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This study aimed to estimate the epidemiological trends of gastric cancer in the United States from 1992 to 2019. This population-based study used the US Surveillance, Epidemiology, and End Results-12 database as a fundamental cohort to analyze gastric cancer incidence, incidence-based mortality (IBM), overall survival (OS) and cancer-specific survival (CSS) probabilities from 1992 to 2019. The Global Burden of Disease study (1990-2018) was used as a likely validation cohort. Age-period-cohort analyses were performed to explore the underlying causes of trend changes. We found that the incidence rate of gastric cancer decreased from 1992 to 2019. IBM also decreased significantly from 1997 to 2019. The 3-year OS and CSS of gastric cancer increased from 22.3% to 28.7% and 25.7% to 33.5%, respectively. However, the proportion of distant gastric cancer cases had unexpectedly increased rapidly from 33.1% in 1992 to 44.7% in 2019. Age-period-cohort modeling found that the incidence and IBM rates remained stable in the groups aged below 50 years, while that in all age groups older than 50 years showed a significant downward trend. High incidence and mortality risks were observed in the younger birth cohorts (birth year after 1990). To conclude, we observed a decline in incidence and mortality rates of gastric cancer in the United States in the past decades. We determined that progression of primary and tertiary preventive measures is the main reason for the reduction in the disease burden of gastric cancer. However, secondary preventive measures for gastric cancer still need to be strengthened.

Aim: This study aimed to explore the efficacy and safety of endoscopic mucosal dissection/endoscopic mucosal resection (ESD/EMR), laparoscopic-assisted radical gastrectomy (LARG), and open radical gastrectomy (ORG) in early-stage gastric cancer. Methods: A total of 417 patients with early-stage gastric cancer who were admitted in two hospitals from January 1, 2014 to July 31, 2017 were selected; the patients were divided into the ESD/EMR group (139 cases), LARG group (108 cases), and ORG group (170 cases) according to the operation methods used. The baseline data, economic cost of health, oncologic characteristics, postoperative complications, 5-year overall survival and disease-free survival, and risk factors of death were compared and analyzed. Results: No significant difference was observed in the baseline data among the three patient groups (P>0.05). The total hospitalization days, operation time, postoperative fluid intake time, hospitalization expenses, and proportion of antibiotic use rate in the ESD/EMR group were lesser than those in other groups (PPPPP>0.05). The 5-year postoperative survival rates of patients in the three groups were 94.2% (ESD/EMR), 93.5% (LARG), and 94.7% (ORG), respectively, with no significant differences (P>0.05). The binary logistics multivariate analysis showed that the tumor size, invasion depth, vascular invasion, and differentiated degree were risk factors for death in patients with gastric cancer. Conclusions: No significant difference was observed between ESD/EMR and radical surgery. However, standardized criteria for excluding metastatic lymph nodes should be established to promote ESD/EMR.

Purpose This study aimed to identify the prognostic variables in patients with metastatic gastric cancer (MGC) and to establish a nomogram based on the number of organs for metastasis (NOM) to predict the survival of MGC patients. Methods Data of 3,909 patients (training cohort) were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database and that of 312 patients (validation cohort) were collected from two Chinese hospitals. Univariate and multivariate Cox regression analyses were performed to identify the significant prognostic variables. A predictive nomogram was built based on SEER cohort and validated in the Chinese cohort. The discrimination and calibration abilities were assessed by concordance index (C-index), calibration plot, and area under the (time-dependent receiver operating characteristic) curve (AUC). Results Race, surgery, chemotherapy, radiotherapy, tumor grade, number of organs affected by metastasis (NOM) were identified by univariate and multivariate Cox regression models. A predictive nomogram was constructed based on the SEER cohort. Excellent C-index, calibration plots, and AUC were obtained using the nomogram in the Chinese cohort. An online version was built based on the nomogram. Conclusion Our nomogram provides a reliable tool for predicting the prognosis of MGC patients.