Patients histopathologically diagnosed as gastric adenocarcinomas with stage IV M0 (without distant organ metastasis) or stage IV M1 (with distant organ metastasis) were included in the study.
Mean age of the patients was 61.1 (34-84), 64.6% male and 35.5% female. The ratio of patients with a performance score of 2-3 was 55%. The BMI was below 20 in 53.6% of the patients. According to histological grading, 41.9% of patients had indifferentiated adenocarcinoma, mucinous cell adenocarcinoma or signet ring cell adenocarcinoma. 84% of patients were clinically at stage IV M1. The percentage of patients with tumor localized upper 1/3 of stomach was 60.8%. While 19.6% of patients had received surgical treatment, 47% of the patients had received chemotherapy as adjuvant or paliative purposes. The percentage of the patients who responded to the therapy (complete response + partial response + stable response) was 39% and the percentage of patients who had progression was 7.2%.
Overall median survival time was 3.1 months and three years survival rate was 8%. At single variable analysis, BMI, clinical stage, surgery, type of surgery and serum level of albumin were significant prognostic factors related to overall median survival time. Gender, clinical stage, surgery, type of surgery, hemoglobine concentration and serum level of albumin were found to be significant prognostic factors related to survival without progression (p<0.05). The factors found to be significant related to overall survival rate in single variable analysis were reevaluated in multiple variable analysis. No surgical treatment, paliative surgery (compared to radical surgery), BMI below 20 were found to be the statistically significant poor prognostic factors related to survival. The factors found to be significant related to survival without progression in single variable analysis were evaluated in multiple variable analysis and no surgical treatment (compared to surgery), male gender (compared to female) were found to be statistically significant poor prognostic parameters. In terms of both overall survival and survival without progression, whether performing surgery or not was statistically most significant independent prognostic factor.
In conclusion, no surgical treatment, paliative surgery instead of radical surgery, and BMI below 20 on first admission were determined as poor prognostic factors related to survival in patients with high grade gastric adenocarcinoma.
Keywords: Gastric cancer, prognostic factors
