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

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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.

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Conflicts of interest

There are no potential or actual conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Chris Deans, Matthew S. W. Yeo, Asim Shabbir, T. K. Ti & Jimmy B. Y. So

  2. National University Cancer Institute, National University Hospital, Singapore, 119074, Singapore

    Mu Yar Soe

Authors
  1. Chris Deans
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  2. Matthew S. W. Yeo
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  3. Mu Yar Soe
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  4. Asim Shabbir
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  5. T. K. Ti
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  6. Jimmy B. Y. So
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Corresponding author

Correspondence to Jimmy B. Y. So.

Additional information

Presented to the 82nd Annual Meeting of the Japanese Gastric Cancer Association, Niigata, Japan 2010.

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Deans, C., Yeo, M.S.W., Soe, M.Y. et al. Cancer of the Gastric Cardia is Rising in Incidence in an Asian Population and is Associated with Adverse Outcome. World J Surg 35, 617–624 (2011). https://doi.org/10.1007/s00268-010-0935-0

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  • DOI: https://doi.org/10.1007/s00268-010-0935-0

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