Gastric Cancers in Singapore: Poor Prognosis Arising From Late Presentation

Abstract

Background: Mortality rates from gastric cancer, apart from those derived from Japanese series, remain poor. This paper sought to determine the present outcome of gastric carcinoma in a predominantly Chinese population in Singapore. Prognostic factors useful in predicting survival were also evaluated in this population. Method: All cases of histologically confirmed gastric adenocarcinoma presenting in 1992 were entered into a prospective database. Prognostic factors related to age, sex, site of disease, depth of invasion, histological grade, nodal status and stage of disease were evaluated in patients with resectable disease to determine their utility in predicting survival. Results: Of I3 I consecutive patients with histologically proven adenocarcinomas, 37% had distant metastases at presentation predominantly in the liver (21 %) and peritoneal cavity (20%). Sixty-four per cent of patients underwent surgery and in only 51% of these patients was resection of the turnour possible. Stages 111 and IV (T4N2) locally advanced disease were present in 38% of patients. Thus the majority of patients presented with late or metastatic disease (75%, stages 111 and IV). Sixty per cent of patients were alive at I year and 40% at 2 years after resection of the tumour (Kaplan-Meier survival plots). In contrast, no patient survived longer than a year if the tumour was not resectable ( P < 0.001, log-rank test). Median survival of patients without surgery was 12 weeks. Median survival for patients with resected stage IV disease was 23 weeks, compared to 18 weeks after surgical bypass. Age, sex, site, depth of invasion and histological grade did not significantly predict survival. Patients with node-negative disease survived longer (2 years, 70%) than those with nodal involvement ( 2 years, 44%; P = 0.06, log-rank test). Pathologic staging with the TNM system was useful in predicting survival ( P < 0.001). Sixty per cent of patients with stage I and II disease were alive at 2 years compared to 54% with stage 111 disease and 0% with stage IV disease. Conclusion: The prognosis of stomach cancer remains poor, due predominantly to late presentation. Pathologic TNM staging and nodal status were useful in predicting survival outcome after resection. If the tumour were resectable, survival was appreciable even in patients with advanced stage Ill (2 years, 54%) and stage IV ( I year, 40%) disease. Strategies to improve outcome should focus on early detection of gastric carcinomas.

The prognostic significance of p53, p27kip1, p21waf1, HER‐2/neu, and Ki67 proteins expression in gastric cancer: A clinicopathological and immunohistochemical study of 121 Arab patients

“…The tumor location, macroscopic appearances, and Lauren's classification are consistent with clinicopathological features reported in Asia and Africa where distal ulcerative intestinal tumors are the most common [33,34]. Seventy one percent of patients presented in advanced stages, an observation noted in several countries where there are no screening programs [35][36][37]. In our series, T1 lesions were found in 1.5% of the patients compared with Japanese population of 70% where mass screening is undertaken [38].…”

The Prognostic Determinants of Gastric Cancer Treatment Outcome in Omani Arab Patients

“…The early stage detection is emphasized by marked differences in 5-year survival rates of 76.4, 37.4 and 7.4% for stages I, II and III, respectively (table 3). Similar patterns of advanced presentation have been noted in several countries where there are no screening programs, which vary between 40 and 80% with similar survival rates to ours [10, 14, 23, 25, 27, 28]. In our study, T1 lesions were found in 2.1% of patients compared to 44–57 and 20% in Japanese and American patients, respectively [23, 29].…”

“…Similar patterns of advanced presentation have been noted in several countries where there are no screening programs, which vary between 40 and 80% with similar survival rates to ours [10, 14, 23, 25, 27, 28]. In our study, T1 lesions were found in 2.1% of patients compared to 44–57 and 20% in Japanese and American patients, respectively [23, 29]. Three case-control studies conducted in Japan showed a 40–60% decrease in mortality from gastric cancer associated with the screening [30].…”

“…Our results, like those from other parts of the world, underscore the importance of the pathological stage at time of diagnosis in determining the outcome [23,24,25,26]. The early stage detection is emphasized by marked differences in 5-year survival rates of 76.4, 37.4 and 7.4% for stages I, II and III, respectively (table 3).…”

“…In conclusion, gastric adenocarcinoma is the most common cancer in the Sultanate of Oman and exemplifies the issues in gastric cancer presentation, management and prognosis in many developing countries [23, 27, 28, 54]. It exhibits the clinicopathological features seen in endemic areas where the majority of tumors are likely to be distal, ulcerative, and intestinal adenocarcinomas.…”