Chronological Changes of Clinicopathologic Features in Gastric Cancer

Choi, Min Gew; Lee, Joo Ho; Park, Kyu Joo; Yang, Han Kwang; Park, Jae Gahb; Lee, Kun Uk; Choe, Kuk Jin; Kim, Jin Pok

Abstract

BACKGROUND: This study was designed to analyze chronological changes of the clinicopathologic features in patients with gastric cancer who had undergone gastric operations at Seoul National University Hospital.
METHODS
A retrospective review of the clinicopathologic features of a total of 2,217 gastric cancer patients was made for four different years: 407 patients in 1986, 507 patients in 1990, 646 patients in 1994, and 657 patients in 1997.
RESULTS
The overall male-to-female ratio was 2.4:1, and there was no significant differences among the year groups. The mean ages were 53.2, 53.4, 54.5, and 55.9 years for each year group, respectively. The most common presenting symptoms were epigastic pain (44.5%), epigastric discomfort (19.5%), and indigestion (11.6%). The duration from onset of symptoms to operation has been shortened in recent years, and the proportions of operations delayed over 6 months were 43.0%, 40.2%, 38.0%, and 27.4% in each year group, respectively. The main cause of delayed diagnosis was neglect of symptoms by the patients (60.7%). The ratio of gastric cancer detected by routine health check-up without symptoms has increased significantly (p<0.01), being 1.2%, 3.4%, 5.1%, and 7.5% in each year group, respectively. Poorly differentiated carcinomas were the most common histopathologic type overall (57.6%), and there was no significant change in the distribution of histologic differentiation over time. The proportion of earlier stages has increased over time (p<0.01), and the ratios of early gastric cancers were 19.7%, 23.1%, 30.3%, and 35.3% in each year group, respectively. The postoperative survival rate of the 1994 year group was improved significantly when compared to that of the 1986 or the 1990 year group (p=0.01); however, there were no significant differences among these year groups with the same stage of the disease.
CONCLUSIONS
These results suggest that the shortened duration of diagnostic delay and, partly, the early detection of the cancer by routine health check-ups have resulted in stage shifting (increased proportion of earlier stages) and improved survival.