in the 1960's to 108/100,000 patients in the last decade. The percentage of affected white males is decreasing at a rate equal to the increasing frequency of black female patients, while the ratios for black males and white females remain constant. The median age rose from 61.5 years to 66 years over the study period.
The operability rate decreased from 82.4% to 72.8% and the resectability rate was 49%. Subtotal gastrectomy was the most common procedure, but radical subtotal gastrectomy gave the best 5-year survival.
There are fewer lesions of the antrum today, but the highest number of 5-year survivors had antral lesions. Long-term survival of patients with lesions of the cardia improved from zero in the first 25 years to 14% in the last decade.
For the last 2 decades, patients with stage III and IV lesions comprised one-half of the 5-year survivors.
Our overall 5-year survival was 7.9%, but in the last decade it was 8.9%. Our 5-year survival for all patients who underwent a resection was 17.9%, but increased to 24.8% for the last decade. These improvements, in combination with a decrease in incidence, have dropped the overall mortality from gastric cancer.
Résumé
Les dossiers de 1,710 patients ayant eu un adénocarcinome de l'estomac traités au cours des dernières années à l'Hôpital de la Charité (Nouvelle Orléans) ont été revus pour chercher des indices qui pourraient permettre de comprendre l'incidence décroissante et le mauvais pronostic de cette maladie.
Le nombre de cancer gastrique par an est passé de 234/ 100,000 dans les années 50 à 195/100,000 dans les années 60 et à 108/100,000 dans la dernière décennie. Le pourcentage d'hommes de race blanche décroît, celui des femmes de race noire augmente, ceux des hommes de race noire et des femmes de race blanche restent stationnaires. L'âge médian a augmenté de 61.5 à 66 ans pendant la période d'étude.
Le taux d'opérabilité a baissé de 82.4% à 72.8%, le taux de résectabilité était de 49%. La gastrectomie subtotale était pratiquée le plus souvent; la gastrectomie subtotale radical a donné la meilleure survie à 5 ans.
Le nombre global de lésions antrales a diminué, mais les meilleures survies à 5 ans correspondent aux patients qui ont des lésions de l'antre. La survie à long terme des patients ayant un cancer du cardia est passée de 0% pendant les 25 premières années à 14% pendant la dernière décennie.
Pendant les 2 dernières décennies, la moitié des survivants à 5 ans avaient des lésions de stade III et de stade IV.
La survie globale à 5 ans était de 7.9%; celle de la dernière décennie de 8.9%. La survie à 5 ans pour tous les patients ayant eu une résection était de 17.9% et est passée à 24.8% pendant la dernière décennie. Nous pensons que la mortalité globale en rapport avec le cancer gastrique a diminué en raison de ces améliorations et du fait de la diminution de son incidence.
Resumen
Se revisaron las historias clínicas de 1,710 pacientes con adenocarcinoma del estómago tratados en el Charity Hospital en un período de 35 años para identificar factores que pudieran ser ayuda para comprender la razón de la decreciente incidencia y el mal pronóstico de la enfermedad.
El número anual de pacientes con cáncer gástrico ha descendido de 234/100,000 en los años 1950's a 195/100,000 en los 1960's y 108/100,000 en la última década. El porcentaje de hombres blancos afectados decrece a una tasa igual a la tasa de aumento en mujeres negras, en tanto que la relación para hombres negros y mujeres blancas se mantiene constante. La edad promedio ascendió de 61.5 a 66 años en el curso del estudio.
La tasa de operabilidad disminuyó de 82.4% a 72.8% y la tasa de resecabilidad fue 49%. La gastrectomía subtotal fue el procedimiento más comúnmente utilizado, pero la gastrectomía subtotal demostró la mejor sobrevida a 5 años. Hoy se ven menos lesiones del antro pero el mayor número de sobrevivientes a 5 años tenía lesiones antrales. La sobrevida a largo plazo en los pacientes con lesiones del cardias mejoró de cero en los primeros 25 años a 14% en la última década.
En las 2 últimas décadas los pacientes con lesiones en estados III y IV representaron la mitad de los sobrevivientes a 5 años.
Nuestra tasa global de sobrevida a 5 años es de 7.9% pero en la ultima década fue de 8.9%. Nuestra tasa de sobrevida a 5 anos para la totalidad de los pacientes sometidos a resección es de 17.9%, pero ascendió a 24.8% en la última década. Tales progresos, junto con el descenso en la incidencia, han reducido la mortalidad por cáncer gástrico.
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Breaux, J.R., Bringaze, W., Chappuis, C. et al. Adenocarcinoma of the stomach: A review of 35 years and 1,710 cases. World J. Surg. 14, 580–586 (1990). https://doi.org/10.1007/BF01658794
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DOI: https://doi.org/10.1007/BF01658794