Gastric Cancer Historic Profile in an Emerging Country: 126 Tunisian Cases.

Abstract

Background: Management of gastric cancer is based on multidisciplinary approach and guidelines. Emerging countries face different issues in the oncologic pathologies and need a deep acknowledge of their epidemiology and prognostic factors. The aim of this study was to describe the clinical and therapeutic features of gastric cancer in Tunisian patients treated in the gastroenterology's department in RABTA academic hospital of Tunis. Methods: We retrospectively analyzed the files of 144 gastric adenocarcinoma diagnosed and treated since 2001-2011. Population was divided into 2 Groups according to whether patients were treated before 2006 (Group I) or after (Group II). Results: We included only 126 cases: 73 patients in Group I vs. 53 in Group II. The median age was 60 years in Group I vs. 57.5 years in Group II. Sex-ratio was 2.84 and 1.3 respectively. Malnutrition was reported in 38% vs. 24% of cases respectively in the Group I and II (p=0.02). Group II had significantly more locally advanced stages such as T4 in 6.8% vs. 18.8% (p=0.04). A total of 46 patients’ vs. 29 had surgical removal: for curative intent in 38% vs. 30% of cases (p=0.34) and for palliative intent in 12.3% vs. 11.3% of cases (p=0.86) respectively in Group I and II. The perioperative treatment was performed in only 2.7% vs. 5.6% of cases (p=0.23); adjuvant chemotherapy in 9.3% vs. 33% (p=0.01) and adjuvant radio-chemotherapy in 9.3% vs. 26.6% (p=0.07). Palliative chemotherapy in metastatic forms was used more frequently after 2006 (52% vs. 92%; p=0.38). After a mean follow-up of 13 months, overall survival at 5 years was 15 vs. 18% respectively in Group 1 and 2 (p=0.9). Conclusion: In our series, the management of these patients has evolved overtime in terms of preoperative staging and adjuvant treatment. There are still efforts to be made to better introduce the perioperative and neo adjuvant therapy in the treatment of Tunisian patients.