Outcome and prognostic factors of gastric cancer in Tunisia

Abstract

Introduction: There are two different etiologies of gastric cardia cancer -Barrett's esophagus and Helicobacter pylori (H. pylori) associated atrophy/intestinal metaplasia. We aimed to evaluate the clinical characteristics and outcome between gastric cardia and non-cardia cancer. Also, we evaluated the clinical outcome according to obesity, H. pylori infection, and gastric atrophy. Methods: We performed a retrospective cohort study of 90 patients with gastric cardia cancer from Jan. 2003 to 2013. The control group was randomly selected in a 2:1 ratio compared with the case group, and 180 patients with gastric non-cardia cancer were selected as age and sex matched control during the same period. Results: The rate of curative resection (R0), disease free survival and overall survival duration were significantly lower in gastric cardia cancer. The rate of recurrence was significantly higher in gastric cardia cancer (28.4% vs 8.0%, P < 0.01). The rate of H. pylori (-) and gastric atrophy (-) of gastric cardia cancer was statistically higher than non-cardia cancer (P < 0.01), but there was no difference in the rate of obesity. Irrespective of obesity or the presence of H. pylori/gastric atrophy, there were no differences of overall survival, recurrence rate and disease-free survival. Conclusion: Gastric cardia cancer had a negative prognostic impact, compared with gastric non-cardia cancer. Although a possible heterogeneity in the pathogenesis and biological behavior of gastric cardia cancer would be present, there was no difference in prognosis.