Prognostic factors in patients with loco-regionally advanced gastric cancer

• Published in: World journal of surgical oncology 2017-09, Vol.15 (1), p.172-172, Article 172
• Main Authors: Hultman, Bo, Gunnarsson, Ulf, Nygren, Peter, Sundbom, Magnus, Glimelius, Bengt, Mahteme, Haile
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Analysis; Biopsy; Cancer; Cancer therapies; Care and treatment; Cellular biology; Chemoradiotherapy - methods; Chemotherapy; Combined Modality Therapy; Diagnosis; Epidemiology; Female; Follow-Up Studies; Gastric cancer; Health aspects; Humans; Identification methods; Incidence; Kaplan-Meier Estimate; Life expectancy; Life span; Liver; Loco-regionally advanced cancer; Lungs; Lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Multivariate analysis; Neoplasm Staging; Palliative Care - methods; Patients; Peritoneal; Peritoneal Neoplasms - diagnosis; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Peritoneum; Prognosis; Prognostic factor; Proportional Hazards Models; Radiation therapy; Retrospective Studies; Stomach - pathology; Stomach cancer; Stomach Neoplasms - diagnosis; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - therapy; Subgroups; Surgery; Survival; Treatment Outcome
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-017-1243-z

The aim of this study was to investigate epidemiologic and prognostic factors relevant to the treatment of loco-regionally advanced gastric cancer (GC). Two hundred and fifty-five patients with GC were identified in Uppsala County between 2000 and 2009. Patient records were analyzed for loco-regionally advanced GC defined as tumor with peritoneal involvement, excluding serosal invasion from the primary tumor only, at primary diagnosis or during follow-up. The presence or not of distant metastasis (DM), including hematogenous metastases (e.g., liver, lung, and bone) and/or distant lymph node metastases, was also analyzed. The Cox proportional hazard model was used for multivariate analysis of factors influencing survival. One hundred and twenty patients (47% of all patients with GC; median age 70.5 years) had loco-regionally advanced disease, corresponding to an incidence of 3.8 per 100,000 person-years. Forty-one percent of these also had DM. Median overall survival (mOS) from the time of the diagnosis of loco-regionally advanced disease was 4.8 months for the total patient cohort, 5.1 months for the subgroup of patients without DM, and 4.7 months for the subgroup with DM. There was no significant difference in mOS between the subgroups with synchronous versus metachronous loco-regionally advanced GC: 4.8 months (range 0.0-67.4) versus 4.7 months (range 0.0-28.3). Using multivariate Cox analysis, positive prognostic factors for survival were good performance status at diagnosis and treatment with palliative chemotherapy and/or radiotherapy. Synchronous DM was a negative prognostic factor. The mOS did not differ when comparing the time period 2000-2004 (5.1 months, range 0-67.4) with the period 2005-2009 (4.0 months, range 0.0-28.3). Peritoneal involvement occurred in almost half of the patients with GC in this study and was associated with short life expectancy. New treatment strategies are warranted.