Causes of Death Following Gastric Cancer Diagnosis: A Population-Based Analysis

Abstract

Conflict of interest: None declared Background:Causes of death (CODs) in patients with gastric cancer (GC) need to be studied. We examined the cancer-specific and non-cancer deaths among patients diagnosed with GC from 1975 to 2019. Material/Methods:We obtained medical records from the Surveillance, Epidemiology, and End Results (SEER) database. We used SEER*Stat software to calculate standardized mortality ratios (SMRs) for specific CODs and performed a competing risk analysis to evaluate the cumulative mortality of specific CODs. Results:The final study cohort included 42 813 patients with GC, with a mean age at diagnosis of 67.7 years. As the end of 2021, a total of 36 924 (86.2%) patients died. Of these deaths, 24 625 (66.7%) were from GC, 6513 (17.6%) were from other types of cancers, and 5786 (15.7%) were from non-cancer causes. The most prevalent noncancer CODs were heart diseases (2104; 5.7%), cerebrovascular diseases (501; 1.4%), and pneumonia/influenza (335; 0.9%). Among patients who survived over 5 years, non-cancer causes surpassed GC as the main CODs. Patients with GC had a higher risk of dying from many non-cancer causes than expected in the general population, particularly from suicide (SMR, 3.03; 95% CI, 2.35-3.85) and septicemia (SMR, 2.93; 95% CI, 2.51-3.4).The competing risk analysis showed that the cumulative mortality of GC gradually declined with a more recent diagnosis. Conclusions:Although GC was the leading COD among patients with GC, non-cancer CODs accounted for a substantial number of deaths. These findings provide useful guidance on potential death risks among patients with GC.

Cause of death among gastric cancer survivors in the United States from 2000 to 2020

“…[11] The most common noncancerous causes of death were diseases of heart and cerebrovascular diseases, which were consistent with findings from several previous studies on various cancers. [11][12][13][14][15][16][17][18] This association may be related to GC treatment. For example, immunotherapy is probably associated with cardiac toxic effects, and HER-2 targeted Trastuzumab may lead to a decrease in left ventricular ejection fraction.…”

“…Our study analyzed SMRs for causes of death in <1 year, 1 to 5 years, 5 to 10 years and >10 years after GC diagnosis, revealing a mild increase in the risk of death after 10 years post-diagnosis. [11] Furthermore, the third leading noncancerous COD in our study was COPD, compared to pneumonia and influenza in the previous study. [11] The most common noncancerous causes of death were diseases of heart and cerebrovascular diseases, which were consistent with findings from several previous studies on various cancers.…”

“…[11] Furthermore, the third leading noncancerous COD in our study was COPD, compared to pneumonia and influenza in the previous study. [11] The most common noncancerous causes of death were diseases of heart and cerebrovascular diseases, which were consistent with findings from several previous studies on various cancers. [11][12][13][14][15][16][17][18] This association may be related to GC treatment.…”

“…Prior to this, there had been only one investigation into the COD among gastric cancer patients, which included a cohort of 42,813 individuals from 1975 to 2019 and served as an inspiration for our current study. [11] To obtain as much data as possible, we only excluded patients without histologic confirmation, those with death or autopsy certificate, and those with insufficient survival information. Meanwhile, we included patients with other missing data, which we determined would not influence the outcome of the COD analysis.…”