Öz
Aim: This study aimed to investigate the relationship between some demographic and clinical factors and survival in patients with gastric cancer.
Materials and Methods: We retrospectively evaluated the records of 252 gastric cancer patients followed up in the medical oncology department between 01.01.2016 and 10.01.2020. Gastric lymphoma, gastrointestinal stromal tumor, and neuroendocrine tumor were excluded. Factors evaluated in the study included age, sex, urban/non-urban residence, admitting complaints, smoking history, Eastern Cooperative Oncology Group (ECOG) score, stage at diagnosis, histological subtype, surgical history, tumor location, grade, diameter and macroscopic view of tumor, metastatic lymph node ratio, chemotherapy regimens, febrile neutropenia, post-chemotherapy radiological reports, chemoradiotherapy (CRT) history and survival after diagnosis.
Results: Mean overall survival (OS) time was significantly shorter in patients with weight loss (p<0.001), high ECOG score (p<0.001), radiological progression (p<0.001), advanced cancer stage (p<0.001) and tumor grade (p=0.024). Mean OS was longer in patients who received chemotherapy compared to those who did not at stage 4 (p<0.001). Mean OS was significantly longer in patients who underwent gastrectomy and received adjuvant CRT compared to those who did not (p<0.001). Mean OS was shorter in patients with a metastatic lymph node ratio over 30% (p<0.001) and those with tumor diameter larger than 3 cm (p=0.02).
Conclusion: In this study, survival time was associated with advanced stage, ECOG score, weight loss, radiological progression, high tumor grade, history of gastrectomy and adjuvant CRT, metastatic lymph node ratio >30%, tumor diameter >3 cm and presence of palliative chemotherapy in terminal patients.
Anahtar Kelimeler
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018 Nov; 68 (6): 394-424.
- Avital I, Stojadinovic A, Pisters PWT, Kelsen DP, Willett CG. Cancer of the Stomach. In: DeViltaVT, Lawrence TS, Rosenberg SA (editors). Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins Wolters Kluwer Health; 2011. p946.
- Zhu H, Yang X, Zhang C et al. Red and processed meat intake is associated with higher gastric cancer risk: a meta-analysis of epidemiological observational studies. PloS one 2013; 8 (8): e70955.
- Tsugane S, Sasazuki S. Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric cancer 2007; 10 (2): 75-83.
- Shikata K, Kiyohara Y, Kubo M et al. A prospective study of dietary salt intake and gastric cancer incidence in a defined Japanese population: the Hisayama study. Intl J Cancer 2006; 119 (1): 196-201.
- Peleteiro B, Lopes C, Figueiredo C, Lunet N. Salt intake and gastric cancer risk according to Helicobacter pylori infection, smoking, tumour site and histological type. BMJ 2011; 104 (1): 198-207.
- Machida-Montani A, Sasazuki S, Inoue M et al. Association of Helicobacter pylori infection and environmental factors in non-cardia gastric cancer in Japan. Gastric Cancer 2004; 7 (1): 46-53.
- Barker D, Coggon D, Osmond C, Wickham C. Poor housing in childhood and high rates of stomach cancer in England and Wales. BMJ 1990; 61 (4): 575.
- Powell J, McConkey C. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. BMJ 1990; 62 (3): 440.
- Akdogan RA, Aslan M. Mide Tümörleri. Özden A, Sahin B, Yılmaz U (editors). Gastroenteroloji. Türk Gastroenteroloji Vakfı, Ankara 2002;107-12 (in Turkish).
- Göksel S, Topuz E, Aykan NF. Mide kanserinde etyoloji, patogenez ve patoloji. İstanbul Onkoloji Enstitüsü Yayınları 1998: 181-6 (in Turkish).
- Kubba A, MacIntyre I. Gastric cancer distal to the cardia—prevention or cure? Sur Onc 1997; 6 (2): 111-24.
- Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric cancer. Crit Rev Oncol Hematol 2009;71(2):127-64.
- Agboola O. Adjuvant treatment in gastric cancer. Cancer Treat Rev 1994; 20 (3): 217-40.
- Siewert JR, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000; 232 (3): 353-61.
- Macdonald JS, Smalley SR, Benedetti J et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345 (10): 725-30.
- Li WY, Han Y, Xu HM et al. Smoking status and subsequent gastric cancer risk in men compared with women: a meta-analysis of prospective observational studies. BMC Cancer 19, 2019: 377.
- Yalcin S. Gastric cancer in Turkey—a bridge between west and east. GCR 2009; 3 (1): 29.
- Tuncer İ, Uygan İ, Kösem M, Özen S, Uğraş S, Türkdoğan K. The Demography and Histopathologic Characteristics Of Upper Gastrointestinal Cancers Appeared in Van and Its Vicinity. Van Tıp Dergisi 2001; 8 (1): 10 (in Turkish).
- Yücel B, Kılıçkap S, Lehimcioğlu Y, Erdiş E, Akkaş EA, Şalk M. Prognostic factors that affect the survival of gastric cancer. Cumhuriyet Medical Journal 2012; 34 (2): 173-82.
- Altınbaş M, Hepşen S, İmamoğlu İ et al. Death Reasons and Factors That Affect on Survival of Cancer Patients. Sakarya Tıp Dergisi 2015; 5 (1): 5-9 (in Turkish).
- Psaltopoulou T, Ntanasis-Stathopoulos I, Tzanninis IG et al. Physical Activity and Gastric Cancer Risk: A Systematic Review and Meta-Analysis. Clin J Sport Med 2016; 26 (6) :445-64.
- Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002; 9 (8): 775-84.
- Sun Z, Zhu GL, Lu C et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients. Ann Oncol 2009; 20 (5): 897-905.
- Kitamura K, Yamaguchi T, Taniguchi H et al. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997; 64 (1): 42-7.
- Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. BMJ 1995; 82 (3): 346-51.
- Ock CY, Oh DY, Lee J et al. Weight loss at the first month of palliative chemotherapy predicts survival outcomes in patients with advanced gastric cancer. Gastric Cancer 2015:8.
- Smalley SR, Benedetti JK, Haller DG et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol 2012; 30 (19): 2327-33.
- Sun L, Su XH, Guan YS et al. Clinical role of 18F fluorodeoxyglucose positron emission tomography/computed tomography in post-operative follow up of gastric cancer: initial results. World J Gastroenterol 2008; 14 (29), 4627–32.
- Nelen SD, van Steenbergen LN, Dassen AE, van der Wurff AA, Lemmens ve, Bosscha K. The lymph node ratio as a prognostic factor for gastric cancer. Acta Oncologia 2013; 52: 1751-9.
- Bozzetti F, Bonfanti G, Audisio RA et al. Prognosis of patients after palliative surgical procedures for carcinoma of the stomach. Surg Gynecol Obstet 1987; 164 (2): 151-4.
- Boddie A, McMurtrey M, Giacco G, McBride C. Palliative total gastrectomy and esophagogastrectomy a reevaluation. Cancer 1983; 51 (7): 1195-200.
- Medina-Franco H, Heslin MJ, Cortes-Gonzalez R. Clinicopathological characteristics of gastric carcinoma in young and elderly patients: a comparative study. Ann Surg Oncol 2000; 7 (7): 515-9.
- Adachi Y, Oshiro T, Mori M, Maehara Y, Sugimachi K. Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol 1997; 4 (2): 137-40.
- Nardi M, Azzarello D, Maisano R et al. FOLFOX-4 regimen as fist-line chemotherapy in elderly patients with advanced gastric cancer: a safety study. J Chemother 2007; 19 (1): 85-9.
- Catalano V, Graziano F, Santini D et al. Second-line chemotherapy for patients with advanced gastric cancer: who may benefit? Br J Cancer 2008; 99 (9): 1402‐07.
- Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006; 24 (18): 2903‐09.
Öz
Amaç: Bu çalışmada, mide kanserine yönelik çok sayıda demografik özellik ve klinik faktörün sağkalıma etkisini araştırmayı hedefledik.
Gereç ve Yöntem: 01.01.2016-10.01.2020 tarihleri arasında takip edilen, mide kanseri tanılı 252 hastanın kayıtları retrospektif olarak değerlendirildi. Mide lenfoması, gastrointestinal stromal tümör ve nöroendokrin tümör tanılı hastalar çalışmaya alınmadı. Tanıdaki yaş, tanı tarihi, cinsiyet, kırsalda ya da şehirde ikamet özellikleri, tanı sonrası yaşam süreleri, başvuru yakınması, sigara öyküsü, Eastern Cooperative Oncology Group (ECOG) performans skoru, tanıdaki evre, histolojik alt tip, operasyon öyküsü ve tipi, tümöre ait grade ve çap, makroskobik tümör görüntüsü ve lokalizasyonu, metastatik lenf nodu yüzdesi, kemoterapi (KT) protokolleri, febril nötropeni, KT sonrası kontrol PET-BT raporları ve kemoradyoterapi (KRT) öyküsü gibi faktörler değerlendirildi.
Bulgular: Kilo kaybı (p<0,001), yüksek ECOG skoru (p<0,001), kontrol PET-BT’de progresyon (p<0,001), ileri evre (p<0,001), yüksek grade tümör (p=0,024) varlığında ortalama genel sağkalım (GSK) süresi anlamlı oranda kısaydı.
Gastrektomi ve adjuvan KRT varlığında GSK süreleri daha uzundu (p<0,001). Evre 4 hastalıkta; palyatif KT alan hastaların GSK süreleri KT almayanlara göre daha uzundu (p<0,001). Metastatik lenf nodu oranı %30’un üzerinde olanlarda ortalama GSK süresi, anlamlı derecede kısaydı (p<0,001). Tümör çapı 3 cm’den fazla olanlarda GSK süresi daha kısaydı (p=0,02).
Sonuç: Çalışmamızda; evre, ECOG skoru, kilo kaybı yakınması, kontrol PET-BT’de progresyon olması, yüksek evre, gastrektomi öyküsü, metastatik lenf nodu oranının %30’un üzerinde olması, tümör çapının 3 cm’den fazla olması, adjuvan KRT öyküsü, terminal dönem hastalarda palyatif amaçlı da olsa KT varlığının GSK süresi ile ilişkili olduğu saptandı.
Anahtar Kelimeler
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018 Nov; 68 (6): 394-424.
- Avital I, Stojadinovic A, Pisters PWT, Kelsen DP, Willett CG. Cancer of the Stomach. In: DeViltaVT, Lawrence TS, Rosenberg SA (editors). Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins Wolters Kluwer Health; 2011. p946.
- Zhu H, Yang X, Zhang C et al. Red and processed meat intake is associated with higher gastric cancer risk: a meta-analysis of epidemiological observational studies. PloS one 2013; 8 (8): e70955.
- Tsugane S, Sasazuki S. Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric cancer 2007; 10 (2): 75-83.
- Shikata K, Kiyohara Y, Kubo M et al. A prospective study of dietary salt intake and gastric cancer incidence in a defined Japanese population: the Hisayama study. Intl J Cancer 2006; 119 (1): 196-201.
- Peleteiro B, Lopes C, Figueiredo C, Lunet N. Salt intake and gastric cancer risk according to Helicobacter pylori infection, smoking, tumour site and histological type. BMJ 2011; 104 (1): 198-207.
- Machida-Montani A, Sasazuki S, Inoue M et al. Association of Helicobacter pylori infection and environmental factors in non-cardia gastric cancer in Japan. Gastric Cancer 2004; 7 (1): 46-53.
- Barker D, Coggon D, Osmond C, Wickham C. Poor housing in childhood and high rates of stomach cancer in England and Wales. BMJ 1990; 61 (4): 575.
- Powell J, McConkey C. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. BMJ 1990; 62 (3): 440.
- Akdogan RA, Aslan M. Mide Tümörleri. Özden A, Sahin B, Yılmaz U (editors). Gastroenteroloji. Türk Gastroenteroloji Vakfı, Ankara 2002;107-12 (in Turkish).
- Göksel S, Topuz E, Aykan NF. Mide kanserinde etyoloji, patogenez ve patoloji. İstanbul Onkoloji Enstitüsü Yayınları 1998: 181-6 (in Turkish).
- Kubba A, MacIntyre I. Gastric cancer distal to the cardia—prevention or cure? Sur Onc 1997; 6 (2): 111-24.
- Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric cancer. Crit Rev Oncol Hematol 2009;71(2):127-64.
- Agboola O. Adjuvant treatment in gastric cancer. Cancer Treat Rev 1994; 20 (3): 217-40.
- Siewert JR, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000; 232 (3): 353-61.
- Macdonald JS, Smalley SR, Benedetti J et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345 (10): 725-30.
- Li WY, Han Y, Xu HM et al. Smoking status and subsequent gastric cancer risk in men compared with women: a meta-analysis of prospective observational studies. BMC Cancer 19, 2019: 377.
- Yalcin S. Gastric cancer in Turkey—a bridge between west and east. GCR 2009; 3 (1): 29.
- Tuncer İ, Uygan İ, Kösem M, Özen S, Uğraş S, Türkdoğan K. The Demography and Histopathologic Characteristics Of Upper Gastrointestinal Cancers Appeared in Van and Its Vicinity. Van Tıp Dergisi 2001; 8 (1): 10 (in Turkish).
- Yücel B, Kılıçkap S, Lehimcioğlu Y, Erdiş E, Akkaş EA, Şalk M. Prognostic factors that affect the survival of gastric cancer. Cumhuriyet Medical Journal 2012; 34 (2): 173-82.
- Altınbaş M, Hepşen S, İmamoğlu İ et al. Death Reasons and Factors That Affect on Survival of Cancer Patients. Sakarya Tıp Dergisi 2015; 5 (1): 5-9 (in Turkish).
- Psaltopoulou T, Ntanasis-Stathopoulos I, Tzanninis IG et al. Physical Activity and Gastric Cancer Risk: A Systematic Review and Meta-Analysis. Clin J Sport Med 2016; 26 (6) :445-64.
- Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002; 9 (8): 775-84.
- Sun Z, Zhu GL, Lu C et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients. Ann Oncol 2009; 20 (5): 897-905.
- Kitamura K, Yamaguchi T, Taniguchi H et al. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997; 64 (1): 42-7.
- Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. BMJ 1995; 82 (3): 346-51.
- Ock CY, Oh DY, Lee J et al. Weight loss at the first month of palliative chemotherapy predicts survival outcomes in patients with advanced gastric cancer. Gastric Cancer 2015:8.
- Smalley SR, Benedetti JK, Haller DG et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol 2012; 30 (19): 2327-33.
- Sun L, Su XH, Guan YS et al. Clinical role of 18F fluorodeoxyglucose positron emission tomography/computed tomography in post-operative follow up of gastric cancer: initial results. World J Gastroenterol 2008; 14 (29), 4627–32.
- Nelen SD, van Steenbergen LN, Dassen AE, van der Wurff AA, Lemmens ve, Bosscha K. The lymph node ratio as a prognostic factor for gastric cancer. Acta Oncologia 2013; 52: 1751-9.
- Bozzetti F, Bonfanti G, Audisio RA et al. Prognosis of patients after palliative surgical procedures for carcinoma of the stomach. Surg Gynecol Obstet 1987; 164 (2): 151-4.
- Boddie A, McMurtrey M, Giacco G, McBride C. Palliative total gastrectomy and esophagogastrectomy a reevaluation. Cancer 1983; 51 (7): 1195-200.
- Medina-Franco H, Heslin MJ, Cortes-Gonzalez R. Clinicopathological characteristics of gastric carcinoma in young and elderly patients: a comparative study. Ann Surg Oncol 2000; 7 (7): 515-9.
- Adachi Y, Oshiro T, Mori M, Maehara Y, Sugimachi K. Tumor size as a simple prognostic indicator for gastric carcinoma. Ann Surg Oncol 1997; 4 (2): 137-40.
- Nardi M, Azzarello D, Maisano R et al. FOLFOX-4 regimen as fist-line chemotherapy in elderly patients with advanced gastric cancer: a safety study. J Chemother 2007; 19 (1): 85-9.
- Catalano V, Graziano F, Santini D et al. Second-line chemotherapy for patients with advanced gastric cancer: who may benefit? Br J Cancer 2008; 99 (9): 1402‐07.
- Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006; 24 (18): 2903‐09.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Haziran 2022 |
| Gönderilme Tarihi | 12 Temmuz 2021 |
| Yayımlandığı Sayı | Yıl 2022 |