胃癌是全球第五常见的癌症，对过去几十年内其发病率、特征、治疗和结果进行研究可以帮助选择临床策略和未来研究方向。本研究旨在分析胃癌发病率、分期和治疗的趋势。该全国范围的人群基础队列研究包括了在荷兰被诊断为非心脏胃癌（NCGC）的患者（1989年至2021年）。根据固定时间段（1989-1993年、1994-1998年、1999-2003年、2004-2008年、2009-2013年、2014-2018年和2019-2021年），分析了肿瘤特征、治疗和存活率的差异。总共鉴定了47,014名患者（中位数[四分位距]年龄，73岁[64-80]岁；28,032名[60%]男性患者），其中大多数是幽门区（当位置可知时）的腺癌。1989年至2021年期间，年龄标准化发病率从每10万人年20.3下降到6.1。在研究期间，未知的T和N分期的记录频率较低，并且转移性疾病的诊断频率较高（1989-1993年：9493名患者中的2633名[28%]；2019-2021年：3200名患者中的1503名[47%]）。随时间推移，较少的转移性疾病患者进行了手术治疗或联合其他治疗方式（1989-1993年为68%，2019-2021年为64%），转移性NCGC患者进行姑息化疗的比例从9%增加到40%。对于非转移性疾病的患者，5年相对生存率从1989年至2021年间从28%（95% CI，26.5%-29.2%）提高至36%（95% CI，33.5%-37.6%）。对于进行切除手术的非转移性疾病患者，5年生存率从1989年至2021年间从40%（95% CI，38.3%-41.8%）提高至51%（95% CI，47.9%-53.3%）。对于转移性疾病患者，1年的相对生存率从1989年至2021年间从10%（95% CI，8.7%-11.1%）提高至19%（95% CI，17.2%-21.6%），但3年的相对生存率仍较低，为5%（95% CI，3.6%-7.5%）。这项涉及47,014名NCGC患者（1989-2021年）的全国范围队列研究结果显示，发病率下降、分期更准确、治疗方式转变以及患者存活率改善。

Gastric cancer is the fifth most common cancer worldwide, and investigating its incidence, characteristics, treatment, and outcomes over the past decades can help in selecting clinical strategies and future research directions.To analyze the trends in incidence, staging, and treatment of gastric cancer.This nationwide, population-based cohort study included patients diagnosed with noncardia gastric cancer (NCGC) between 1989 and 2021 in the Netherlands.Differences in tumor characteristics, treatment, and survival were analyzed per fixed time periods (1989-1993, 1994-1998, 1999-2003, 2004-2008, 2009-2013, 2014-2018, and 2019-2021).In total, 47 014 patients (median [IQR] age, 73 [64-80] years; 28 032 [60%] male patients) were identified with mostly adenocarcinomas of the antrum region (when location was known). Age-standardized incidence decreased from 20.3 to 6.1 per 100 000 person-years between 1989 and 2021. During the study period, unknown T and N stages were recorded less frequently, and metastatic disease was diagnosed more frequently (1989-1993: 2633 of 9493 patients [28%]; 2019-2021: 1503 of 3200 patients [47%] in 2019-2021). Over time, fewer patients with metastatic disease underwent surgery with or without other treatment modalities (68% in 1989-1993 vs 64% in 2019-2021), and palliative chemotherapy in metastatic NCGC increased from 9% to 40%. For patients with nonmetastatic disease, 5-year relative survival improved from 28% (95% CI, 26.5%-29.2%) to 36% (95% CI, 33.5%-37.6%) between 1989 and 2021. For patients with nonmetastatic disease undergoing a resection, 5-year survival increased from 40% (95% CI, 38.3%-41.8%) to 51% (95% CI, 47.9%-53.3%). For patients with metastatic disease, 1-year relative survival increased from 10% (95% CI, 8.7%-11.1%) to 19% (95% CI, 17.2%-21.6%), but 3-year relative survival remained poor at 5% (95% CI, 3.6%-7.5%).In this nationwide cohort study involving 47 014 patients diagnosed with NCGC (1989-2021), the results showed a decrease in incidence, more accurate staging, a shift in treatment modalities, and improved patient survival.