Gastric cancer is still generating interest because of its poor prognosis. The aim of this study was to investigate time trends in diagnostic assessment, patterns of care, and survival of gastric cancers.We considered 5,010 gastric cancers diagnosed between 1976 and 2007 in a well-defined French population. Logistic regressions were used to identify factors associated with R0 resection and operative mortality. A multivariate relative survival analysis was performed.Diagnostic modalities have changed. Since 1988, endoscopy is performed when gastric cancer is suspected (95.5%). However, there has been no strong variation in stage over time: the proportion of stage I cancers increased from 5.5% to 13.4% between the periods 1976-1979 and 2004-2007 (p0.001) whereas that of advanced cases remained stable, 64.8% and 65.0%, respectively. R0 resections rose from 36.7% (1976-1979) to 46.7% between 1980 and 1999, and decreased to 32.7% thereafter. Age, tumor location, and period were associated with R0 resection. Neoadjuvant and adjuvant chemotherapy were rarely used before 2000, then reached 15.0% and 19.1%, respectively, during the later period. Operative mortality after R0 resection decreased from 18.3% during the 1976-1979 period to 4.3% during the 2004-2007 period (p0.001). Prognosis slightly improved during the three first periods, from 13.0% to 22.6%, then leveled off, not exceeding 26.0% thereafter. Stage, age, histology, and time period significantly influenced survival.Changes in diagnostic modalities were associated with minor changes in stage and prognosis for gastric cancer. Earlier diagnosis and new therapeutic strategies are the best way to improve the prognosis.