Three decades of clinical-pathological trends in gastric cancer: prospective data from a Portuguese hospital.

Introduction: Gastric cancer is a heterogeneous disease, whose pathological and clinical patterns have changed in the last decades. In most western countries, decreases in incidence and mortality and a proximal migration have been reported. The clinical and pathological trends in an European country with high prevalence of gastric cancer were reviewed, based on the patients treated at a University Hospital.

Methods: Analysis of a prospective database with 1618 patients who underwent surgery for gastric cancer in the last 3 decades. The patients were divided in 3 groups according to decades and the cohorts were analyzed according to demographic, surgical and pathological factors.

Results: The mean age increased from 59.8 to 65.6 years. Antral tumors and intestinal cancer were the most frequent. The rate of complete resection increased as well as the percentage of total gastrectomies and D2-type lymphadenectomies. There was an increase both in early stage carcinomas and in surgically treated Stage-IV carcinomas. The median overall crude survival almost doubled from 14 to 22 months (p = 0.003), but once stratified for stage, only in stage II patients could we observe a significant increase in survival time. (29-47 months; p = 0.047).

Conclusion: The proximal migration described for Western Europe was not observed and the intestinal-type carcinoma is still the most frequent. We are treating older patients, often with more advanced disease. In spite of an increasing surgical aggressiveness, the prognosis has only been significantly improved in Stage-II cancers. The prognosis for advanced cancer is still dismal, hence the need for effective adjuvant treatments.