Is cardia cancer aetiologically different from distal stomach cancer?

Abstract

The coexistence of two aetiologically distinct types of cardia cancer, with distinctive histological characteristics of the neoplastic and nonneoplastic gastric mucosa, may explain the heterogeneous evidence of its association with Helicobacter pylori infection. We compared gastric cardia and noncardia cancers with regard to the frequency of H. pylori infection, the histological characteristics of the nonneoplastic gastric mucosa and the tumour histological type. We evaluated 41 cardia and 339 noncardia cancer cases undergoing gastrectomy, and 380 community controls. H. pylori infection and CagA infection status were assessed by enzyme-linked immunosorbent assay and western blot, respectively. Histological characteristics of the neoplastic and nonneoplastic mucosa were obtained from pathology reports. The association between infection and cancers with different location was quantified in a case-control analysis and cardia and noncardia cancers were further compared. No positive relation was found for H. pylori infection, but CagA-positive strains were associated with an increased risk of noncardia cancer (odds ratio=1.60, 95% confidence interval=1.17-2.18). Twenty-seven (65.8%) cardia cancer cases, predominantly of the intestinal type (66.7%), had nonneoplastic atrophic mucosa and 208 (61.4%) noncardia cancers (56.7% of the intestinal type). Among the cases occurring in nonatrophic patients, the proportion of cancers of the Laurén's intestinal type was 71.4% for cardia and 54.2% for noncardia gastric cancers. Cardia and noncardia cancers were similar with regard to the relation with infection, histological type and condition of the nonneoplastic mucosa, supporting the predominance of cardia cancers determined by H. pylori infection in this European high-risk setting.

Clinicopathological features and prognosis of gastric cardia adenocarcinoma: A multi‐institutional U.S. study

“…Overall long-term survival was comparable among GCA and non-cardia patients; however, we did note that early stage patients with GCA had a worse 5-year OS and DFS. Some studies have suggested that GCA may be more biologically aggressive with increased lymphatic and serosal invasion [11][12][13][14]. In the present study, we noted that some clinicopathological features between GCA and non-cardia patients were similar while others were different (Table I).…”

“…Some studies have suggested that GCA may be more biologically aggressive with increased lymphatic and serosal invasion . In the present study, we noted that some clinicopathological features between GCA and non‐cardia patients were similar while others were different (Table ).…”

“…Several studies have suggested that GCA may have distinct risk factors, tumor characteristics and biological behavior compared with non‐cardia gastric adenocarcinoma . Specifically, multiple mechanisms have been described for carcinogenesis associated with inflammation caused by Helicobacter pylori infection in patients with distal adenocarcinoma, but the etiological role of H. pylori among patients with cardia lesions is still ill defined .…”

Tobacco smoking and intestinal metaplasia: Systematic review and meta-analysis

“…Published articles were included when all of the following criteria were met: (1) original reports of case-control or cross-sectional studies, including baseline evaluations of randomized clinical trials or cohort studies; (2) articles addressing the association between tobacco smoking and the occurrence of IM in human adults; (3) exposure defined as smoking cigarettes, pipes, bidis or cigars; and (4) outcome defined as intestinal metaplasia of the stomach, excluding the cardia, as this is a more heterogeneous condition that may follow the aetiology of oesophageal more closely than that of gastric cancer [18][19][20]. Among reports with overlapping samples, we selected those providing data regarding the largest number of cases or presenting more detailed information regarding tobacco exposure.…”

MDM4 genetic variants and risk of gastric cancer in an eastern chinese population

“…Gastric cancer can generally be classified into two categories: cardia gastric cancer (CGC) arising in the area of the stomach adjoining the esophageal-gastric junction, and non-CGC (NCGC) arising from more distal regions of the stomach. Several investigators have suggested that cardia gastric cancer may have distinct risk factors, clinical features and biological behavior compared with non-CGC [22, 27, 28]. Risk factors for CGC include obesity, GORD and Barrett's esophagus, a metaplastic condition that can result from GORD [8, 9, 29, 30]].…”