Determining Risk Factors for Gastric and Esophageal Cancers between 2009-2015 in East-Azarbayjan, Iran Using Parametric Survival Models

Elaheh Zarean,Mehdi Yaseri,Mahmood Mahmoudi,Tara Azimi,Morteza Hajihosseini,Payam Amini

doi:10.31557/apjcp.2019.20.2.443

Abstract

Background:Esophageal cancer (EC) and Gastric cancer (GC) have been identified as two of the most common cancers in the northeastern regions of Iran. The increasing rates of these types of cancers requires attention. This study aims to assess the potential risk factors for these two cancers and then determine shared risk factors between them in a population of Iranian patients using parametric survival models. Methods:This retrospective cohort study was conducted using 127 patients with EC and 184 patients with GC in East Azarbaijan, Iran who were diagnosed and registered during the years 2009-2010 in Iran’s National Cancer Control Registration Program and were followed for five years. Parametric survival models were used to find the risk factors of the patients. Akaike Information Criteria was used to identify the best parametric model in this study. Interaction analysis was used to determine shared risk factors between EC and GC.Results:The mean (±standard deviation) age of diagnoses for EC and GC were 66.92(±11.95) and 66.5(±11.5) respectively. The survival time ranges of GC patients was (0.07-70.33) and the survival time ranges were from 0.10 to 69.03 months for EC patients. Multivariable Log- logistic model showed that being married (OR=2.25, 95% CI: 1.33 - 3.81) for EC patients and Esophagectomy surgery for EC (OR: 1.62, 95% CI: 1.04 – 2.55) and GC (OR: 1.60, 95% CI: 1.02 – 2.53) had significant effects on survival. Age at the time of diagnosis, job status, and Esophagectomy surgery were statistically comparable regarding their magnitude of effect on survival of two cancers (all Ps>0.05). Conclusion:Esophagectomy surgery and being married were important risk factors in EC and GC. The log-logistic model was the most appropriate statistical approach to identify significant risk factors on survival of both cancers.

Highlights

Gastrointestinal tract (GI) cancers including esophageal, stomach and colorectal cancer are considered to be the three most common cancers in Asia and Iran as well (Ghadimi et al, 2012; Pourhoseingholi et al, 2015)
We investigated the possible association between the survival of the patients with Esophageal cancer (EC) and Gastric cancer (GC) and several of the most common prognosis factors
We assessed the impact of age at the time of diagnosis, gender, education, marital status, job status, smoking habit, non-communicable disease (NCD) diagnosis status, Esophagectomy surgery, chemotherapy, radiotherapy and socioeconomic status (SES)

Summary

Introduction

Gastrointestinal tract (GI) cancers including esophageal, stomach and colorectal cancer are considered to be the three most common cancers in Asia and Iran as well (Ghadimi et al, 2012; Pourhoseingholi et al, 2015). Based on the analysis of a series of cases referred to clinics and the universities in Shiraz and Tehran, Northeastern of Iran has one of the highest rates of EC. These analyses revealed that approximately 3-4% of all registered cancers were esophageal cancer (Sadjadi et al, 2005). The log-logistic model was the most appropriate statistical approach to identify significant risk factors on survival of both cancers

Objectives

Methods

Conclusion