Gastric Cancer In Mexico Research Articles

Treatment modalities and oncological outcomes in a cohort of patients with advanced gastric cancer in Mexico.

e15590 Background: Gastric cancer (GC) represents the third leading cause of cancer related death in Mexico. Treatment modalities and outcomes have been infrequently reported in our population. Methods: we retrospectively reviewed medical records from all consecutive patients with histologically confirmed metastatic GC treated from January 2005 to December 2015 at our institution. EG junction primaries were excluded. Overall survival (OS) was estimated by Kaplan Meier method from histological diagnosis to dead or last date of follow up and compared by Log-rank test. P value < 0.05 was considered significant. Results: 172 patients were included: 53.5% women, median age 55 years. Lauren’s classification: diffuse 57%, intestinal 20%, 3% mixed and 20% non-specified. Signet ring cells were found in 66% of cases. 37% have T4 tumors. Treatment modalities: 22% none treatment, 12% palliative care, 48% systemic chemotherapy at any time of disease course, 29% initial palliative surgery (derivative o gastrectomy), gastrectomy at any time in 14% (n 24). An R0 resection was achieved in 6/24 of patients. For those patients who received systemic chemotherapy (n 83) objective response rate was 34% and disease control rate 70%. Median OS according to treatment is shown in table. Only 35% of patients received second line chemotherapy and 7% a third line. Conclusions: patients with advanced GC have a dismal prognosis in our center. A third of patients present with terminal disease and are ineligible for oncological treatment. Chemotherapy can be offered to less than a half of patients. Palliative gastrectomy is offered to 12%. Multimodal therapy is associated with the best survival but could be offered to less than 10% of patients. [Table: see text]

Risk factors associated with gastric cancer in Mexico: education, breakfast and chili.

the aim of the study was to use a validated questionnaire to identify factors associated with the development of gastric cancer (GC) in the Mexican population. the study included cases and controls that were paired by sex and ± 10 years of age at diagnosis. In relation to cases, 46 patients with a confirmed histopathological diagnosis of adenocarcinoma-type GC, as reported in the hospital records, were selected, and 46 blood bank donors from the same hospital were included as controls. The previously validated Questionnaire to Find Factors Associated with Gastric Cancer (QUFA-GC©) was used to collect data. Odds ratio (OR) and 95% confidence interval (IC) were estimated via univariate analysis (paired OR). Multivariate analysis was performed by logistic regression. A decision tree was constructed using the J48 algorithm. an association was found by univariate analysis between GC risk and a lack of formal education, having smoked for ≥ 10 years, eating rapidly, consuming very hot food and drinks, a non-suitable breakfast within two hours of waking, pickled food and capsaicin. In contrast, a protective association against GC was found with taking recreational exercise and consuming fresh fruit and vegetables. No association was found between the development of GC and having an income that reflected poverty, using a refrigerator, perception of the omission of breakfast and time period of alcoholism. In the final multivariate analysis model, having no formal education (OR = 17.47, 95% CI = 5.17-76.69), consuming a non-suitable breakfast within two hours of waking (OR = 8.99, 95% CI = 2.85-35.50) and the consumption of capsaicin ˃ 29.9 mg capsaicin per day (OR = 3.77, 95% CI = 1.21-13.11) were factors associated with GC. an association was found by multivariate analysis between the presence of GC and education, type of breakfast and the consumption of capsaicin. These variables are susceptible to intervention and can be identified via the QUFA-GC

Immunohistochemical assessment of HER2 expression in gastric cancer. A clinicopathologic study of 93 cases

Abstract Background Gastric cancer in Mexico is ranked third in both males and females. Most patients present clinically with advanced disease and treatment options are sparse. HER2 overexpression in gastric cancer is related to poor outcome. Immunohistochemical testing for HER2 is becoming the standard of care for guiding adjuvant treatment of gastric cancer with trastuzumab. Objectives To determine the frequency of HER2 overexpression in patients with gastric cancer in the Hospital de Oncologia del Centro Medico Nacional, Siglo XXI and its association with other histopathological findings. Material and methods Patients with gastric cancer who underwent surgery between March 12, 2006 and August 31, 2011, were enrolled in this retrospective study. Diagnosis was confirmed by review of slides and immunohistochemistry with anti-HER2 antibody was performed. Scoring was done by Hoffman scoring system. Medical records were evaluated. Results Ninety-three patients were included in the study, with 43 (46.2%) male and 50 (53.7%) female patients. The median age was 64 years. HER2-positive tumours were identified in 6 patients (6.45%) and located most frequently in the proximal stomach. There was no difference in HER2 overexpression in relation to age, gender or histologic type. Conclusion In our study, about 7% of patients with gastric cancer were HER2-positive on immunohistochemistry.

Mortality trends and years of potential life lost from gastric cancer in Mexico, 2000-2012

BackgroundIn 2013 in Mexico, gastric cancer (GC) was the third leading cause of death from cancer in individuals 20 years of age or older. GC remains a public health problem in Mexico due to its high mortality and low survival rates, and the significantly lower quality of life of patients with this condition. ObjectivesThe aims of this study were to determine mortality trends nationwide, by state and socioeconomic region, and to determine rates of age-adjusted years of potential life lost due to GC, by state and socioeconomic region, within the period of 2000-2012. MethodsMortality records associated with GC for 2000-2012 were obtained from the National Health Information System of the Mexican Department of Health. Codes from the Tenth Revision of the International Classification of Diseases corresponding to the basic cause of death from GC were identified. Mortality and age-adjusted years of potential life lost rates, by state and socioeconomic region, were also calculated. ResultsIn Mexico, 69,107 individuals died from GC within the time frame of 2000-2012. The age-adjusted mortality rate per 100,000 inhabitants decreased from 7.5 to 5.6. The male:female ratio was 1.15:1.0. Chiapas had the highest death rate from GC (9.2, 95% CI 8.2-10.3 [2000] and 8.2, 95% CI 7.3-9 [2012]), as well as regions 1, 2, and 5. Chiapas and socioeconomic region 1 had the highest rate of years of potential life lost. ConclusionsUsing the world population age distribution as the standard, the age-adjusted mortality rate in Mexico per 100,000 inhabitants that died from GC decreased from 7.5 to 5.6 between 2000 and 2012. Chiapas and socioeconomic regions 1, 2, and 5 had the highest mortality from GC (Chiapas: 9.2, 95% CI 8.2-10.3 [2000] and 8.2, 95% CI 7.3-9 [2012], region 1: 5.5, 95% CI 5.2-5.9 [2000] and 5.3, 95% CI 4.9-5.7 [2012]; region 2: 5.3, 95% CI 5-5.6 [2000] and 5.4, 95% CI 5.1-5.8 [2012]; region 5: 6.1, 95% CI 5.6-6.6 [2000] and 4.6, 95% CI 4.2-5 [2012]). Chiapas and socioeconomic region 1 had the highest rate of years of potential life lost (Chiapas: 97.4 [2000] and 79.6 [2012] and region 1: 73.5 [2000] 65 [2012]).

Mortality trends and years of potential life lost from gastric cancer in Mexico, 2000-2012.

In 2013 in Mexico, gastric cancer (GC) was the third leading cause of death from cancer in individuals 20 years of age or older. GC remains a public health problem in Mexico due to its high mortality and low survival rates, and the significantly lower quality of life of patients with this condition. The aims of this study were to determine mortality trends nationwide, by state and socioeconomic region, and to determine rates of age-adjusted years of potential life lost due to GC, by state and socioeconomic region, within the period of 2000-2012. Mortality records associated with GC for 2000-2012 were obtained from the National Health Information System of the Mexican Department of Health. Codes from the Tenth Revision of the International Classification of Diseases corresponding to the basic cause of death from GC were identified. Mortality and age-adjusted years of potential life lost rates, by state and socioeconomic region, were also calculated. In Mexico, 69,107 individuals died from GC within the time frame of 2000-2012. The age-adjusted mortality rate per 100,000 inhabitants decreased from 7.5 to 5.6. The male:female ratio was 1.15:1.0. Chiapas had the highest death rate from GC (9.2, 95% CI 8.2-10.3 [2000] and 8.2, 95% CI 7.3-9 [2012]), as well as regions 1, 2, and 5. Chiapas and socioeconomic region 1 had the highest rate of years of potential life lost. Using the world population age distribution as the standard, the age-adjusted mortality rate in Mexico per 100,000 inhabitants that died from GC decreased from 7.5 to 5.6 between 2000 and 2012. Chiapas and socioeconomic regions 1, 2, and 5 had the highest mortality from GC (Chiapas: 9.2, 95% CI 8.2-10.3 [2000] and 8.2, 95% CI 7.3-9 [2012], region 1: 5.5, 95% CI 5.2-5.9 [2000] and 5.3, 95% CI 4.9-5.7 [2012]; region 2: 5.3, 95% CI 5-5.6 [2000] and 5.4, 95% CI 5.1-5.8 [2012]; region 5: 6.1, 95% CI 5.6-6.6 [2000] and 4.6, 95% CI 4.2-5 [2012]). Chiapas and socioeconomic region 1 had the highest rate of years of potential life lost (Chiapas: 97.4 [2000] and 79.6 [2012] and region 1: 73.5 [2000] 65 [2012]).

Dietary Patterns and Gastric Cancer Risk in Mexico

Multiple epidemiological studies have evaluated the relationship between diet and gastric cancer (GC), focusing on individual foods and nutrients. However, some studies have estimated the association between dietary patterns and GC risk. To identify the dietary patterns of residents of Mexico City and to assess the association of these patterns with GC, a population-based case-control study with 248 histologically confirmed GC cases and 478 controls paired by age and sex was carried out. The dietary patterns were characterized from 22 food groups through factorial analysis. Three major dietary patterns were identified. Pattern 1 was characterized by the consumption of vegetables, fruits, and white meat; subjects in the highest quintile of this pattern had a lower GC risk than those in the lowest quintile [odds ratio (ORQ5 vs. Q1) = 0.43; 95% confidence interval (95%CI): 0.24–0.77; P trend = 0.010]. A comparison between the extreme quintiles of the third pattern (which included major consumption of refined grains and desserts), resulted in the following: ORQ5 vs. Q1 = 4.80; 95%CI: 2.56−8.98; P-trend < 0.001). Additionally, we found no significant association between the second pattern (characterized by high consumption of Mexican food) and GC risk. This is the first study of associations between dietary patterns and GC in Mexico to confirm that GC risk is lower in individuals with healthy dietary patterns.

763 - Epidemiological Data of Patients with Gastric Cancer in Mexico

ABSTRACT Introduction The gastric cancer is very common neaplasm in Asia and Central and SouthAmerica. With large differences among patients diagnosed and treated in Europe, America and Asia. We present some epidemiological data of patients with gastric cancer. Methods Methodology was analyzed the database of all patients diagnosed of adenocarcinoma of the stomach from January 1999 to December 2011 served in the Medical Oncology service. Results We identified 1179 patients evaluated by Medical Oncology, these 1130 with histology adenocarcinoma, 40 with stromal tumor gastro-intestinal, 3 with leiomiosarcoma, 3 with scamous cell and 3 with neuroendocrine tumor. Of the cases with adenocarcinoma, 56% were men with a mean age of 55.8 years +/- 13.6 and 44% occured in women with a mean age of 52.2 years +/- 13.4 (p Conclusions Gastric cancer in Mexico is a serious health problem, is diagnosed in young patients with poor prognostic factors as the diffuse histological type, poorly differentiated and signet-ring cells. The location of the tumor in esophago-gastric junction is more common in men. The diagnosis in made in most patients in advanced stages (III-IV). Disclosure All authors have declared no conflicts of interest.

Capsaicin consumption, Helicobacter pylori CagA status and IL1B-31C > T genotypes: A host and environment interaction in gastric cancer

Gastric cancer (GC) has been associated with a complex combination of genetic and environmental factors. In contrast to most countries, available information on GC mortality trends showed a gradual increase in Mexico. Our aim was to explore potential interactions among dietary (chili pepper consumption), infectious (Helicobacter pylori) and genetic factors (IL1B-31 genotypes) on GC risk. The study was performed in three areas of Mexico, with different GC mortality rates. We included 158 GC patients and 317 clinical controls. Consumption of capsaicin (Cap), the pungent active substance of chili peppers, was estimated by food frequency questionnaire. H. pylori CagA status was assessed by ELISA, and IL1B-31 genotypes were determined by TaqMan assays and Pyrosequencing in DNA samples. Multivariate unconditional logistic regression was used to estimate potential interactions. Moderate to high Cap consumption synergistically increased GC risk in genetically susceptible individuals (IL1B-31C allele carriers) infected with the more virulent H. pylori (CagA+) strains. The combined presence of these factors might explain the absence of a decreasing trend for GC in Mexico. However, further research on gene–environment interactions is required to fully understand the factors determining GC patterns in susceptible populations, with the aim of recommending preventive measures for high risk individuals.

Omission of breakfast and risk of gastric cancer in Mexico.

To investigate factors associated with gastric cancer (GC) in the Mexican population using a validated questionnaire. We designed and validated in Spanish a Questionnaire to Find Factors Associated with Diseases of the Digestive Tract using GC as a model. A cross-sectional study using 49 subjects, with confirmed histopathological GC diagnosis, and 162 individuals without GC participated. Odds ratio and 95% CIs were estimated in univariate and multivariate analysis adjusted for possible confounding factors. In order to match age groups, a multivariate sub-analysis was performed in subjects ≥ 39 years of age and in females and males separately. In the univariate analysis, we found an association between GC and education to primary level or below, low socioeconomic status, the use of dental prostheses, omission of breakfast, consumption of very hot food and drink, addition of salt to prepared foods, consumption of salt-preserved foods and the pattern of alcohol consumption. We found protection against GC associated with the use of mouthwash, food refrigeration and regular consumption of fruit and vegetables. In the multivariate sub-analysis with subjects of ≥ 39 years, the omission of breakfast was identified as a risk factor for GC. Our study suggests an association between the omission of breakfast and the failure to refrigerate food with GC in the Mexican population.

Methylenetetrahydrofolate reductase 677C&gt;T polymorphism and gastric cancer susceptibility in Mexico

This study investigated whether methylenetetrahydrofolate reductase MTHFR 677C>T polymorphism modified gastric cancer (GC) risk independently as well as in combination with folate intake and alcohol consumption. A hospital-based case-control study of 201 cases and 427 controls was conducted in three geographical areas of Mexico, between 1994 and 1996. The MTHFR 677T allele frequency was 51.0% in cases compared with 45.3% in controls. After controlling for dietary sources of folate, alcohol intake and other selected variables, a significant increase in GC risk was found among carriers of the 677TT genotype compared with those with the 677CC genotype (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.00-2.59), with a significant trend (P = 0.048). There were no significant interactions between the MTHFR polymorphism and consumption of folate and alcohol. Our results suggest that the high prevalence of MTHFR 677T allele may be a contributor to the high rate of morbidity and mortality in GC in Mexico.

Trends in Helicobacter pylori Infection and Gastric Cancer in Mexico

Infection by Helicobacter pylori affects about 50% of the human population. Of those infected, 10% to 15% will develop peptic ulcer and up to 3% will present with gastric cancer. These estimates suggest that around 7% of the world's population will eventually develop H. pylori –associated

Helicobacter pylori-CagA seropositivity and nitrite and ascorbic acid food intake as predictors for Gastric Cancer

A hospital-based case-control study was carried out between 1994 and 1996 to evaluate the risk of gastric cancer (GC) according to Helicobacter pylori-CagA (+) seropositivity, nitrite and ascorbic acid intake. Three geographical areas of Mexico were selected on the basis of their contrasting dietary patterns and H. pylori seroprevalence. Nitrite and ascorbic acid consumption were estimated by interview among 211 cases and 454 matched controls. Serum antibodies against IgG H. pylori and CagA were detected by immunosorbent assays. The adjusted risk for GC was significantly higher among CagA+ subjects compared with those that were CagA negative (Odds Ratio (OR)=2.04 95% Confidence Interval (CI) 1.37–3.02 P for trend P<0.001), this effect remained significant among diffuse GC cases (OR 2.05 95% CI 1.25-3-36). No significant effects due to nitrite and ascorbic consumption or interactions of these nutrients with CagA seropositivity were detected. Seropositivity to H. pylori CagA+ strains may be an independent factor for diffuse GC in Mexico.

Capsaicin consumption, Helicobacter pylori positivity and gastric cancer in Mexico

Gastric cancer (GC) incidence has not declined in Mexico. We assessed whether the intake of capsaicin (CAP), the pungent compound of chili peppers, increases the risk of GC independently of H. pylori positivity (Hp). From 1994 to 1996, a hospital-based case-control study was performed in 3 areas of Mexico; 234 cases of GC and 468 matched controls were enrolled and their diet and other characteristics were inquired. Chili pepper intake was queried by interview and CAP content of chilies was determined in a separate analysis by gas chromatography to estimate CAP intake; IGg Hp serum antibodies were determined by ELISA. The risk of GC was increased (OR = 1.71; 95% CI = 0.76-3.88) among high-level consumers of CAP (90-250 mg of capsaicin per day, approximately 9-25 jalapeño peppers per day) as compared to low-level consumers (0-29.9 mg of capsaicin per day, approximately 0 to less than 3 jalapeño peppers per day; p for trend p = 0.026); this effect was independent of Hp status and other potential GC determinants and was higher among diffuse GC cases (OR = 3.64; 95% CI = 1.09-12.2; p for trend = 0.002) compared to intestinal GC cases (OR = 1.36; 95% CI = 0.31-5.89; p for trend = 0.493). No significant interaction was found between CAP intake and Hp on GC risk. Chili pepper consumption might be an independent determinant of GC in Mexico.

Gastric cancer in Mexico.

Gastric cancer in Mexico.

Nutrient intake and gastric cancer in Mexico

In contrast to the decreasing trends observed in most countries, gastric-cancer mortality has remained at about the same level in Mexico throughout the last 40 years. As part of a study carried out in the metropolitan area of Mexico City, an assessment of nutrient intake and gastric cancer is presented here. The study population comprised 220 cases of gastric cancer and 752 population-based controls. Our results showed 70 to 80% reduction in the risk of developing this tumor, associated with the intake of polyunsaturated fat, fiber and vitamin E; and this effect was independent of the histological type of the tumor (i.e., intestinal or diffuse). On the other hand, an increased risk of gastric cancer was related to the consumption of saturated fat (OR(Q4vs.Q1) = 4.37, 95% CI 1.89-10.12) and, cholesterol (OR(Q4vs.Q1) = 2.39, 95% CI 1.23-4.64), but such effects were restricted to the intestinal type of gastric cancer. In the whole study population, mono-unsaturated fat intake increased the risk for gastric cancer, and a marginally significant increasing trend was observed for protein consumption. The findings from this study add information about the role of specific nutrients in the etiology of gastric cancer.

Infection with CagA+ Helicobacter pylori strains as a possible predictor of risk in the development of gastric adenocarcinoma in Mexico.

Helicobacter pylori strains possessing the Cag pathogenicity island have been associated with increased gastric inflammation and with duodenal ulcer. In contrast, studies on the association of cagA+ H. pylori infections and gastric cancer have shown conflicting results. The aim of our study was to determine whether H. pylori and CagA status are associated with gastric cancer in Mexico. We selected serum samples from 3 geographic areas with gastric cancer mortality rates per 100,000 inhabitants of 2.5 (low risk), 4.5 (medium risk) and 6.4 (high risk). H. pylori infection was determined by the detection of antibodies to H. pylori whole cell antigen by an enzyme-linked immunosorbent assay (ELISA). To study the prevalence of infection with cagA+ strains, serum IgG antibodies to CagA were determined by ELISA using a recombinant CagA antigen. Of the 2,775 individuals studied, 1,931 were H. pylori seropositive and 1,710 had antibodies against CagA. The risk for gastric cancer in the 3 populations studied increased proportionally as infection with cagA+ strains increased (p < 0.001 for trend). H. pylori infection also showed association with gastric cancer (p < 0.05). Individuals seropositive for CagA, but seronegative for H. pylori whole cell antigen, were more frequent in areas with higher gastric cancer rates (p < 0.01). These results support the possible role of CagA(+) status as predictor of risk for gastric adenocarcinoma in Mexico; this is in agreement with results in European and American populations, but contrary to studies in some Asian countries.

Alcohol consumption and gastric cancer in Mexico.

This paper presents an assessment of alcohol consumption, including the popular Mexican liquor tequila, in relation to the incidence of gastric cancer. We conducted a population-based case-control study in Mexico City, with 220 gastric cancer cases and 752 population-based controls. A food frequency questionnaire was used to measure consumption of alcohol and other dietary items. Grams of ethanol were estimated by the Food Intake Analysis System 3.0 software. After adjustment for known risk factors, wine consumption was positively associated with the risk of developing gastric cancer (OR=2.93; CI 95% 1.27-6.75) in the highest category of wine consumption, corresponding to at least 10 glasses of wine per month, with a significant trend (p=0.005). This association remained among intestinal (OR=2.16; CI 95% 0.68-6.92, p-value for trend=0.031 ) and diffuse (OR=4.48; CI 95% 1.44-13.94, p-value for trend=0.018 ) gastric cancer cases. A borderline significant trend between GC risk and total ethanol intake was observed (p=0.068). Consumption of beer and distilled alcoholic beverages including brandy, rum, and tequila was not associated with GC risk. The results indicate the need to focus on the study of the potential effects of different types of wine, with emphasis on components other than ethanol regarding the incidence of gastric cancer, even among populations with moderate to low levels of alcohol consumption.

Histological types of gastric cancer in Mexico.

Gastric cancer is the second leading cause of malignant tumours in Mexico. The distribution of the histological types of this tumour has not been estimated from a population-based representative sample. The histological types of gastric cancer according to the Lauren classification and selected socio-demographic characteristics for 220 patients from different socioeconomic levels are reported. The study population represents 66% of all new gastric cancer cases during 1989-1990 reported to the Mexico City Cancer Registry. The patients attended four public hospitals, seven social security hospitals and four private hospitals in Mexico City. A second histological diagnosis was performed by one pathologist. No specific histological type of gastric cancer predominated since the estimated distribution for intestinal gastric cancer was 44.5%, for diffuse gastric cancer 43.2% (and the remaining 12.3% corresponded to indeterminate tumours). The distribution of intestinal and diffuse gastric cancer did not vary significantly according to socioeconomic level or medical care unit and it showed a clear relationship with gender, the intestinal type of gastric cancer being more common among males. Mexico may not have been affected by the gastric cancer epidemic at the beginning of the twentieth century but the available information and the results of this study are only useful to demonstrate that, currently, no histological type of gastric cancer (according to Lauren's classification) predominates significantly in this country.

Chili Pepper Consumption and Gastric Cancer in Mexico: A Case-Control Study

Laboratory studies indicate that capsaicin, the hot-tasting component of chili peppers, may be carcinogenic. A population-based case-control study was conducted in Mexico City during 1989-1990 to evaluate the relation between chili pepper consumption and gastric cancer risk. The study included 220 incident cases and 752 controls randomly selected from the general population. Information was collected by interview. Chili pepper consumers were at high risk for gastric cancer compared with nonconsumers (age- and sex-adjusted odds ratio = 5.49, 95% confidence interval (CI) 2.72-11.06). Among consumers, there was a highly significant trend of increasing risk with increasing self-rated level of consumption (low, medium, and high) (p = 2 x 10(-7). The odds ratio for high-level consumers compared with nonconsumers was 17.11 (95% CI 7.78-37.59). However, when consumption was measured as frequency per day, a significant trend among consumers was not observed. Multivariable adjustment increased the magnitude of the chili pepper-gastric cancer association, but a significant trend among consumers (measured as frequency per day) was still not observed. Chili pepper consumption may be a strong risk factor for gastric cancer, but further studies are needed to test this hypothesis.