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


Gastric cancer, gastrectomy, survival, prognosis

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).


Objective: To investigate whether there is a relationship between tumour location and prognostic factors in gastric cancer.

Methods: Total 293 patients who underwent curative surgical resection for gastric cancer were retrospective analysed.  Siewert Type II and III tumours were defined as PGC. More distally located tumours were defined as DGC. Siewert Type I tumours were excluded.

Results: Of the 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, TNM 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 did not affect survival.

Keywords: Gastric cancer, gastrectomy, survival, prognosis


1. 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. PMID: 30207593; doi: 10.3322/caac.21492
2. 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. PMID: 17851842; doi: 10.1080/02841860701403046.
3. 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. PMID: 31289585; doi: 10.7150/jca.30371.
4. 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. PMID: 29520154; doi: 10.2147/OTT.S157378.
5. 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. PMID: 31312217; doi: 10.1155/2019/9784039.
6. 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.
7. 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. PMID: 28094848; doi: 10.3322/caac.21388.
8. Maric R, Cheng KK. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 1999;86(8):1098-9. PMID: 10498429; doi: 10.1046/j.1365-2168.1999.01197-15.x.
9. 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. PMID: 15273542; doi: 10.1097/
10. 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. PMID: 16822992; doi: 10.1056/NEJMoa055531.
11. 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. PMID: 21444866; doi: 10.1200/JCO.2010.33.0597.
12. 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. PMID: 24535815.
13. 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. Italian Gastrointestinal Tumor Study Group. Ann Surg 1999;230(2):170-8. PMID: 10450730; doi: 10.1097/00000658-199908000-00006.
14. 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. PMID: 27853375; doi: 10.2147/OTT.S110828.
15. 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. PMID: 26166663; doi: 10.1097/PAT.0000000000000276.
16. 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. PMID: 10947021; doi: 10.1007/s10434-000-0520-0.
17. Costa LB, Toneto MG, Moreira LF. Do Proximal and Distal Gastric Tumours Behave Differently? Arq Bras Cir Dig 2016;29(4):232-5. PMID: 28076476; doi: 10.1590/0102-6720201600040005.
18. 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. PMID: 25430447.
19. Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel) 2011;3(2):2141-59. PMID: 24212800; doi: 10.3390/cancers3022141.
20. 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. PMID: 22595731.
21. Kim IH. Current status of adjuvant chemotherapy for gastric cancer. World J Gastrointest Oncol 2019;11(9):679-85. PMID: 31558973.
22. 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. PMID: 11450793.
23. 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. PMID: 28299508; doi: 10.1245/s10434-017-5832-4.