Abstract
BackgroundThe aim of this study was to investigate epidemiologic and prognostic factors relevant to the treatment of loco-regionally advanced gastric cancer (GC).MethodsTwo 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.ResultsOne 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).ConclusionPeritoneal 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.
Highlights
The aim of this study was to investigate epidemiologic and prognostic factors relevant to the treatment of loco-regionally advanced gastric cancer (GC)
In a recent nationwide Swedish registry study (n = 7559), peritoneal metastases (PM) in GC were found in 32% of cases [7]
The aim of this study was to investigate epidemiologic and prognostic factors in patients with loco-regionally advanced GC defined as tumor with peritoneal involvement, excluding serosal invasion from the primary tumor only, as well as analyzing patients with or without distant metastasis (DM)
Summary
The aim of this study was to investigate epidemiologic and prognostic factors relevant to the treatment of loco-regionally advanced gastric cancer (GC). In 1975, gastric cancer (GC) was the most common neoplasm worldwide. GC is currently the second most common cause of death globally (10% of all cancer deaths), and adenocarcinoma constitutes 90% of all gastric malignancies [2]. A major reason for GC is often diagnosed late, since symptoms usually become obvious at an advanced stage. Advanced GC (stage IV) is present in about 20–30% of patients at diagnosis [5]. In a recent nationwide Swedish registry study (n = 7559), peritoneal metastases (PM) in GC were found in 32% of cases [7]. Location other than cardia, signet cell type, and the number of distant metastases were the risk factors for PM
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