Population-based study of diagnosis, treatment and prognosis of gastric cancer

Background Gastric cancer remains a common cancer with a poor prognosis. Improving trends seen in Japan have not yet been observed in Western countries. Methods A population‐based series of 1329 patients with gastric cancer diagnosed over an 18‐year period in CBte d'Or, France, was used to establish time trends in diagnostic strategy, treatment and prognosis. Results The use of endoscopy alone increased from 2·7 per cent in 1976–1978 to 76·6 per cent in 1991–1993 (P < 0·0001). This trend was associated at first with a significant decrease in the use of radiography alone, then by a significant decrease in the use of both radiography and endoscopy. The proportion of resections for cure increased from 37·9 per cent in 1976–1978 to 50·0 per cent in 1991–1993 (mean 3‐year variation +5·8 per cent, P < 0·01). The proportion of cases confined to the gastric wall increased from 6·1 to 11·7 per cent (mean 3‐year variation +13·1 per cent, P < 0·01), while the proportion of other stages remained stable. The operative mortality rate decreased dramatically from 25·6 per cent in 1976–1978 to 13·6 per cent in 1991–1993 (P < 0·001) and the 5‐year relative survival rate rose from 12·8 per cent in 1976–1978 to 26·4 per cent in 1988–1990 (P < 0·001). Conclusion This study has demonstrated that improvements in the care of patients with gastric cancer have been achieved, but that further progress may be made.