Shifting proportions of XXXX .

@entity1 @entity5 @entity356 @entity3
OBJECTIVES: To substantiate reports of increasing proportions of @entity356 of diffuse histologic type and in the proximal portion of the stomach, to better understand the prognostic features that govern survival, and to determine whether alterations of operative strategy might improve the surgical results. DESIGN: Retrospective analysis of 289 consecutive @entity1 with @entity356 operated on by general surgeons over a 26-year period. Records were reviewed for location, histologic type, resection, operative mortality, lymph node status, and outcome. SETTING: The Section of Surgical Oncology, the New England Deaconess Hospital, Boston, Mass. MAIN OUTCOME MEASURES: Survival rate, length of life of the @entity1 who died, and operative mortality. RESULTS: A marked and significant shift of @entity356 to a proximal location (54% between 1985 and 1990) occurred over 26 years (P = .0075) with a significant stage improvement at presentation (P = .0235). Percentages of @entity5 that were of the diffuse, poorly differentiated histologic type increased to 48%. More curative operations were performed in the last period (61%), and this upward trend from 37% was significant. Proximal @entity356 had a poorer prognosis with more operative deaths, more lymph node @entity3 , and worse survival rates than @entity5 . Poor survival rates occurred even when comparing @entity1 with negative lymph nodes or favorable histologic features with @entity1 with similar @entity5 . CONCLUSIONS: Despite significant increases in the proportion of proximal @entity5 , survival rates have improved only slightly. Nodal status plays a less prognostic role than does location or histologic type but does provide prognostic information for individual locations. Survival rates for diffuse histologic @entity5 were consistently worse than those for intestinal histologic @entity5 , which emphasizes the underlying disease biology controlling outcome. Radical lymphadenectomy for @entity356 would not improve surgical outcome in the United States.
