Abstract Background Despite the decreasing incidence of gastric cancer in the United States, cancers of the stomach remain one of the leading causes of cancer related death in globally. Most patients are asymptomatic and have advanced disease when diagnosed. Studies have shown similar prognosis for proximal and distal tumors, although most studies exclude lesions in the cardia given overlap with esophageal cancers. Distal tumors involving the pylorus often leads to symptoms, such as gastric outlet obstruction presenting with nausea and emesis, which may lead to earlier diagnosis; therefore, we compared the adjusted survival with gastric adenocarcinomas based on location. Methods Using SEER*Stat software, we performed a retrospective cohort study by extracting U.S. survival data from the Surveillance, Epidemiology and End Results Database for all gastric adenocarcinomas based on location (antrum, body, fundus, pylorus) for the period between 1975 and 2016 for individuals aged > 30 years of age. Survival was compared by calculating relative hazard ratios (HRs) for cancer-specific death in the 5-year period following diagnosis with Cox proportional hazards models, adjusted for covariates, with significance set at p < 0.05. Data were analyzed using SAS 9.4 software and R. Results Survival analysis included 31,158 patients and showed no survival benefit comparing adenocarcinomas of the pylorus with those in the antrum (HR 1.02, 95% CI 0.97–1.07), body (HR 1.03, 95% CI 0.97–1.09). However, lower survival was seen for those in the fundus (HR 1.19, 95% CI 1.12–1.27). Male sex (HR 1.13, 95% CI 1.10–1.27), older age (HR 1.26, 95% CI 1.21–1.30), lack of chemotherapy (HR 1.06, 95% CI 1.02–1.10) and absence of surgery (HR 1.45, 95% CI 1.38–1.53) were associated with higher mortality. There were also statistically significant differences across higher stage and grade tumors, racial groups, and marital status. Conclusons Despite early presentation of symptoms, our study corroborated data suggesting no difference in prognosis between pyloric gastric adenocarcinomas and proximal tumors, except those in the fundus. While involvement of the pylorus often leads to clear clinical manifestations including weight loss, early satiety, nausea, and emesis, earlier identification of malignancy compared to adenocarcinomas in more indolent locations does not necessarily improve survival outcomes.
Tsay et al. (Mon,) studied this question.