Gastric cardia cancers comprise gastric cancers which involve stomach of distal 2cm from gastroesophageal junction. It has been reported that cardia cancer has relatively poorer prog- nosis than gastric cancer of the other sites. To evaluate clinicopathological characteristics of gastric cardia cancer and to determine prognostic factors, we analyzed retrospectively 198 pa- tients who underwent operations for gastric cardia cancers between 1970 and l991 and had the following results. Gasric resection was performed in 176 patients. The ratio of gastric cardia cancer to gastric cancers of the other sites was slightly decreased in 1980s than in l970s (over- all 3.8% of gastric cancers). Gastric cardia cancer had poorer 5-year survival rate than those of gastric cancers of other sites (34.2% for cardia, 38.5% for fundus, 54.1% for body, 48.9% for an- trum). In cardia cancer, 2.5% was early gastric cancer, 89.3% had more than serosal invasion, 66. 5% had positive lymph node involvement and 75.2% were in stage III 4 IV. There was esophageal involvement in 33.5%; despite clear proximal resection mergin on frozen biopsies, there were positive resection margin of 21.4% (3/14) in cases with resection margin of less than 2 cm and 3.7% (6/162) in cases with resection margin of 2cm or more than 2cm (p<0.05, Fisher's exact test). These results suggest that the length of proximal resection margin should be at least 2 cm to get a cancer-free proximal resection margin in gastric cardia cancer. Multivariate analysis revealed that depth of invasion, length of proximal resection margin and lymph node metastasis were significant prognostic factors. We conclude that poorer prognosis of gastric cardia cancer is due to more advanced stage at the time of diagnosis. Therefore, to improve the survival of gastric cardia cancer, better means of early diagnosis should be developed.
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