Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2022; 14(11): 2238-2252
Published online Nov 15, 2022. doi: 10.4251/wjgo.v14.i11.2238
Features of gastric cancer by anatomic subsite in northern China: A multi-center Health Science Report database study
Rui-Ze Qu, Yan-Peng Ma, Xiao-Yuan Bao, Li-Yuan Tao, Xin Zhou, Si-Yi Lu, Yi Zhang, Bing-Yan Wang, Fei Li, Lin Tuo, Zhi-Peng Zhang, Wei Fu
Rui-Ze Qu, Yan-Peng Ma, Xin Zhou, Si-Yi Lu, Yi Zhang, Bing-Yan Wang, Fei Li, Zhi-Peng Zhang, Wei Fu, Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing 100191, China
Xiao-Yuan Bao, Medical Informatics Center, Peking University Health Science Center, Beijing 100191, China
Li-Yuan Tao, Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
Lin Tuo, Department of Hospital Management, Peking University Health Science Center, Beijing 100191, China
Author contributions: Qu RZ, Ma YP and Bao XY contributed equally; Fu W, Zhang ZP, and Tuo L contributed equally to this article; Fu W and Zhang ZP contributed to conceptualization; Qu RZ, Ma YP, Tao LY, and Bao XY contributed to data curation; Qu RZ, Ma YP, and Tao LY contributed to formal analysis; Fu W and Zhang ZP contributed to funding acquisition and supervision; Qu RZ and Ma YP contributed to investigation; Bao XY and Tuo L contributed to methodology; Fu W, Zhang ZP, and Tuo L contributed to project administration and resources; Bao XY and Tuo contributed to software; Ma YP, Zhou X, Wang BY, Li F, Lu SY, and Zhang Y contributed to validation; Qu RZ, Ma YP, and Bao XY contributed to visualization; Qu RZ and Ma YP contributed to writing-original draft; Fu W, Zhang ZP, Tuo L, Qu RZ, Ma YP, and Zhou X contributed to writing-review & editing.
Supported by the National Natural Science Foundation of China, No. 81972702, No. 91959110, and No. 62173005.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Peking University Third Hospital (Approval No. IRB00006761-M2019387).
Informed consent statement: Written informed consent was waived because of the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The datasets analyzed during the current study are stored in the Medical Information Center, Peking University Health Science Center, and are not available for the public owing to privacy protection, but could be accessed on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Fu, MD, Chief Doctor, Professor, Department of General Surgery, Cancer Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. fuwei@bjmu.edu.cn
Received: August 5, 2022
Peer-review started: August 5, 2022
First decision: September 29, 2022
Revised: October 5, 2022
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 15, 2022
Processing time: 101 Days and 22 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer is among the most common digestive malignant tumors worldwide. China is among the regions with the highest gastric cancer incidence. Differences in clinical and epidemiological features of this tumor type based on its presence in the anatomical subsites of the stomach have been reported.

Research motivation

Few population-based studies have been conducted in China to determine differences among tumors at different locations, and analyses of data from northern China are lacking.

Research objectives

To examine the clinical features of gastric cancer at different anatomical sites in patients from northern China. We also aimed to examine the associated variability and trends.

Research methods

We conducted a cross-sectional study used incident gastric cancer case data from 10 Peking University-affiliated hospitals, and the clinical and prevailing local features were analyzed.

Research results

Ten thousand seven hundred and nine patients were enrolled, including antral, cardia, and stomach body gastric cancer cases. Cancer in the cardia had the highest male:female ratio, proportion of elderly patients, and patients with complications, including hypertension, diabetes, cerebrovascular, and coronary diseases (P < 0.001). gastric cancer involving the antrum showed the lowest proportion of patients from rural areas and accounted for the highest hospitalization rate and cost (each P < 0.001). The proportion of patients with cancer involving the cardia increased with an increase in the number of gastroesophageal reflux disease (GERD) cases during the same period (P < 0.001). Multivariate analysis revealed that tumor location in the cardia increased the risk of in-hospital mortality (P = 0.046). Anatomical subsite was not linked to postoperative complications.

Research conclusions

In this study, we first examined the epidemiologic features of gastric cancer in northern China based on anatomical subsites, showing a higher male ratio, older age distribution, older age-related trend, increasing proportion, close relationship with GERD, and increased risk of in-hospital mortality in gastric cardia cancer than in other types. This cancer site was also associated with younger age distribution, increased likelihood of residence in the city, and decreasing trends in the proportion of antral cancer. Overall, the constituent ratio of gastric cardia cancer in northern China was higher than the average level in China and Europe, and lower than that in North America and West Asia. Compared to previous reports in China, the constituent ratio of gastric cardia cancer in this study was slightly higher than that in the northwest China and lower than that in southwest China but showed high inner similarity compared with other global regions. Similarly, the proportion of antral gastric cancer is in the mid-level worldwide. Regionality is a typical phenomenon in both cardia and non-cardia (including gastric body and antrum) cancers and is generally considered to be linked to race, unique eating habits, and the environment.

Research perspectives

This is the first study to report the composition ratio characteristics and changes in gastric cancer trends based on anatomical sites in patients in northern China. This study examined plausible explanations for these findings. Large-scale screening programs for gastric cancer and infection, increasing awareness and prevention of risk factors, reducing smoking and obesity, as well as patient stratification for treatment based on anatomical sites are required to reduce the burden of gastric cancer.