Gastric Cancer-specific Mortality Research Articles

Prediction of presurgical metabolic syndrome for gastric cancer-specific mortality is more evident in smokers: The FIESTA study.

We aimed to test whether the prediction of presurgical metabolic syndrome for postsurgical survival outcomes of gastric cancer hinges upon cigarette smoking status. This study is a part of the ongoing Fujian prospective investigation of cancer (FIESTA) study. Patients with gastric cancer received radical resection of primary gastric cancer between January 2000 and December 2010, with the latest follow-up ended in December 2015. The 1:1 propensity score matching analysis was adopted to balance confounders between smokers and never-smokers. Effect-size estimates are expressed as hazard ratio (HR) with 95% confidence interval (CI). Model performance was evaluated using the Hosmer and Lemeshow test and 10-fold cross-validated area under the receiver operating characteristic curve (AUROC). Statistical analyses were completed with SAS software (v9.4). Total 2779 patients with gastric cancer were analyzed, including 2223 smokers and 556 never-smokers. Median follow-up time was 45.6months. Cigarette smoking was not associated with postsurgical survival differences. Presurgical metabolic syndrome complication was significantly associated with increased gastric cancer-specific mortality in smokers (HR [95% CI]: 2.73 [1.53-4.89], p < 0.001), but not in never-smokers. Relative excess risk due to interaction was estimated to be 2.43 (95% CI: 0.40-4.45). After constructing a risk assessment score, one unit increment was associated with 10% reduced risk of gastric cancer-specific mortality (HR [95% CI]: 0.90 [0.88-0.91], p < 0.001), with 10-fold cross-validated AUROC being 0.82 (95% CI: 0.74-0.92). Our findings showed that the prediction of presurgical metabolic syndrome for gastric cancer-specific mortality was more evident in smokers. Practically, this study provides evidence base for future personalized prediction and helped risk-stratify gastric cancer patients who might experience serious postsurgical consequences.

Beneficial effects of endoscopic screening on gastric cancer and optimal screening interval: a population-based study.

BACKGROUND : The effectiveness of endoscopic screening on gastric cancer has not been widely investigated in China and the screening interval of repeated screening has not been determined. METHODS : In a population-based prospective study, we included 375,800 individuals, 14,670 of whom underwent endoscopic screening (2012-2018). We assessed the associations between endoscopic screening and risk of incident gastric cancer and gastric cancer-specific mortality, and examined changes in overall survival and disease-specific survival following screening. The optimal screening interval for repeated endoscopy for early detection of gastric cancer was explored. RESULTS : Ever receiving endoscopic screening significantly decreased the risk of invasive gastric cancer (age- and sex-adjusted relative risk [RR] 0.69, 95 % confidence interval [CI] 0.52-0.92) and gastric cancer-specific mortality (RR 0.33, 95 %CI 0.20-0.56), particularly for noncardia gastric cancer. Repeated screening strengthened the beneficial effect on invasive gastric cancer-specific mortality of one-time screening. Among invasive gastric cancers, screening-detected individuals had significantly better overall survival (RR 0.18, 95 %CI 0.13-0.25) and disease-specific survival (RR 0.18, 95 %CI 0.13-0.25) than unscreened individuals, particularly for those receiving repeated endoscopy. For individuals with intestinal metaplasia or low grade intraepithelial neoplasia, repeated endoscopy at an interval of < 2 years, particularly within 1 year, significantly enhanced the detection of early gastric cancer, compared with repeated screening after 2 years (P-trend = 0.02). CONCLUSION : Endoscopic screening prevented gastric cancer occurrence and death, and improved its prognosis in a population-based study. Repeated endoscopy enhanced the effectiveness. Screening interval should be based on gastric lesion severity.

Association between absolute lymphocyte count and overall mortality in patients with surgically resected gastric cancer.

Background/AimsLymphocytes are an important component of the cell-mediated immune system. As lymphopenia is reportedly associated with poor prognoses in patients with various cancers, we investigated this notion in patients who underwent curative gastrectomy.MethodsWe retrospectively analyzed the association between absolute lymphocyte count (ALC) and prognosis in patients with stage I–III gastric cancer who underwent curative surgical resection. Ever lymphopenic patients were defined as those with ALCs < 1,000/μL at any time post-diagnosis except within 30 days post-surgery. Adjusted multivariable regression models were used to evaluate the associations between lymphopenia and overall mortality, gastric cancer-specific mortality, and disease-free survival.ResultsWe investigated 1,222 patients diagnosed between January 2011 and December 2015. Fifty-six patients (4.6%) were lymphopenic at diagnosis and nearly one-quarter (24.8%) were ever lymphopenic with a mean minimum ALC of 640/μL. Older age (odds ratio [OR], 1.02) and higher stage (stage III vs. I; OR, 3.01) were positively associated with ever lymphopenia. On multivariable analysis, ever lymphopenia predicted higher overall mortality (hazard ratio [HR], 1.83; p = 0.008), higher gastric cancer-specific mortality (HR, 1.58; p = 0.048), and shorter disease-free survival (HR, 1.83; p = 0.006). The 5-year gastric cancer-specific mortality rates for ever- and never lymphopenic patients were 10.9% and 3.7%, respectively; their 5-year cumulative recurrence rates were 15.1% and 4.6%, respectively.ConclusionsThis study demonstrate that ever lymphopenia is independent prognostic factor for overall mortality and recurrence in patients with potentially curable gastric cancer; hence, ALCs may be a biomarker for predicting the prognoses of patients with stage I–III gastric cancer who had curative gastrectomy.

Comparable Cancer-Specific Mortality of Patients With Early Gastric Cancer Treated With Endoscopic Therapy vs Surgical Resection

Endoscopic therapy is used commonly for superficial gastric cancer with very low risk of metastasis to the lymph nodes. However, limited population-based studies from the West have evaluated long-term outcomes of patients who received endoscopic therapy vs surgery. We used the Surveillance Epidemiology and End Results database to identify and compare features and outcomes of patients who underwent endoscopic therapy (n= 786) or surgery (n= 2577) for Tis or T1aN0M0 superficial gastric cancer, diagnosed from 1998 to 2014. Multivariate logistic regression was performed to identify factors associated with endoscopic therapy. Overall survival and gastric cancer-specific survival times were compared after we controlled for covariates. Use of endoscopic therapy increased from 15.1% of cases in 1998 to 2000 to 39.0% of cases in 2013 to 2014. Endoscopic therapy was used more frequently in patients who were older, female, or Caucasian, or with lesions that were located in the proximal stomach or were limited in depth (Tis vs T1a) and size, compared with surgery. The median follow-up time was 59 months (interquartile range, 31-102 mo). Percentages of 5-year overall and cancer-specific survival were 57% and 99% in the endoscopic therapy group and 76% and 95% in the surgery group. After we adjusted for clinical factors using a multivariate Cox proportional hazards model, we found no significant difference in gastric cancer-specific mortality between patients who received endoscopic therapy vs surgery (hazard ratio, 1.42; 95% CI, 0.91-2.23; P= .12). In an analysis of a large population database, we found an increased trend in endoscopic therapy for superficial gastric cancer compared with surgery from 1998 through 2014. Patients who received endoscopic therapy vs surgery had comparable long-term cancer-specific mortality.

774P - The prognostic value of higher absolute lymphocyte counts for patients with surgically resected non-advanced gastric cancer

BackgroundLymphocytes are an important portion of the cell-mediated immune system, and play a significant role in immune responses to cancer. We investigated whether peripheral lymphocyte are associated with disease-free survival, gastric cancer-specific survival, and overall survival in surgically resected gastric cancer. MethodsWe retrospectively evaluated stage II-III gastric cancer patients who underwent curative surgical resection to analyze correlations among absolute lymphocyte counts and prognosis. Multivariable regression models adjusted for age, performance status, cancer stage, neoadjuvant/adjuvant chemotherapy use, HER2 expression were used to evaluate associations between absolute lymphocyte count, disease-free survival, gastric cancer-specific overall survival, and overall survival. ResultsA total of 338 stage II-III gastric cancer patients were diagnosed from January 2011 to December 2015. At the time of diagnosis, lymphopenic were 31 (9.1%) and no patients were neutropenic. Nearly one quarter (25.1%) were ever neutropenic (ANC <1.0 K/μL) and nearly half (52.6%) were lymphopenic (ALC <1.0 K/μL) with a mean minimum ALC value of 1.00 K/μL. On multivariable analysis, ever lymphopenia predicted higher recurrence rate [HR=12.4; 95% CI 4.9-31.3], higher gastric cancer-specific mortality [HR=22.7; 95% CI 6.5-79.1], and higher overall mortality [HR=36.6; 95% CI 10.3-130.0]. Five year disease-free survival was 57% for patients who were ever lymphopenic versus 96% for those who were not. Fiver year gastric cancer specific overall survival was 65% versus 98% for ever lymphopenic and never lymphopenic patients, respectively. ConclusionsHigher peripheral lymphocyte counts predicted lower recurrence rate and better overall survival from potentially curable gastric cancer, suggesting that immune function may enhance the effectiveness of non-advanced gastric cancer treatment. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Impact of age on stage-specific mortality in patients with gastric cancer: A long-term prospective cohort study.

Controversies exist regarding the impact of age on gastric cancer-related mortality according to cancer stage. In our prospective cohort study, we evaluated the impact of age on stage-specific mortality in patients with gastric cancer. Between 2002 and 2006, patients with newly diagnosed gastric cancer were recruited from two university-affiliated hospitals in Korea. Follow-up data were updated regularly based on medical records and telephone surveys. Patients were classified into four subgroups according to age: <50, 50–59, 60–69, and 70–79 years. A total of 448 patients were followed up for 81.6 months (interquartile range, 25.0–139.3 months). The number of patients with stage I, II, III, and IV disease was 247, 74, 88, and 39, respectively. Overall, age was an independent risk factor for gastric cancer-specific mortality (hazard ratio [HR], [95% confidence interval (CI)]: 1.53 [0.91–2.57], 1.88 [1.21–2.91], and 2.64 [1.69–4.14] in the 50–59, 60–69, and 70–79 years groups, respectively, with the <50 years group as reference). In patients with stage I and II gastric cancer, the 70–79 years group was associated with a significantly higher rate of cancer-specific mortality than the <50 years group (stage I: HR [95% CI], 9.55 [2.11–43.12]; stage II: HR [95% CI], 7.17 [2.32–22.18]). However, age was not an independently associated factor for cancer-specific mortality in patients with stage III and IV gastric cancer. Although age was an independent risk factor for gastric cancer-related mortality in patients with gastric cancer, its impact may differ depending on the stage of cancer.

Frequency and Prognosis of Pulmonary Metastases in Newly Diagnosed Gastric Cancer.

Purpose: The purpose of this study was to analyze the frequency and prognosis of pulmonary metastases in newly diagnosed gastric cancer using population-based data from SEER.Methods: Patients with gastric cancer and pulmonary metastases (GCPM) at the time of diagnosis in advanced gastric cancer were identified using the Surveillance, Epidemiology and End Result (SEER) database of the National Cancer Institute from 2010 to 2014. Multivariable logistic regression was performed to identify predictors of the presence of GCPM at diagnosis. Receiver operator characteristics analysis was performed to significant predictors on multivariable logistic regression and was then assessed with Delong's test. Multivariable Cox regression was developed to identify factors associated with all-cause mortality and gastric cancer-specific mortality. Survival curves were obtained according to the Kaplan-Meier method and compared using the log-rank test.Results: We identified 1,104 patients with gastric cancer and pulmonary metastases at the time of diagnosis, representing 6.02% of the entire cohort and 15.19% of the subset with metastatic disease to any distant site. Among the entire cohort, multivariable logistic regression identified six factors (younger, upper 1/3 of stomach, intestinal-type, T4 staging, N1 staging, and presence of more extrapulmonary metastases to liver, bone, and brain) as positive predictors of the presence of pulmonary metastases at diagnosis. The value of AUC for the multivariable logistic regression model was 0.775. Median survival among the entire cohort with GCPM was 3.0 months (interquartile range: 1.0–9.0 mo). Multivariable Cox model in SEER cohort confirmed five factors (diagnosis at previous period, black race, adverse pathology grade, absence of chemotherapy, and presence of more extrapulmonary metastases to liver, bone, and brain) as negative predictors for overall survival.Conclusions: The findings of this study provided population-based estimates of the frequency and prognosis for GCPM at time of diagnosis. The multivariable logistic regression model had an acceptable performance to predict the presence of PM. These findings may provide preventive guidelines for the screening and treatment of PM in GC patients. Patients with high risk factors should be paid more attention before and after diagnosis.

Prediction of a New Smoking-Dependent Risk Score for Postsurgical Gastric Cancer-Specific Mortality: The Fiesta Study

We did post hoc analysis of the Fujian prospective investigation of cancer (FIESTA) database, aiming to identify smoking-dependent risk factors that differentially associated with gastric cancer-specific mortality, and further construct a smoking-dependent scoring system for risk assessment. Patients with gastric cancer received radical gastrectomy between 2000 and 2010, with the follow-up ending in 2015. 2779 patients had data on smoking status, including 2223 smokers and 556 never-smokers. Risk estimates were expressed as hazard ratio (HR) with 95% confidence interval (CI). The median follow-up time was 45.55 months. Smoking was not associated with postsurgical survival differences, whereas risk profiles differed between smokers and never-smokers. Particularly, the presence of the metabolic syndrome was significantly associated with increased gastric cancer-specific mortality in smokers (HR (95% CI), p: 2.73 (1.53-4.89), <0.001), but not in never-smokers. Based on significant factors of either smokers or never-smokers, we built a risk score, with 1 unit increment associating with 10% reduced risk of gastric cancer-specific mortality (HR (95% CI), p: 0.90 (0.88-0.91), <0.001). Our findings indicate there is a diverse risk profile between smokers and never-smokers and an additive interaction between smoking and the metabolic syndrome, and importantly we developed a scoring system with a strong predictive capability. Funding: This study was financially supported by the Joint Funds for the Innovation of Science and Technology of Fujian Province (Grant No. 2017Y9090 and 2017Y9082), the Natural Science Foundation of Fujian Province (Grant No. 2018Y0024). The funder of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: The conduct of this study was approved by the ethics committee of Fujian Provincial Cancer Hospital, and all patients signed informed consent.

Different Risk Profiles for the Postsurgical Prognosis of Gastric Cancer Patients with Different Blood Types: The FIESTA Study.

Objectives: We here attempted to evaluate the prediction of different “ABO” blood groups for postsurgical gastric cancer-specific mortality by using data from the ongoing Fujian prospective investigation of cancer (FIESTA) study.Methods: Initially, a total of 3413 patients with gastric cancer were consecutively enrolled between January 2000 and December 2010 to receive radical gastrectomy, and they were followed up until December 2015. Study patients were divided into the “O+” group and the blood type “O-” group.Results: Of 2781 eligible patients, 1116 (40.1%) were in the “O+” group and 1665 (59.9%) in the “O-” group, with mortality rate of being 45.0% (n = 502) and 45.3% (n = 755), respectively. A 1:1 propensity score match between the “O+” and the “O-” groups was used. After adjustment, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), high total cholesterol and high low-density lipoprotein cholesterol, had non-overlapping 95% confidence intervals between the “O+” and the “O-” groups and simultaneously had detectable statistical significance in either group only. A forward method in the multivariate-adjusted COX model was employed and there were five shared risk factors between both groups, including diabetes mellitus, low high-density lipoprotein cholesterol, regional lymph node metastasis, tumor size and TNM stage. Further nomogram plot revealed that presurgical risk factors selected can better predict the risk of early gastric cancer-specific mortality (C-index: 0.737 for the “O-” group and 0.751 for the “O+” group).Conclusions: Our findings indicated that the prognostic factors differed between postsurgical gastric cancer patients with “O+” and “O-” blood types.

Prior gastroscopy and mortality in patients with gastric cancer: a matched retrospective cohort study

The role of prior gastroscopy on the outcome of patients with gastric cancer remains unknown. This study determines the association between intervals of prior gastroscopy and mortality in patients with gastric cancer. We identified 20,066 newly diagnosed patients with gastric cancer in the National Health Insurance Database of Taiwan between 2002 and 2007. After we excluded patients who had gastroscopies performed≤6 months before the diagnosis of cancer, patients were matched into 3 cohorts according to the intervals of prior gastroscopy: 6 months to 2 years (<2 Y cohort), 2 to 5 years (2-5 Y cohort), and none within the previous 5 years (>5 Y cohort). The 3 cohorts were matched for age, curative treatment for gastric cancer, Helicobacter pylori therapy, and propensity scores comprised of sex, comorbidities, and concomitant medication usage. The primary outcome is the hazard ratio (HR) of all-cause mortality. After matching, we identified 1286, 1286, and 5144 patients for the<2 Y, 2 to 5 Y, and >5 Y cohorts. Compared with the >5 Y cohort, the HR of all-cause mortality for the<2 Y and 2 to 5 Y cohorts was 0.80 (95% confidence interval [CI], 0.72-0.89; P< .001) and 0.83 (95% CI, 0.76-0.91; P< .001), respectively. The HRs of gastric cancer-specific mortality were significantly lower in the<2 Y (0.80; 95% CI, 0.71-0.91; P< .001) and 2 to 5 Y cohorts (0.83; 95% CI, 0.75-0.93; P< .001). Patients with gastric cancer who had a gastroscopy performed within 5 years before the cancer diagnosis had significantly lower mortality. Our results may support the role of repeat endoscopic examination or surveillance endoscopy in selected patients.

Outcome of endoscopic submucosal dissection for early gastric cancer of conventional and expanded indications: systematic review and meta-analysis.

Current guidelines for treating early gastric cancer (EGC) with endoscopic submucosal dissection (ESD) are being developed with broader criteria. This systematic review and meta-analysis aimed to assess the application of expanded indications (EIN) by comparing outcomes between conventional indication (CIN) and EIN groups. Literature databases were searched. Short-term outcomes, including endoscopic resection rates, complications and local recurrence, and long-term outcomes including gastric cancer-specific mortality and overall mortality were compared in the two groups. In all, 13 studies were identified and evaluated. The EIN group had lower rates of en bloc (93.6% vs 97.0%, P < 0.0001), complete (87.8% vs 95.8%, P < 0.00001) and curative resection (82.4% vs 94.0%, P < 0.00001) than the CIN group. The rates of delayed bleeding and perforation were both significantly higher in the EIN group (3.9% vs 2.8%, P = 0.04 and 3.9% vs 1.8%, P < 0.0001). Local recurrence rates were 0.6% in the CIN group and 1.5% in the EIN group (P = 0.03). There were no significant differences between the two groups in the gastric-cancer specific mortality (P = 0.22) and the overall mortality (P = 0.37). Long-term mortality in the EIN group did not significantly differ from those in the CIN group, although the EIN group was associated with more unfavorable short-term outcomes. Thus, ESD could be recommended as an effective therapy for EGC of EIN.

Abstract 4537: Tumoral expression on peroxisome proliferator-activated receptor ≤ is an independent prognostic marker in intestinal type of gastric cancer

Abstract Introduction: Peroxisome proliferator-activated receptor ≤ (PPARδ) is a member of the nuclear hormone receptor family that regulates the expression of mediators of the inflammatory response. Metaplastic change secondary to chronic inflammation of gastric mucosa is regarded as a premalignant condition of intestinal-type gastric cancer (IGC). We aimed to evaluate the prognostic significance of PPARδ in IGC patients. Methods: The clinical significance of PPARδ was explored using tissue microarray methods and immunohistochemical staining of specimens from 306 IGC patients. The Kaplan-Meier method was used to calculate survival curves, and differences between the survival curves were assessed using the log-rank test. Cox proportional hazards regression was used to assess the effect of PPARδ expression on survival while controlling for other confounding covariates. Results: Among 306 patients with IGC (stage I-IV), PPARδ expression was detected by immunohistochemistry in the tumors of 209 (68.3%). The patients with PPARδ-positive tumors had significantly lower overall and gastric cancer-specific mortalities (P = 0.0010 and 0.0016, respectively, by the log-rank test) than did those with PPARδ-negative tumors. A positive PPARδ expression was a significant independent prognostic factor for gastric cancer-specific mortality by the Cox regression analysis in patients with IGC (adjusted hazard ratio, 0.42; 95% confidence interval, 0.22-0.81). The relationship between PPARδ and lower mortality was not modified by other clinical variables including tumor stage (all Pinteraction &amp;gt; 0.05). Conclusions: tumor expression of PPARδ was independently associated with lower mortality of patients with IGC. Keywords: Gastric cancer, Intestinal-type gastric cancer, Peroxisome proliferator-activated receptor ≤ (PPARδ), Prognostic marker, Survival Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4537. doi:1538-7445.AM2012-4537

Trends in Clinicopathologic Characteristics and Prognostic Predictors of Survival Outcome in Black Patients with Gastric Carcinoma: A Single Institution's Experience

Age, gender, and ethnic group-related differences influence the outcome of gastric cancer. Our aim was to analyze the trends and association of clinicopathologic characteristics and prognostic factors of gastric cancer in black patients over a period of 28 y. A retrospective analysis of all black patients treated for gastric cancer from 1979 to 2007 at Howard University Teaching Hospital. This period was divided into two time frames, 1979-1993 and 1994-2007. Of 286 patients in our study, there were 160 (55.9%) males versus 126 (44.1%) females. For the period 1979-1993, there were a total of 169 (59.1%) patients versus 117 (40.9%) for 1994-2007. A significant increase in the incidence of cardia/fundus tumors and stage IV tumors was noted between the two periods (P<0.02, P<0.004), 8.9% versus 12% and 71.4% versus 50.8%. The median survival time for the period 1979-1993 was 30.5 mo versus 39.2 mo for 1994-2007. The median survival time for males was 35.7 mo versus 34.9 mo for females. Significant independent predictors of a shorter gastric cancer-specific survival include tumor stage IV (HR 8.4 95% CI 2.0-35.0, P<0.003), female gender (HR 2.3 95% CI 1.0-4.9, P<0.02). Increased incidence of cardia/fundus tumors and stage IV disease may contribute to the sustained higher gastric cancer-specific mortality observed amongst black patients. Female gender emerged as an independent predictor of a shorter survival time.

Survival following microscopically confirmed radical resection of N0 gastric cancer.

In a series of 128 patients operated on for gastric cancer, 27 satisfied microscopic criteria for radical resection. The median age of these patients was 72.3 (range 36-84) years at operation; the median hospital stay after surgery was 12.9 days. The median observation time was 3.8 years and the crude 5-year survival rate 48 per cent. Older patients did remarkably well. No significant difference was found in the number of survivors, survival-observation time or hospital stay in the age groups 55-64, 65-74 or 75-84 years. Thus, age alone should not be considered a barrier to curative surgical treatment. When the study was ended, 12 of the 27 patients who underwent microscopically confirmed radical resection were still alive; six had died from recurrent gastric cancer and nine from other causes. At 5 years after microscopically confirmed radical resection for gastric carcinoma, the gastric cancer-specific mortality rate was 23 per cent.