Time trends in gastric carcinoma: changing patterns of type and location

To determine whether there have been major changes in various aspects of gastric carcinoma, we reviewed the records of 302 patients with gastric cancer diagnosed between 1973 and 1989. Patients were divided into two groups: group I, 1973-80 (n = 163), and group II, 1981-88 (n = 139). On admission, no significant differences in presenting symptoms and physical signs were found, except for an increase in dysphagia (p less than 0.005) in group II. Endoscopy with targeted biopsy and biphasic-contrast examination were of equal merit in detecting malignancy (99.7%). A significant increase in the proportion of patients with cardia carcinoma was noted in group II (p less than 0.02). The proportion of patients with early gastric cancer decreased from 11% to 7.2%. The proportion of patients with intestinal-type carcinoma decreased in period II (p less than 0.05), accompanied by an increase in the proportion of patients with diffuse-type carcinoma during the same period (p less than 0.01). The overall 5-yr survival estimate was 17%. Independent prognostic variables were T stage (p less than 0.0001) and N stage (p less than 0.001), whereas Lauren type and tumor site were only significant in univariate survival analysis (p less than 0.05 and p less than 0.005, respectively).