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Comparison on Clinicopathological Features, Treatments and Prognosis between Proximal Gastric Cancer and Distal Gastric Cancer: A National Cancer Data Base Analysis.

ABSTRACT: Background: The aim of this study was to examine the differences in clinicopathological features, treatment strategies and prognosis between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC). Methods: Patients with gastric adenocarcinoma were identified from the National Cancer Database during the years 2004-2015. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards models. Results: A total of 97,060 patients were identified with gastric adenocarcinoma. DGC was associated with older age, more advanced tumor stage, and poorly differentiated tumors compared with PGC (all p<0.01). In the multivariate analysis, patients with DGC had a worse prognosis compared with those with PGC. In early and locally advanced stage, the prognosis of DGC was better compared with PGC. In distant metastasis stage, the prognosis of DGC was worse compared with PGC. Compared with patients underwent gastrectomy who received adjuvant therapy (AT) in locally advanced stage, a survival benefit was seen for DGC patients who received neoadjuvant therapy (NAT) or NAT plus AT, whereas PGC patients with locally advanced disease did not share this result (p>0.05). Conclusion: PGC and DGC differed in their clinicopathologic characteristics and prognosis and heterogeneity may be due to differences in tumor biology. Tumor location should be taken into consideration when stratifying patients for optimal therapeutic strategies.

SUBMITTER: Wang X

PROVIDER: S-EPMC6603385 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Comparison on Clinicopathological Features, Treatments and Prognosis between Proximal Gastric Cancer and Distal Gastric Cancer: A National Cancer Data Base Analysis.

Wang Xiang X Liu Fangfang F Li Yumin Y Tang Song S Zhang Yawei Y Chen Yingtai Y Khan Sajid A SA

Journal of Cancer 20190602 14

Background: The aim of this study was to examine the differences in clinicopathological features, treatment strategies and prognosis between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC). Methods: Patients with gastric adenocarcinoma were identified from the National Cancer Database during the years 2004-2015. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards models. Results: A total of 97,060 patients were identified ...[more]

PMID: 31289585

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Project description:Background:The prognostic relevance of gastric tumor location has been reported and debated. Our study was conducted to examine the differences in clinicopathological features, prognostic factors, and overall survival (OS) between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC). Patients and Methods:Patients with PGC or DGC were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) during 1997-2017. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models. Results:We reviewed 16,119 cases of gastric cancer patients, including 6,479 of PGC and 9,640 of DGC. PGC patients presented as older patients (61.5 versus 56.4 years, P<0.001) and more males (82.9% versus 68.2%, P<0.001). Compared with DGC, PGC was more likely to be in later pT stage (pT3 and pT4, 65.0% versus 52.8%, P<0.001) and lymph node metastasis (54.8% versus 50.9%, P<0.001). In univariate analysis, PGC patients had a worse survival outcome in stage I (Hazard ratio [HR] = 2.04, 95% CI: 1.42-2.94) but a better prognosis in stage IV (HR = 0.85, 95% CI: 0.73-0.98) when compared to DGC patients. However, multivariate analysis demonstrated that PGC was not an independent predictor for poor survival (HR = 1.07, 95% CI: 1.00-1.14). Results from multivariate analysis also revealed that pT4, lymph node metastasis, distant metastasis, no gastrectomy, and Borrmann IV were independent predictors associated with poor survival for both PGC and DGC patients. Additional prognostic factors for PGC patients included underweight (BMI < 18.5) (HR = 1.29, 95% CI: 1.06-1.58), linitis plastica (HR = 2.13, 95% CI: 1.25-3.65), and overweight (23 ? BMI <27.5) (HR = 0.80, 95% CI: 0.71-0.90). During the 20-year study period, the 5-year OS increased significantly for both PGC and DGC, with the increase rate of 91.7% and 67.7%, respectively. Conclusion:In China, PGC significantly differed from DGC in clinicopathological characteristics and prognostic factors. However, there was no significant relationship between survival outcome and gastric tumor location.

Project description:Most gastric cancers develop in patients with chronic gastritis. Chronic gastritis can be classified into two major subtypes: Helicobacter pylori (H. pylori)-induced gastritis and autoimmune gastritis (AIG). Whereas H. pylori-related gastric cancers are more common and have been extensively investigated, the clinicopathological features of gastric cancer with autoimmune gastritis are unclear. Patients diagnosed with gastric cancer and hospitalized in the University Tokyo Hospital from 1998 to 2017 were enrolled. Diagnosis of autoimmune gastritis was based on positivity for serum anti-parietal cell antibody (APCA). We evaluated mucin expression and immune cell infiltration by immunohistochemical staining for MUC5AC, MUC6, PD-L1, CD3, CD11, Foxp3, and PD1. We also examined the presence of bacterial taxa that are reportedly enriched in AIG. Survival analyses of recurrence and 5-year mortality were also performed. In total, 261 patients (76 APCA-positive and 185 APCA-negative) were analyzed. Immunohistochemical staining in the matched cohort showed that AIG-related gastric cancer had higher MUC5AC expression (p = 0.0007) and MUC6 expression (p = 0.0007). Greater infiltration of CD3-positive (p = 0.001), Foxp3-positive (p < 0.001), and PD1-positive cells (p = 0.001); lesser infiltration of CD11b-positive (p = 0.005) cells; and a higher prevalence of Bacillus cereus (p = 0.006) were found in AIG-related gastric cancer patients. The cumulative incidences of gastric cancer recurrence were 2.99% at 2 years, 15.68% at 6 years, and 18.81% at 10 years in APCA-positive patients; they were 12.79% at 2 years, 21.35% at 6 years, and 31.85% at 10 years in APCA-negative patients. The cumulative incidences of mortality were 0% at 3 years and 0% at 5 years in APCA-positive patients; they were 1.52% at 3 years and 2.56% at 5 years in APCA-negative patients. We identified molecular differences between AIG and non-AIG gastric cancer. Differences in T-cell populations and the gastric microbiota may contribute to the pathogenesis of gastric cancers and potentially affect the response to immunotherapy.

Dataset Information

Comparison on Clinicopathological Features, Treatments and Prognosis between Proximal Gastric Cancer and Distal Gastric Cancer: A National Cancer Data Base Analysis.

Publications

Comparison on Clinicopathological Features, Treatments and Prognosis between Proximal Gastric Cancer and Distal Gastric Cancer: A National Cancer Data Base Analysis.

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