Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: A population-based study in the Netherlands

Dassen, A.E.; Lemmens, V.E.P.P.; van de Poll-Franse, L.V.; Creemers, G.J.; Brenninkmeijer, S.J.; Lips, D.J.; vd Wurff, A.A.M.; Bosscha, K.; Coebergh, J.W.W.

doi:10.1016/j.ejca.2010.02.013

« Previous Next »European Journal of Cancer
Volume 46, Issue 6 , Pages 1101-1110, April 2010

Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: A population-based study in the Netherlands

A.E. Dassen
- Jeroen Bosch Hospital, Department of Surgery, P.O. Box 90153, 5200 ME’s-Hertogenbosch, The Netherlands
- Corresponding author: Tel.: +31 736992001; fax: +31 736992163.
V.E.P.P. Lemmens
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands
- Erasmus MC University Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
L.V. van de Poll-Franse
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands
- Tilburg University, CoRPS, Department of Medical Psychology, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
G.J. Creemers
- Catharina Hospital, Department of Oncology, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
S.J. Brenninkmeijer
- TweeSteden Hospital, Department of Surgery, P.O. Box 90107, 5000 LA Tilburg, The Netherlands
D.J. Lips
- Jeroen Bosch Hospital, Department of Surgery, P.O. Box 90153, 5200 ME’s-Hertogenbosch, The Netherlands
A.A.M. vd Wurff
- St. Elisabeth Hospital, Department of Oncology, P.O. Box 90151, 5022 GC Tilburg, The Netherlands
K. Bosscha
- Jeroen Bosch Hospital, Department of Surgery, P.O. Box 90153, 5200 ME’s-Hertogenbosch, The Netherlands
J.W.W. Coebergh
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands
- Erasmus MC University Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Received 20 December 2009; received in revised form 30 January 2010; accepted 9 February 2010. published online 11 March 2010.

Abstract

Background

Survival of gastric cancer in the Western world remains poor. We conducted a retrospective population-based study to evaluate trends in incidence, treatment and outcome of gastric adenocarcinoma.

Methods

All patients diagnosed with gastric adenocarcinoma during 1990–2007 in the Dutch Eindhoven Cancer Registry area were included (n=4797). Trend analyses were conducted for incidence, mortality, tumour and patient characteristics, treatment and crude overall survival, according to tumour location (cardia versus non-cardia). Temporal changes in the odds of undergoing surgery and the risk of death were analysed by means of multivariable regression methods.

Results

Age-standardised incidence decreased among males (24–12 per 100,000 inhabitants) and females (10–6); mortality rates decreased at a similar pace. The proportion of cardia tumours remained stable. Stage distribution worsened over time among patients with cardia (stages I and II: 32% in 1990–1993 and 22% in 2006–2007, p=0.005) and non-cardia (stage IV: 33% in 1990–1993 and 40% in 2006–2007, p=0.0003) cancer. Chemotherapy rates increased in all settings. Five-year survival worsened over time for patients with non-cardia tumours. Age and stage had significant influence on survival after stratification for tumour localisation. After adjustments for relevant factors (i.e. stage), the risk of death decreased since the late 90s for patients with a cardia tumour (hazard ratio 0.8, p=0.01).

Conclusion

The absence of improvement in survival rates indicates the need for earlier detection and prospective studies to evaluate new therapy regimens with standardised surgery and pathology.

Keywords: Gastric cancer, Gastric adenocarcinoma, Incidence, Treatment, Survival, Epidemiology