Prognostic Factors and Survival in Stomach Cancer – Analysis of 15 Years of Data from a Referral Hospital in Iran and Evaluation of International Variation

Abstract

Background: Stomach cancer is the most common cancer among Iranian men. We studied survival rates and prognostic factors of stomach cancer in a referral hospital in Tehran, Iran. Patients and Methods: We followed 367 stomach cancer patients hospitalized between 1991 and 2007 in the Baqyiatallah Hospital. We estimated survival rates overall and among operable patients exclusively. Hazard ratios (HR) for the different prognostic factors were estimated with the Cox regression model. Furthermore, we studied international variations in stage distribution and 5year survival for stomach cancer. Results: Overall, 5year survival of stomach cancer was low (14%), and the majority of patients (53%) were diagnosed at stage IV. Stage, tumor size, age, and gender were statistically significant prognostic factors. Relative risk of mortality in stage IV compared to stage IA was 9.9 (95% confidence interval 5.8–16.9). The highest 5year survival was reported from Japan, particularly among screening detected patients (89.4%). Among operable patients, 5year survival was 32.6% in France, 26% in the USA, and 30.5% in China, which was close to the rates estimated in our study (24%). Conclusions: Due to stomach cancer being frequently diagnosed in advanced stages, its prognosis is poor in Iran. Early diagnosis and downstaging strategies need to be prioritized to improve the prognosis of stomach cancer.

Retinoid Receptors in Gastric Cancer: Expression and Influence on Prognosis

“…Many studies have reported on the prognostic importance of several clinicopathological factors, such as age, gender, macroscopic type (Borrmann I, II, III, and IV), tumor size, cell differentiation and TNM classification (Gobbi et al, 2011;Jiang et al, 2011;Khedmat et al, 2011), therefore, the multivariate analysis which included the expressions of RARa, RARβ, RARγ, RXRa, RXRβ and RXRγ and the aforesaid clinical variables was performed using the Cox proportional hazards mode. The score of the expressions of RARs/RXRs from 1 to 3 calculated RARs/RXRs positive, while the score of the expression of RARs/RXRs zero calculated RARs/RXRs negative.…”

“…The incidence of gastric carcinoma is declining, it remains the second leading cause of cancer-related mortality worldwide (Crew and Neugut, 2006) with fiveyear survival in France (32.6%), the USA (26%), China (30.5%), Iran (24%) and Japan (screening: 89.4%, no screening: 66.5%) (Msika et al, 2000;Cunningham et al, 2005;Kunisaki et al, 2006;Deng et al, 2010;Khedmat et al, 2011), by the time of diagnosis, most patients have advanced stages of disease (Deng et al, 2010). Its achievement of locoregional control for advanced disease remains very difficult, despite multimodal therapy, 54% of patients had locoregional recurrence (Gunderson and Sosin, 1982).…”

Prognostic Significance of Preoperative and Postoperative Plasma Levels of Ghrelin in Gastric Cancer: 3-Year Survival Study

“… 2 Several studies have reported a low survival rates of GC in Iran and other low and middle income countries. 2 , 3 , 4 Clinical parameters, including stage at the diagnosis and appropriate treatment (e.g., extent of lymphadenectomy) are the main prognostic factors in GC; 3 , 4 , 5 however, patients with similar clinical stages may experience different survival rates. 6 Therefore, research for exploring new diagnostic and prognostic factors is still warranted.…”

Endoscopic Findings in a Mass Screening Program for Gastric Cancer in a High Risk Region - Guilan Province of Iran

“…GC is more prevalent in North and Northwest of the country and its incidence rate in the northwest is more similar to eastern Asia which considered as hot point regions of GC (Sadjadi et al, 2003;Ferlay et al, 2004). The majority cases of GC are being diagnosed in advanced stages, since it is usually asymptomatic in early stages and when symptoms appear it is in late stages leading to poor prognosis (Khedmat et al, 2011). The five year survival of early GC which is limited to mucosa and sub-mucosa is estimated 85-90%, while it decreases as less as 14% in advanced stages (Nakamura et al, 1992;Khedmat et al, 2011).…”

“…The majority cases of GC are being diagnosed in advanced stages, since it is usually asymptomatic in early stages and when symptoms appear it is in late stages leading to poor prognosis (Khedmat et al, 2011). The five year survival of early GC which is limited to mucosa and sub-mucosa is estimated 85-90%, while it decreases as less as 14% in advanced stages (Nakamura et al, 1992;Khedmat et al, 2011). The beneficial effectiveness of screening programs has been confirmed in its endemic regions.…”