Twenty-year experience with multimodal treatment of gastric cancer patients in Poland

Background: Poland is among the countries with high morbidity and mortality rates for gastric carcinoma (GC). Differences of GC biology depending on the geographical regions were assumed. in the literature, there are no reports from detailed clinicopathologic studies carried out in large series of GC patients in Poland. Methods: Based on the prospectively collected data of 3696 GC patients treated surgically between 1977-1999, potentially significant prognostic factors were analyzed to assess their prognostic value, and their time related distribution during the over 20-year period of the study. Results: The mean age of the patients was 59.0 (SD 11.6) years and ranged from 20 to 93 years. The male-to-female ratio was 2.3. Overall cumulative 5-year survival was 0.28 (for early GC 0.85) and significantly increased over the period of study. Among factors analyzed the depth of invasion, lymph nodes status, tumor size, age, UICC-R classification and ratio of involved to removed lymph nodes are of statistically significant and most important prognostic value. In the over 20-year period of study the rate of diffuse type carcinoma according to Lauren increased, but the tumor locations did not change significantly. The rate of early GC did not change throughout the period of study but number of most advanced cases decreased. Chemo- and chemoimmunotherapy improved outcomes in some groups of patients. Conclusions: The basic clinicopathologic profile of Polish patients is similar to that reported in Western Europe and Japan, except for significantly higher early GC occurrence in Japan. According to the obtained results the prognosis of GC depends clearly upon the stage of the disease at the time of surgery. The improvement of outcomes during over 20 years of GC study in Poland was due to introducing better diagnosis and routine multimodal treatment.