Chemotherapy is more active against proximal than distal gastric carcinoma.

OBJECTIVE

Patients with localized proximal gastric carcinoma (PGC) have a poorer outcome than those with distal gastric carcinoma (DGC) following curative resection. However, it remains uncertain whether the location of the primary tumor influences the effect of chemotherapy in advanced gastric carcinoma.

METHODS

We assessed 270 eligible patients with unresectable, advanced gastric carcinoma who had received first-line chemotherapy between 1989 and 2001. We defined PGC as carcinoma located in the upper one third, and DGC as carcinoma located in the lower two thirds of the stomach.

RESULTS

Of the 270 patients, 91 (33.7%) had PGC, and 179 (66.3%) had DGC. The response rate of the primary lesion was 58.6% (51/87) in the PGC group and 35.1% (59/168) in the DGC group (p < 0.01). The overall response rate for all sites was 55.6% (50/90) in the PGC group and 39.0% (69/177) in the DGC group (p = 0.01). The median survival time was 318 days in the PGC group and 251 days in the DGC group (p = 0.0336). A multivariate analysis revealed that performance status, extent of disease, and location of the primary lesion were significantly related to survival.

CONCLUSIONS

Our data suggest that the response rate and survival time after first-line chemotherapy in advanced gastric carcinoma are better in patients with PGC than in those with DGC.