Sex as a prognostic factor in gastric cancer

Sex disparity, prediagnosis lifestyle factors, and long-term survival of gastric cancer: a multi-center cohort study from China

BACKGROUND

This multi-center cohort study aimed to investigate whether sex and prediagnosis lifestyle affect the prognosis of gastric cancer.

METHODS

Patients with gastric cancer were from four gastric cancer cohorts of the National Cancer Center of China, The First Hospital of Lanzhou University, Lanzhou University Second Hospital, and Gansu Provincial Cancer Hospital. Prediagnosis lifestyle factors in our study included body mass index (BMI) at diagnosis, usual BMI, weight loss, the history of Helicobacter pylori (Hp) infection, and the status of smoking and drinking.

RESULTS

Four gastric cancer cohorts with 29,779 gastric cancer patients were included. In total patients, female patients had a better prognosis than male patients (HR = 0.938, 95%CI: 0.881-0.999, P = 0.046). For prediagnosis lifestyle factors, BMI at diagnosis, usual BMI and the amount of smoking were statistically associated with the prognosis of gastric cancer patients. Female patients with smoking history had a poorer survival than non-smoking females (HR = 0.782, 95%CI: 0.616-0.993, P = 0.044). Tobacco consumption > 40 cigarettes per day (HR = 1.182, 95%CI: 1.035-1.350, P = 0.013) was independent adverse prognostic factors in male patients. Obesity paradox was observed only in male patients (BMI < 18.5, HR = 1.145, 95%CI: 1.019-1.286, P = 0.023; BMI: 23-27.4, HR = 0.875, 95%CI: 0.824-0.930, P < 0.001; BMI ≥ 27.5, HR = 0.807, 95%CI: 0.735-0.886, P < 0.001).

CONCLUSIONS

Sex and some prediagnosis lifestyle factors, including BMI at diagnosis, usual BMI and the amount of smoking, were associated with the prognosis of gastric cancer.

Gender Differences in Patients with Gastric Adenocarcinoma

Background: Gastric cancer (GC) epidemiology and outcomes vary by gender. Methods: We reviewed 18,436 GC patients from 2008 to 2018 and looked for gender differences in clinical characteristics and survival. Results: The gender proportion was 71% male and 29% female. Males had a significantly (p < 0.001) higher proportion of differentiated GC (66.3%) and a lower proportion of undifferentiated GC (26.3%). Diagnosis through medical check-ups was more common in males (30.0% vs. 26.4%, p < 0.001). Clinical staging revealed 54.6% of males and 52.9% of females had localized disease without lymph node metastasis (LNM), while distant metastasis occurred in 17.4% of males and 16.9% of females (p < 0.001). Kaplan-Meier survival curves indicated females had a significantly higher overall survival (p = 0.0018). The survival advantage for females was evident in the early stages, with a significant difference in localized disease without LNM (p < 0.001) and localized disease with LNM (p = 0.0026, log-rank test) but not in the advanced stages. Multivariate Cox regression analysis showed a significantly reduced mortality risk in females (p < 0.001). Conclusions: Significant gender differences exist with regard to pathological type, presentation, clinical stage, and overall survival. These findings suggest gender-specific strategies for screening, diagnosis, and treatment.

Sex Disparity in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis aimed to ascertain whether sex-based differences influence clinicopathological characteristics and survival outcomes of gastric cancer patients.

BACKGROUND

Gastric cancer in females has received less attention than in males. Clinicopathological features and survival outcomes of females with gastric cancer have been reported in several studies with controversial results.

METHODS

We systematically reviewed clinical studies from PubMed, Cochrane Library, Embase, and Web of Science published up to June 2022. The effect sizes of the included studies were estimated using odds ratios (ORs). Heterogeneity was investigated using the χ2 and I ² tests, while sensitivity analyses were performed to identify the source of substantial heterogeneity. All data used in this study were obtained from previously published studies obviating the need for ethical approval and patient consent.

RESULTS

Seventy-six studies with 775,003 gastric cancer patients were included in the meta-analysis. Gastric cancer patients were less likely to be females (P < 0.00001). Female patients were younger in age (P < 0.00001) and showed a higher percentage of distal (P < 0.00001), non-cardia (P < 0.00001), undifferentiated (P < 0.00001), diffuse (P < 0.00001), and signet-ring cell carcinoma (P < 0.00001). Female patients showed better prognosis in both 3-year (P = 0.0003) and 5-year overall survival (OS) (P < 0.00001), especially White patients. However, females were associated with lower 5-year OS relative to males in the younger patients (P = 0.0001).

CONCLUSIONS

In conclusion, gender differences were observed in clinicopathological characteristics and survival outcomes of gastric cancer. Different management of therapy will become necessary for different genders.

Outcomes of patients with malignant esophagogastric junction obstruction receiving metallic stents: A single-center experience

BACKGROUND

Malignancies-related esophagogastric junction (EGJ) obstruction is usually diagnosed in inoperable status with poor clinical outcomes. Metallic stent placement at EGJ could improve dysphagia for these patients. However, studies regarding the outcomes in these patients receiving metallic stents are still limited. This study aimed to investigate the outcomes of metallic stent placement in malignant EGJ obstruction.

METHODS

Forty-one patients with inoperable malignant EGJ obstruction receiving metallic stent placement were retrospectively enrolled. The clinical outcomes between different stents and deployment techniques were analyzed.

RESULTS

The overall technical success rate was 97.6% and clinical success rate was 92.1%. The median overall survival time was 77 (4-893) days, and the patency time was 71 (4-893) days, respectively. Poststent radiotherapy significantly prolonged survival and stent patency. Between patients receiving uncovered or partially covered metal stents, there was no difference in procedure-related complications, survival time, and stent patency time. Moreover, the clinical outcomes in patients receiving duodenal stents for malignant EGJ obstruction are not inferior to those receiving esophageal stents.

CONCLUSION

This study provides crucial information for endoscopists to establish individualized stenting strategies for malignant EGJ obstruction.

Sex as a Prognostic Factor in Systematic Reviews: Challenges and Lessons Learned

Sex is a common baseline factor collected in studies that has the potential to be a prognostic factor (PF) in several clinical areas. In recent years, research on sex as a PF has increased; however, this influx of new studies frequently shows conflicting results across the same treatment or disease state. Thus, systematic reviews (SRs) addressing sex as a PF may help us to better understand diseases and further personalize healthcare. We wrote this article to offer insights into the challenges we encountered when conducting SRs on sex as a PF and suggestions on how to overcome these obstacles, regardless of the clinical domain. When carrying out a PF SR with sex as the index factor, it is important to keep in mind the modifications that must be made in various SR stages, such as modifying the PF section of CHARMS-PF, adjusting certain sections of QUIPS and extracting data on the sex and gender terms used throughout the studies. In this paper, we provide an overview of the lessons learned from carrying out our reviews on sex as a PF in different disciplines and now call on researchers, funding agencies and journals to realize the importance of studying sex as a PF.

Prognosis after surgery for gastric adenocarcinoma in the Swedish Gastric Cancer Surgery Study (SWEGASS)

BACKGROUND

Most studies examining prognostic factors after gastrectomy come from selected patients and non-Western populations. This nationwide population-based cohort study aims to identify prognostic factors after surgery for gastric adenocarcinoma in an unselected Western cohort.

METHODS

This study included 98% of patients who underwent gastrectomy for gastric adenocarcinoma in Sweden in 2006-2015, with follow-up through 2019. Data were collected from medical records and national registries. Exposures were sex, age, education, comorbidity, tumor sub-localization, tumor stage, calendar period, and pre-operative chemotherapy. Outcomes were 3-year all-cause and disease-specific mortality. Cox regression produced hazard ratios (HRs) with 95% confidence intervals (95% CIs), adjusted for the other study exposures.

RESULTS

Among all 2154 patients, 3-year all-cause mortality was 53.3%. Factors influencing 3-year all-cause mortality after multivariable adjustment were tumor stage (stage IV vs. stage 0-I: HR 8.72, 95% CI 6.77-11.24), comorbidity (Charlson comorbidity score ≥2 vs. 0: HR 1.63, 95% CI 1.39-1.90), age (>75 vs. <65 years: HR 1.48, 95% CI 1.24-1.78), and calendar period (2006-2010 vs. 2011-2015: HR 0.83, 95% CI 0.73-0.95). No independent prognostic influence was found for sex (women vs. men: HR 1.01, 95% CI 0.85-1.09), pre-operative chemotherapy (yes vs. no: HR 0.92, 95% CI 0.78-1.08), tumor sub-localization (non-cardia vs. cardia: HR 1.01, 95% CI 0.83-1.22), or education (≥13 vs. ≤9 years: HR 0.89, 95% CI 0.74-1.07). The results were similar for 3-year disease-specific mortality.

CONCLUSION

Survival after gastrectomy for gastric adenocarcinoma needs further improvement. Tumor stage, comorbidity, age, and calendar period were independently prognostic, while sex, pre-operative chemotherapy, tumor sub-localization, and education were not.

Do Sex-Related Differences of Comorbidity Burden and/or In-Hospital Mortality Exist in Cancer Patients? A Retrospective Study in an Internal Medicine Setting

Cancer represents important comorbidity, and data on outcomes are usually derived from selected oncologic units. Our aim was to evaluate possible sex-related differences and factors associated with in-hospital mortality (IHM) in a consecutive cohort of elderly patients with cancer admitted to internal medicine. We included all patients admitted to our department with a diagnosis of cancer during 2018. Based on the International Classification of Diseases, 9th Revision, Clinical Modification, demography, comorbidity burden, and diagnostic procedures were evaluated, with IHM as our outcome. We evaluated 955 subjects with cancer (23.9% of total hospital admissions), 42.9% were males, and the mean age was 76.4 ± 11.4 years. Metastatic cancer was diagnosed in 18.2%. The deceased group had a higher modified Elixhauser Index (17.6 ± 7.7 vs. 14 ± 7.3, p < 0.001), prevalence of cachexia (17.9% vs. 7.2%, p < 0.001), and presence of metastasis (27.8% vs. 16.3%, p = 0.001) than survivors. Females had a higher age (77.4 ± 11.4 vs. 75.5 ± 11.4, p = 0.013), and lower comorbidity (10.2 ± 5.9 vs. 12.0 ± 5.6, p < 0.001) than males. IHM was not significantly different among sex groups, but it was independently associated with cachexia and metastasis only in women. Comorbidities are highly prevalent in patients with cancer admitted to the internal medicine setting and are associated with an increased risk of all-cause mortality, especially in female elderly patients with advanced disease.

Update, validation and comparison of three different clinicopathological scores for patients with resected gastric cancer: A western experience

INTRODUCTION

Gastric cancer (GC) is a multifactorial disease. Several prognostic scores have been proposed for refining the prognostic information provided by the TNM classification. Our aim is to validate and compare the prognostic performance of different clinicopathological scores in a western cohort of patients (Marubini, Haraguchi and Kologlu scores).

MATERIAL AND METHODS

Retrospective study of all cases of GC resected in a western tertiary center (N = 377). Clinicopathological features were collected, scores were applied and statistical analyses were performed.

RESULTS

315 cases were finally included. According to Marubini, Haraguchi and Kologlu scores, patients were stage I (18.5%, 13.3% and 49%), II (29.3%, 47.2% and 29.5%) and III (52.2%, 39.5% and 21.5%, respectively). All classifications were significantly associated with lymphovascular invasion, perineural infiltration, lymph node involvement, patient progression and death due to GC. All scores showed good patient stratification by Kaplan-Meier analyses, but OS and DFS curves depending on Haraguchi score were less evenly spaced. Kologlu classification showed prognostic superiority over Haraguchi and Marubini classifications by ROC analysis. AUC values for OS and DFS were 0.654 and 0.647 (Marubini), 0.626 and 0.618 (Haraguchi) and 0.724 and 0.709 (Kologlu). Kologlu and Marubini classifications were independent factors for both OS and DFS, but Haraguchi classification was independently associated only with DFS.

CONCLUSIONS

Clinicopathological scores can be easily validated and are cost-effective. Kologlu score is the most thorough classification, and it showed the best prognostic performance for both DFS and OS in our study. More studies are needed to validate its value in other populations.

Gastric cancer in patients with gastric atrophy and intestinal metaplasia: A systematic review and meta-analysis

AIM

Intestinal metaplasia (IM) and gastric atrophy (GA) are precancerous lesions in the stomach. There is a large debate on natural course of these lesions and surveillance strategy in these patients. This meta-analysis was aimed to find the most appropriate follow up and the rate of progression from IM and GA to GC.

METHODS

This meta-analysis is followed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including EMBASE, PubMed, Web of Science databases, Scopus, and the Cochrane Library were searched until July 2018. Cochran's Q test and I-square (I2) test were used to examine heterogeneity across included studies. We pooled data using random-effect or fixed effect models indicated as incidence rate or proportion with 95% confidence intervals (CI). The variables of study included demographic data, endoscopy interval, follow up interval and time, GA and IM type and GC stage. Moreover, incidence rate of GC and progress rate, regress and persistence proportion in both GA and IM patients were assessed.

RESULTS

Overall, 68 original articles out of 32981 citations were included in our meta-analysis. The pooled GC incidence rate in patients with GA was 1.24 (95% CI, 0.80, 1.76; I2: 83.6%) cases per 1,000 person-years. The rates of later diagnosis of IM and gastric dysplasia in patients with GA were estimated as 41.42 (95% CI, 3.11, 64.45; I2: 95.6%) and 6.23 (95% CI, 2.34, 11.46; I2: 83.0%) cases per 1,000 person-years, respectively. The pooled regressed proportion was 32.23 (95% CI, 18.07-48.02; I2: 94.0%) and the persistence proportion was 38.83 (95% CI, 20.20-59.13; I2: 97.0%) per 100 observations in GA patients. In IM studies, the pooled incidence rate of GC was 3.38 (95% CI, 2.13, 4.85; I2: 93.4%) cases per 1,000 person-years. The progressed rate to dysplasia in IM patient was estimated to be 12.51 (95% CI, 5.45, 22.03; I2: 95.1%) cases per 1,000 person-years. The pooled regressed proportion was 31.83 (95% CI, 25.48-38.51; I2: 91.0%) and the persistence proportion was 43.46 (95% CI, 32.52-54.71; I2: 96.0%) per 100 observations in IM patients.

CONCLUSION

Overall, the incidence of GC in patients with IM and GA are low but there is heterogeneity in data with the highest rate in Asian, males with those with incomplete IM. There is probability of regression or persistence without progression in patients with IM and GA who receive appropriate management.

Simultaneous Quantification of Serum Multi-Phospholipids as Potential Biomarkers for Differentiating Different Pathophysiological states of lung, stomach, intestine, and pancreas

Background: Aberrant lipid metabolism is closely associated with cancer.

Materials & Methods: Serum levels of sphingomyelins (SM) (34:1), phosphatidylcholine (PC) (34:2), PC(34:1), PC(36:4), PC(36:3), and PC(36:2) in 1449 serum samples (including 599 normal controls, 69 patients with benign lung diseases (BLDs), 61 with benign colorectal diseases, 54 with benign gastric diseases, 67 with benign pancreatic diseases, and 246 with lung cancer (LC), 144 with colorectal cancer, 94 with gastric cancer, 115 with pancreatic cancer) were quantified simultaneously based on their respective calibration equations with correlation coefficient of >0.98.

Results: Receiver operating characteristic (ROC) analysis indicated that 18 panels obtained from these six phospholipids have high diagnostic ability to differentiate between different pathophysiological states. For example, a combination of SM(34:1), PC(34:2), PC(34:1), PC(36:3), and PC(36:2) to differentiating male patients with early stage LC from male normal controls plus male BLDs with a value under ROC curve (AUC) of 0.957, a sensitivity of 88.9%, and a specificity of 90.8%. SM(34:1) and PC(34:1) to differentiating female patients with early stage LC from female normal controls plus female BLDs with an AUC of 0.903, a sensitivity of 90.0%, and a specificity of 77.5%.

Conclusion: Change trends of these six phospholipids were significantly correlated with gender, physiological states, and cancer stages.

[Gastric cancer in a Spanish hospital: Segovia General Hospital (2005-2008)]

OBJECTIVE

To estimate the incidence, pathological characteristics, treatment patterns, survival and mortality of gastric cancer in Segovia from 2005-2008.

METHODS

We conducted a retrospective, descriptive study of 163 patients diagnosed with gastric cancer at the Segovia General Hospital during the study period.

RESULTS

We estimated a gastric cancer incidence of 25 cases/100,000 inhabitants. The ratio of men to women was 1.6:1. The mean age was 72 years. The most important findings were diagnosis in stages III and IV (64.5%), the high frequency of intestinal carcinoma (56.4%) and the gastric antrum as the most frequent localization (48.8%). At the end of the study, 54.2% of patients had died and the median overall survival was 19 months. The main factors for an unfavorable prognosis were advanced tumoral stage (III and IV), the number of nodes involved, and diffuse histological type. Despite surgical treatment with curative intent, 63.2% of tumors at early stages (I and II) recurred during the study.

CONCLUSIONS

The risk of gastric cancer in Segovia is higher in men aged over 70 years. Most tumors are diagnosed at advanced stages and recurrences are common, limiting the possibility of cure. Early diagnosis of this entity and improved treatments are required.

Clinicopathological features of female gastric carcinoma patients with curative resection: comparison with male patients

Little is known about the clinicopathological features of female gastric carcinoma (FGC) patients. We compared the clinicopathologic features and outcomes of FGC patients with curative resection with those of male gastric carcinoma (MGC) patients. We reviewed the hospital records of 940 FGC patients between 1986 and 2005 at Chonnam National University Hospital. Multivariate analysis showed that presence of serosal invasion, lymph node metastasis, and operative type were significant prognostic factors for survival of FGC patients with curative resection. Furthermore, the overall 5-year survival rate of FGC patients with curative resection (53.4%) was higher than that of MGC patients (47.6%, p<0.05). In advanced cases, no significant difference was observed in the overall 5-year survival rate between the FGC and MGC patients (41.6% vs 37.4%, p>0.05). Therefore, serosal invasion, lymph node metastasis, and type of operation were statistically significant parameters associated with survival. Early detection is more important for improving the prognosis of female patients with gastric cancer than for male patients.

Gender and ploidy in cancer survival

Background

Females carry a better prognosis than men for many cancer types. We hypothesized that chromosomal changes, in particular numerical alterations of the sex chromosomes or the presence of near-triploidy may contribute to these gender differences.

Methods

To characterize the influence of gender a literature search was performed for survival data of 27 tumor types. All entities were categorized by the strength of evidence for differences in survival between females and males. To test our hypothesis the Mitelman database of chromosomal alterations was evaluated for the major tumor types occurring in both women and men. Numerical gonosome alterations were documented and mean chromosome numbers were converted into histograms to provide insight into the ploidy level of 37 cancer types.

Results

In general, a survival advantage of women could be shown for most, but not all cancer types. In addition, 36.859 karyograms were analyzed. Numerical gonosome alterations were more frequent in males than females indicating a potential link with gender differences in survival. Neartriploidy was a common phenomenon in many cancer types suggesting that it represents a metastable condition of the cancer genome. It was not related to gender differences in survival. However, the extent of triploidy and aneuploidy was associated with poor prognosis in carcinomas. There was no single case in the Mitelman database with normal chromosome number (n = 46) that did not carry at least one structural or numerical aberration.

Conclusions

Our study highlights the importance of chromosomal changes in tumor formation and progression. In addition, it suggests potential associations with gender specific differences in survival.

Electronic supplementary material

The online version of this article (doi:10.1007/s13402-011-0013-0) contains supplementary material, which is available to authorized users.

Population-based differences in treatment outcome following anticancer drug therapies

Population-based differences in toxicity and clinical outcome following treatment with anticancer drugs have an important effect on oncology practice and drug development. These differences arise from complex interactions between biological and environmental factors, which include genetic diversity affecting drug metabolism and the expression of drug targets, variations in tumour biology and host physiology, socioeconomic disparities, and regional preferences in treatment standards. Some well-known examples include the high prevalence of activating epidermal growth factor receptor (EGFR) mutations in pulmonary adenocarcinoma among northeast (China, Japan, Korea) and parts of southeast Asia (excluding India) non-smokers, which predict sensitivity to EGFR kinase inhibitors, and the sharp contrast between Japan and the west in the management and survival outcome of gastric cancer. This review is a critical overview of population-based differences in the four most prevalent cancers in the world: lung, breast, colorectal, and stomach cancer. Particular attention is given to the clinical relevance of such knowledge in terms of the individualisation of drug therapy and in the design of clinical trials.

Prognostic factors and availability of D2 lymph node dissection for the patients with stage II gastric cancer: comparative analysis of subgroups in stage II

BACKGROUND

According to the fifth edition of the UICC TNM classification, stage II gastric cancer has three subgroups: T1N2M0, T2N1M0, and T3N0M0. This study was designed to investigate the prognosis of stage II gastric cancer according to the T and N category to verify the accuracy of TNM staging for stage II and to determine the prognostic factors for patients with stage II gastric cancer by subgroup.

METHODS

Clinicopathologic data from 326 patients with stage II gastric cancer were studied. We stratified the patients into T2N1 and T3N0 groups and performed comparative analysis between the two groups as well as univariate and multivariate survival analyses for each group.

RESULTS

The five-year survival rate for patients with T2N1 disease was 75.6%, whereas for patients with T3N0 disease it was 68.3%. There was no significant difference in survival between T2N1 and T3N0 groups (p = 0.174). Univariate survival analysis showed that age, gender, histological type, and the extent of lymph node dissection were significant prognostic factors for stage II gastric cancer. However, multivariate analysis demonstrated that only gender and the extent of lymph node dissection were significant variables. Among these variables, gender was an independent prognostic factor for survival only in the T2N1 group. On the other hand, the extent of lymph node dissection was an independent prognostic factor in the T3N0 group, not in the T2N1 group.

CONCLUSIONS

There was no significant difference in survival between the T2N1 and the T3N0 groups. Thus, our data support the accuracy of the TNM staging classification for stage II gastric cancer. We found a significant survival benefit with D2 dissection for T3N0 but not T2N1. However, before recommending limited lymph node dissection for T2N1 stage disease, development of a preoperative method for prediction of depth of invasion and lymph node status is needed.

pN3M0 gastric cancer: the category that allows the sub-classification of stage-IV gastric cancer (IVa and IVb)

BACKGROUND

Since the publication of the fifth edition of the UICC TNM classification, the rate of curative surgical resection for stage-IV gastric cancer has increased. It is related to the N3 category, which was the prior pN1 or pN2 in the fourth UICC TNM staging system and now pN3 in the fifth. We performed a retrospective analysis to determine whether the prognosis of N3M0 gastric cancer is different from that of other stage-IV gastric cancer; this may support sub-division of this disease.

METHODS

We analyzed 422 patients with stage-IV gastric cancer who underwent gastric resection from 1983 to 2002 at Korea University Hospital. Clinical and pathological characteristics as well as survival of the patients were evaluated retrospectively according to the TNM categories.

RESULTS

The 5-year survival rate for those with N3M0 gastric cancer was 10.5%; this was influenced by depth of invasion (P = 0.001). According to the survival analysis in patients with stage-IV subtypes, the mean survival time was 25.6 months for T1-3N3M0, 24.7 months for T4N1-2M0, 10.0 months for T4N3M0, and 13.6 months for anyT anyNM1. Thus, the survival of patients with T4N3M0 and M1 stage disease was significantly shorter than that of patients with T1-3N3M0 and T4N1-2M0 stage disease (P = 0.000).

CONCLUSIONS

Sub-classification of stage-IV gastric cancer into IVa (T1-3N3M0, T4N1-2M0) and IVb (T4N3M0, anyT anyNM1) may be helpful to predict the outcome of patients with stage-IV gastric cancer.

Gastric cancer

Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths. The incidence, diagnostic studies, and therapeutic options have undergone important changes in the last decades, but the prognosis for gastric cancer patients remains poor, especially in more advanced stages. Surgery is the mainstay of treatment of this disease, even if it is associated with a high rate of locoregional and distant recurrence. There is ongoing debate regarding the role of adjuvant treatment In advanced disease, palliation of symptoms, rather than cure, is the primary goal of patient management. Several combination therapies have been developed and have been examined in phase III trials; however, in most cases, they have failed to demonstrate a survival advantage over the reference arm. This review summarizes the most important recommendations for the management of patients with gastric cancer.

[Survival and prognostic factors for gastric cancer. Analysis of 2,334 patients]

BACKGROUND

The analysis of the survival of patients diagnosed with gastricadenocarcinoma and the factors which modify prognosis.

PATIENTS AND METHOD

Retrospective cohort study of overall patients diagnosed with gastric adenocarcinoma treated in the Xeral-Calde and Juan Canelejo hospitals of Lugo and La Coruña (Spain) between 1975 and 1993. The following variables were studied: age, sex, the year of diagnosis, place of residence, delayed diagnosis, localisation of the primitive tumour, the TNM classification, the Laurén histological type and the type of surgical resection when conducted. The Kaplan-Meier statistical method was employed to determine the probability of survival. Cox regression was used to determine prognosis factors.

RESULTS

The diagnosis was established on 2,334 patients: 63,2% were males;the average overall age was 66.5 (11,9 SD) years, the median delayed diagnostic was 3,19 months, the lower third was the most common localisation (46,3%), 30,2% of the cases were diagnosed in the IV stage, and curative surgery was conducted in 46,4% of the cases. The probability of survival for overall numbers was 26% and curative surgery, was conducted in 45% of cases. The most advanced states in the TNM classification and the absence of curative surgery were factors associated with the poorest prognosis.

CONCLUSIONS

Survival after gastric cancer is low. Initial stage and radical surgical treatment are the main factors for prognosis.

Long-term prognosis of gastric cancer in a European country: a population-based study in Florence (Italy). 10-year survival of cases diagnosed in 1985-1987

This paper analysed, in a population-based series of 1976 gastric cancers diagnosed in Florence (Italy), from 1985 to 1987, the relationship between prognostic variables (demographic, clinical and pathological) and 10-year survival rates. Gastric cancer was mostly detected in elderly patients (mean age: 70.5 years) and at advanced stages (i.e. approximately 50% of the patients could not undergo radical surgery). Ten-year observed survival was 12.1% (95% confidence interval (CI): 10.6-13.6%) for the whole series and 20.8% (95% CI: 18.3-23.3%) for resected cases; relative survival was, respectively, 20.9% (95% CI: 18.4-23.4%) and 32.0% (95% CI: 28.1-35.9%). Ten-year relative survival was 86% for stage IA (95% CI: 73-99%) and 67% for stage IB (95% CI: 52-82%). Multivariate analysis showed a significantly better prognosis in females and a significantly worse prognosis in patients aged 65 years or more (reference: < or = 59 years). In addition, an independent prognostic effect was observed for pT in the resected cases (reference: pT3; pT1: RR = 0.47, 95% CI: 0.34-0.64; pT2 = 0.71, 95% CI: 0.58-0.87; pT4: RR = 2.02, 95% CI: 1.49-2.75), pN (reference: pN0; pN1: RR = 2.13, 95% CI: 1.70-2.68; pN2-3: RR = 3.14, 95% CI: 2.42-4.07; pN+ no. nodes involved unspecified: RR = 4.26, 95% CI: 3.11-5.83) and surgical margin involvement (reference: not involved; involved: RR = 1.36, 95% CI: 1.08-1.72). In addition, the stage, after adjustment for age, gender and surgical margin involvement, showed a strong independent prognostic value (reference: stage II; IA: RR=0.37, 95% CI: 0.25-0.57; IB: RR=0.70, 95% CI: 0.50-0.98; IIIA: RR = 1.80, 95% CI: 1.40-2.33; IIIB: RR = 2.82, 95% CI: 2.14-3.72; IV: RR = 3.29, 95% CI: 2.36-4.59). In conclusion, on the basis of a large population-based series, our results confirm the prognostic effect on long-term gastric cancer survival of pathological and demographic variables. In addition, the study shows that Italy had a relatively good, long-term survival when diagnosis was performed at early stages. However, only a few cases were diagnosed at stages when cure by radical surgery is more likely (i.e. stage I accounted for approximately 20% of the resected cases and less than 10% of all incident cases).

Gender and survival in malignant tumours

BACKGROUND

Epidemiological evidence supports the existence of a survival advantage for female patients with melanoma. This survival advantage often persists when other prognostic variables are taken into account. The basis for this female advantage or male disadvantage is not established although female sex steroids can retard melanoma invasion in vitro.

DESIGN

In considering the mechanisms involved, we have examined the literature to establish whether this female survival advantage is shared by other solid tumours. The tumours selected were breast, lung, colorectal, oesophageal, gastric, pancreatic and soft tissue sarcoma. A Medline database search was carried out to identify those studies in which gender was investigated as a prognostic indicator.

RESULTS

Results from large, mostly retrospective series show that for 5 of these 7 tumour groups, there is evidence for a female survival advantage. In particular, this survival advantage is usually more prominent in early stage disease.

CONCLUSION

Melanoma is not unique in showing a female survival advantage. Although the current literature does not address the mechanisms involved, we suggest that these are worth investigating as they may contribute to new treatment modalities aimed at preventing metastatic spread.

Dietary and familial determinants of 10-year survival among patients with gastric carcinoma

BACKGROUND

Although the role of diet in gastric carcinoma (GC) causation has been investigated extensively, its association with long term survival has never been explored in detail.

METHODS

The authors assessed the vital status on December 31, 1997 of a series of 382 patients with GC who were interviewed in 1985-1987 in the framework of a population-based case-control study in a high risk area for GC in Italy. Follow-up information at 10 years was available for all but three patients. The risk of dying was evaluated by Cox proportional hazard models, including patient age, gender, social status, disease stage at diagnosis, and lymph node involvement as confounding variables.

RESULTS

The overall survival probability was 0.26 at 5 years and 0.18 at 10 years after interview. The most important predictors were disease stage, lymph node involvement, and histopathologic grading (TNM classification). Overall, a high intake of alcohol was associated with an increased risk of dying (P = 0.02). In contrast, survival was increased in patients with a high intake of alpha-tocopherol (P = 0.04). A positive first-degree family history of GC was reported by 84 patients and tended to be associated with a reduced risk of death. A significant protective trend was found with increasing intake of vegetable fat and starch among these familial cases, with a 50% risk reduction. In contrast, this subgroup showed a two-fold increased risk of dying with a high intake of animal protein, animal fat, and preformed N-nitrosodimethylamine.

CONCLUSIONS

The current results provide evidence that premorbid diet may influence the prognosis of patients with GC, and they suggest that specific pathways for disease progression may exist among familial cases.

Interactive effects of psychosocial stressors and gender on mouse mammary tumor growth

We have previously demonstrated that social housing condition significantly affects the growth rate of the androgen-responsive Shionogi mouse mammary carcinoma (AR SC115) in male mice. The present study examined the effects of social housing condition and acute daily exposure to a novel environment on the growth rate of an androgen-independent variant of the AR SC115 carcinoma, designated SC115V, in male and female mice. Immediately following tumor cell injection, male and female mice that were reared as individuals (I) or in groups (G) of the same sex were rehoused either from individual to same-sex groups (IG) or from group to individual (GI), or remained in their group housing condition (GG). Approximately half the mice in each housing condition were subjected to acute daily exposure to novel environments (novelty stress), a treatment shown previously to increase the significant difference in tumor growth rates between male mice in the IG and GI housing conditions. The remaining mice were left undisturbed (no novelty stress). In the presence of acute daily novelty stress, the growth rate of the SC115V tumor was significantly increased in GI compared to IG males. However, no significant differences in SC115V tumor growth rates among nonstressed GI, IG, or GG males were observed. For females, in contrast to males, acute daily novelty stress significantly decreased tumor growth in GI compared to IG mice, whereas under nonstressed conditions, tumor growth rate was significantly increased in GI compared to IG females. Neither housing condition nor novelty stress altered estrous cyclicity, nor did the stage of the estrous cycle at the time of tumor cell injection influence tumor growth rates. These findings suggest that social housing condition and novelty stress may interact to produce differential effects on the growth rate of the SC115V tumor in male and female mice.

Socioeconomic status and survival of gastric cancer patients

Survival differences in cancer patients according to socioeconomic status (SES) have been reported for several organs, but the relationship with gastric cancer prognosis has not been conclusively defined. The present study analysed the survival of 122 incident, histologically confirmed gastric cancer patients diagnosed between 1985 and 1987 in Genoa, Italy and enrolled in a multicentric case-control study on gastric cancer occurrence and dietary habits. Adjusting for age at diagnosis, tumour stage, histopathological grading and surgery (i.e. curative gastric resection), Cox's proportional hazards regression model showed statistically significant hazard ratio (HR) (relative risk) estimates below unity for education (> 5 versus < or = 5 years of schooling, HR = 0.40, P = 0.003) and occupation (higher versus lower income job, HR = 0.59, P = 0.030). Also, the same final regression model revealed a positive prognostic effect for origin (Southern Italy migrants versus Genoa natives) (HR = 0.56, P = 0.039) and female gender (HR = 0.58, P = 0.020). High SES, origin from lower risk area for gastric cancer occurrence and female gender are positive prognostic categories for gastric cancer patients.

Gastric cancer in the European Union (1968-1992): mortality trends and cohort effect

PURPOSE

To analyze patterns and trends in gastric cancer mortality in the European Union (EU) over the period 1968-1992, paying special attention to changes associated with birth cohort.

METHODS

Poisson log-linear models were used to quantify geographic differences and relative annual changes. To assess trends associated with birth cohort, invariant parameters from sex-specific age-period-chohort models (net drift and curvature), for each country, were used to choose a restricted slope range for cohort effect.

RESULTS

Gastric cancer mortality declined throughout the EU. The male-to-female ratio stood at around 2 in all countries, yet showed a slight rise over time. Portugal reported the highest age-adjusted rates for men and women (45.63 and 23.31 per 100,000 person-years, respectively). The rate ratio between two extreme countries (Portugal/Denmark) exceeded 3. Quantitative intercountry differences were found in trend slopes, with a decrease of 5% per annum in Finland. Risk of dying associated with birth cohort decreased over successive generations. Small local rises in risk, in almost all countries among generations born around the 1940s, support the importance of diet early in life in the etiology of gastric cancer.

CONCLUSIONS

Despite the substantial decline in gastric cancer mortality witnessed in the EU, stress must be accounted for the wide differences among countries and the smaller decline in the youngest generations, particularly among women. This latter finding suggests a possible stabilization or even a rise in the rates in future, rendering it important for these trends to be monitored over the next few years.