It was generally believed that the prognosis of gastric neuroendocrine carcinoma (GNEC) was worse than gastric adenocarcinoma (GAC). However, almost all previous studies compared the prognosis of GNEC and GAC based on East Asians. In this study, we evaluated the clinicopathological features and prognosis of GNEC and GAC in Whites. Patients with GNEC and GAC were identified from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity score matching (PSM) analysis to match the age, sex, TNM stage, and treatments received between GNEC and GAC, then compared the overall survival (OS) and cancer-specific survival (CSS) in the two types. A total of 392 cases of GNEC and 12,835 cases of GAC in Whites were recognized. After PSM, the 5-year OS rates of GNEC and GAC were 50.3% and 43.0%, respectively (p = 0.010). The 5-year CSS rates of GNEC and GAC were 57.4% and 50.1%, respectively (p = 0.012). Besides, multivariable cox regression analyses showed that GNEC was an independent predictor of improved OS (HR 0.719; 95% CI 0.607–0.853) and CSS (HR 0.691; 95% CI 0.571–0.835) in the matched data. The prognosis of GNEC was better than GAC in Whites, showing significant ethnic differences. Appropriate treatments and follow-up strategies for GNEC in Whites are probably different from East Asians. The potential genetic and molecular mechanisms need to be further explored.

Despite a decline in the incidence and mortality rates of gastric cancer attributed to lifestyle interventions and extensive initiatives for H. pylori screening and treatment, gastric cancer remains a significant contributor to the global cancer burden [1–3]. In 2020, there were over one million estimated new cases of the diseases and approximately 770 000 related deaths […]

Background: Gastric carcinoma with coexisting exocrine and neuroendocrine components (GC-EN) is rare and clinically aggressive, but its temporal pattern and prognostic impact remain poorly characterized. Materials and Methods: We retrospectively analyzed 1043 patients who underwent curative gastrectomy at our center between 2008 and 2024. Following tumor–node–metastasis staging and 1:2 pTNM stage matching, 882 patients were included; 294 had GC-EN, of which 175 had GNEC, and 588 had GC. Clinicopathological characteristics were compared, survival outcomes were assessed using Kaplan–Meier estimates and multivariate Cox regression, and the proportion of GNEC cases in our center and the U.S. surveillance, epidemiology, and end results (SEER) database were evaluated. Survival patterns of GNEC were further compared with published international cohorts using Engauge Digitizer software. Results: Among the patients with gastric cancer admitted for treatment, the proportion of NEC fluctuated between 4.01% and 4.38% (2008–2013) and finally dropped to 1.6% (2020–2021), whereas the SEER database showed a modest rise with a late dip (1.67% → 2.72% → 2.44%). The overall survival (OS) of patients with NEC appeared to improve at our center (1-/2-/3-year OS: 85.1%/59.6%/34% in 2008–2012 to 94.1%/87.5%/76.2% in 2021–2024), whereas that in the SEER database declined over the same periods. The 5-year OS of the two databases remained similar (42.7% vs. 41.0%). The 1, 2 and 5-year survival rates of NEC in the external cohorts were higher than those in the SEER and Berlin series; however, the 3-year survival rates were similar, with the Italian multicenter cohort performing the worst. The Kaplan–Meier analysis demonstrated significantly worse OS for GC-EN versus GC (p < 0.001); within GC-EN, the NEC subgroup (NEC ≥ 70%) had the poorest outcomes (p < 0.001), whereas mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) and adenocarcinoma-dominant (AC-dominant) cases had similar outcomes as GC (p = 0.52, p = 0.81). In the multivariable Cox model, GC-EN histology remained independently associated with worse OS (HR = 1.49, 95% CI 1.15–1.92; p < 0.01). Metastatic lymph node burden and higher pTNM stage were associated with worse survival, whereas greater lymph node retrieval and age 40–65 years were protective. After adjustment, vascular invasion, tumor size, and location were not independently significant. Conclusions: Over the past 16 years at the National Cancer Center of China, the proportion of NEC cases decreased, and survival appeared to improve. NEC-dominant disease appeared to be the main driver of poor prognosis within GC-EN, whereas MiNEN and AC-dominant tumors showed survival patterns similar to GC in this cohort. These findings emphasize the need for GC-EN-specific risk stratification and tailored treatment strategies.

Background: Gastroparesis is a significant early complication following radical distal gastrectomy (RDG) for gastric cancer. However, the full spectrum of clinical characteristics, recovery duration, and prognostic implications of postoperative gastroparesis (PGS) has yet to be elucidated clearly. Methods: Patients who underwent RDG for gastric cancer were identified from the National Cancer Center (NCC) of China between 2010 and 2020. Propensity score matching (PSM) was used to adjust for selection biases. Logistic regression models or Cox proportional hazards models were employed to identify risk factors or prognostic factors, respectively. Results: Among the 4649 patients who underwent RDG, 104 cases (2.2%) developed PGS. Age ≥ 60 years [odds ratio (OR), 1.600 (1.075–2.380), P = 0.020], smoking history [OR, 2.793 (1.842–4.234), P < 0.001], long operative time [OR, 1.005 (1.001–1.008), P = 0.004], intraoperative blood transfusion [OR, 2.183 (1.371–3.477), P = 0.001], low tumor differentiation [OR, 3.019 (1.877–4.856), P < 0.001], and absence of neoadjuvant therapy [OR, 4.610 (1.443–14.724), P = 0.010] were identified as independent risk factors for PGS. The median recovery time for PGS was 19 (interquartile range (IQR): 13–30) days. Multivariate analysis revealed that a greater distance from cardia to anastomosis [OR, 1.795 (1.252–2.573), P = 0.001] and older age [OR, 1.058 (1.002–1.117), P = 0.042] were associated with prolonged recovery time of PGS. No significant differences in in-hospital mortality ( P = 0.479) and overall survival (OS) ( P = 0.503) were observed between the PGS and non-PGS groups. Furthermore, multivariate analysis indicated that patients with longer PGS recovery time had worse OS compared to patients with shorter PGS recovery time [hazard ratio (HR), 0.487 (0.245–0.967), P = 0.040] and non-PGS patients [HR, 0.506 (0.281–0.911), P = 0.023]. Conclusion: Age, smoking history, operative time, intraoperative blood transfusion, tumor differentiation, and neoadjuvant therapy were independent risk factors for PGS after RDG. Notably, a greater distance from cardia to anastomosis was significantly associated with prolonged recovery time of PGS. Furthermore, longer PGS recovery time independently predicted poorer OS, highlighting the significance of early intervention for PGS.