Prognostic Differences of Tumor Localization in Gastric Cancer Patients Undergoing Curative Resection


Gastric cancer

How to Cite

Gulmez, S., Senger, A. S., Uzun, O., Omeroglu, S., Ofluoglu, C. B., Oz, A., Polat, E., & Duman, U. (2022). Prognostic Differences of Tumor Localization in Gastric Cancer Patients Undergoing Curative Resection. Iranian Red Crescent Medical Journal, 24(3).


Background: Gastric cancer is the fifth most frequent cancer worldwide and the third major cause of cancer-related fatalities

Objectives: The current study aims to investigate whether there is a relationship between tumor location and various prognostic factors in patients who underwent curative resection for gastric cancer.

Methods: A total of 293 patients who underwent curative surgical resection for gastric cancer were analysed retrospectively. Siewert type II and III tumours were defined as proximal gastric cancer (PGC). More distally located tumours were defined as distal gastric cancer (DGC). Siewert type I tumours were excluded.

Results: Out of 293 patients, 78 were diagnosed with PGC and 215 had DGC. There was a significant relationship between preoperative/postoperative chemotherapy administration, gastrectomy type, presence of lymphatic metastasis, Tumour-Node-Metastasis stage, and tumour localization (P < 0.05). There was no significant difference between PGC and DGC in terms of length of hospital stay (P = 0.137). Five-year survival rates for PGC and DGC were 48.4% and 45.8%, respectively (P = 0.863). pT stage, preoperative and postoperative chemotherapy were determined as independent risk factors (P < 0.05).  The location of the tumour and the type of surgical resection did not affect the prognosis (P > 0.05).

Conclusion: Tumour localization is not a prognostic factor in gastric cancer. When safe surgical margins were provided in DGC, total gastrectomy for DGC had no effect on the survival rate.


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492. [PubMed: 30207593].

Falk J, Carstens H, Lundell L, Albertsson M. Incidence of carcinoma of the oesophagus and gastric cardia. Changes

over time and geographical differences. Acta Oncol. 2007;46(8):1070-4. doi: 10.1080/02841860701403046. [PubMed: 17851842].

Wang X, Liu F, Li Y, Tang S, Zhang Y, Chen Y, et al. Comparison on Clinicopathological Features, Treatments and Prognosis between Proximal Gastric Cancer and Distal Gastric Cancer:

A National Cancer Data Base Analysis. J Cancer. 2019;10(14):3145-53. doi: 10.7150/jca.30371. [PubMed: 31289585].

Yu X, Hu F, Li C, Yao Q, Zhang H, Xue Y. Clinicopathologic characteristics and prognosis of proximal and distal

gastric cancer. Onco Targets Ther. 2018;11:1037-44. doi: 10.2147/OTT.S157378. [PubMed: 29520154].

Zhao L, Huang H, Zhao D, Wang C, Tian Y, Yuan X, et al. Clinicopathological Characteristics and Prognosis of Proximal and Distal Gastric Cancer during 1997-2017 in China National Cancer Center. J Oncol. 2019;2019:9784039. doi: 10.1155/2019/9784039. [PubMed: 31312217].

Ilhan E, Ureyen O. A Comparison of Subtotal Gastrectomy and Total Gastrectomy for Distal Gastric Cancer. Indian Journal of Surgery. 2019;81:70-6. doi: 10.1007/s12262-018-1834-0.

Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-9. doi: 10.3322/caac.21388. [PubMed: 28094848].

Maric R, Cheng KK. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1999;86(8):1098-9. doi: 10.1046/j.1365-2168.1999.01197-15.x. [PubMed: 10498429].

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. doi: 10.1097/ [PubMed: 15273542].

Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20. doi: 10.1056/NEJMoa055531. [PubMed: 16822992].

Ychou M, Boige V, Pignon JP, Conroy T, Bouche O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin

Oncol. 2011;29(13):1715-21. doi: 10.1200/JCO.2010.33.0597. [PubMed: 21444866].

Del Rio P, Rocchi M, Dell'Abate P, Pucci F, Mazzetti C, Sianesi M. Advanced stage gastric cancer and neoadjuvant chemotherapy: our experience in surgical resectability. Ann Ital Chir. 2013;84(6):623-9. [PubMed: 24535815].

Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial.

Ann Surg. 1999;230(2):170-8. doi: 10.1097/00000658-199908000-00006. [PubMed: 10450730].

Kong L, Yang N, Shi L, Zhao G, Wang M, Zhang Y. Total versus subtotal gastrectomy for distal gastric cancer: meta-analysis of randomized clinical trials. Onco Targets Ther. 2016;9:6795-800. doi: 10.2147/OTT.S110828. [PubMed: 27853375].

Huang Q, Shi J, Sun Q, Gold JS, Chen J, Wu H, et al. Clinicopathological characterisation of small (2 cm or less) proximal and distal gastric carcinomas in a Chinese population. Pathology. 2015;47(6):526-32. doi: 10.1097/PAT.0000000000000276. [PubMed: 26166663].

Piso P, Werner U, Lang H, Mirena P, Klempnauer J. Proximal versus distal gastric carcinoma--what are the differences?. Ann Surg Oncol. 2000;7:520-5. doi: 10.1007/s10434-000-0520-0. [PubMed: 10947021].

Costa LB, Toneto MG, Moreira LF. Do Proximal and Distal Gastric Tumours Behave Differently?. Arq Bras Cir Dig. 2016;29(4):232-5. doi: 10.1590/0102-6720201600040005. [PubMed: 28076476].

Song W, Liu Y, Ye J, Peng J, He W, Chen J, et al. Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach. Chin Med J (Engl). 2014;127(123):4049-54. [PubMed: 25430447].

Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel). 2011;3(2):2141-59. doi: 10.3390/cancers3022141. [PubMed: 24212800].

Doglietto GB, Rosa F, Bossola M, Pacelli F. Lymphadenectomy for gastric cancer: still a matter of debate?. Ann Ital Chir. 2012;83(3):199-207. [PubMed: 22595731].

Kim IH. Current status of adjuvant chemotherapy for gastric cancer. World J Gastrointest Oncol. 2019;11(9):679-85. doi: 10.4251/wjgo.v11.i9.679. [PubMed: 31558973].

Pacelli F, Papa V, Caprino P, Sgadari A, Bossola M, Doglietto GB. Proximal compared with distal gastric cancer: multivariate analysis of prognostic factors. Am Surg. 2001;67(7):697-703. [PubMed: 11450793].

Petrelli F, Ghidini M, Barni S, Steccanella F, Sgroi G, Passalacqua R, et al. Prognostic Role of Primary Tumor Location in Non-Metastatic Gastric Cancer: A Systematic Review and Meta-Analysis of 50 Studies. Ann Surg

Oncol. 2017;24(9):2655-68. doi: 10.1245/s10434-017-5832-4. [PubMed: 28299508].