Overall Survival and Associated Clinical Factors in Unresectable Locally Advanced or Metastatic Gastric Cancer: A Retrospective Analysis from the Single Institute Cancer Registry (The CARES-GC Study)
DOI:
https://doi.org/10.64960/srimedj.v40i6.267082Keywords:
gastric cancer, survival, advanced-stage, ThailandAbstract
Background and Objective: Gastric cancer (GC) remains a primary global health concern with poor survival outcomes, especially in Thailand, where real-world data are limited. This study aimed to evaluate the 1-year overall survival (OS) and identify prognostic factors among Thai patients with advanced GC.
Materials and Methods: A retrospective, single-center cohort study was conducted using the Cancer Registry and Survival (CARES) database of Maharat Nakhon Ratchasima Hospital. Patients diagnosed with advanced GC from 2018 to 2023 were included and followed up until December 31, 2024. The primary outcome was 1-year OS, and prognostic factors related to 1-year OS were analyzed using univariable and multivariable logistic regression. The median OS was planned to be analyzed using Kaplan-Meier estimation as an exploratory analysis.
Results: Among 306 patients, the crude 1-year OS rate was 10.5%, with a median OS of 2.6 months (95% CI: 2.03–3.16). Patients who received both surgery and chemotherapy had the longest median survival (12.95 months, 95% CI: 5.57–20.32), while those on best supportive care had the shortest (1.81 months, 95% CI: 1.45–2.16). Independent predictors of 1-year survival included symptom duration (OR: 0.87, 95% CI: 0.76–1.00, p = 0.042), chemotherapy (OR: 0.28, 95% CI: 0.11–0.76, p = 0.012), and curative surgery (OR: 0.15, 95% CI: 0.05–0.45, p = 0.001).
Conclusion: The 1-year survival rate for advanced GC in our study was 10.5%, with a median OS of 2.6 months, which is lower than in other studies. Chemotherapy, curative surgical intent, and earlier symptom detection were linked to better survival outcomes. While both treatment options have demonstrated benefits in enhancing survival rates, the percentage of patients receiving these treatments remains low, highlighting the need to identify barriers to care and improve management strategies for this population.
References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74(3):229–63. doi:10.3322/caac.21834.
American Joint Committee on Cancer. AJCC cancer staging manual. Eighth edition, corrected at 3rd printing. Amin MB, Greene FL, Edge SB, editors. Chicago, IL: AJCC, American Joint Committee on Cancer; 2017.
Nanthanangkul S, Suwanrungruang K, Wiangnon S, Promthet S. Survival of stomach cancer cases in Khon Kaen, Thailand 2000-2012. Asian Pac J Cancer Prev 2016;17(4):2125–9. doi:10.7314/APJCP.2016.17.4.2125.
Hu HM, Tsai HJ, Ku HY, Lo SS, Shan YS, Chang HC, et al. Survival outcomes of management in metastatic gastric adenocarcinoma patients. Sci Rep 2021;11(1):23142. doi:10.1038/s41598-021-02391-z.
Tiengo T, Fernandes GA, Curado MP. Gastric adenocarcinoma: 1-year overall survival, disability-adjusted life years, years of life lost, and prognostic factors-a single-institution experience. Front Oncol 2022;12:918833. doi:10.3389/fonc.2022.918833.
Chancharoen A. The clinicopathologic features, survival rate and prognostic factors on survival of patients with stomach cancer. Srinagarind Med J 2022;37(5):475–8.
Thong-Ngam D, Tangkijvanich P, Mahachai V, Kullavanijaya P. Current status of gastric cancer in Thai patients. J Med Assoc Thail Chotmaihet Thangphaet 2001;84(4):475–82.
Alshehri A, Alanezi H, Kim BS. Prognosis factors of advanced gastric cancer according to sex and age. World J Clin Cases 2020;8(9):1608–19. doi:10.12998/wjcc.v8.i9.1608.
Zhu X, Ge B, Wen L, Huang H, Shi X. Analysis of multiple factors influencing the survival of patients with advanced gastric cancer. Aging (Albany NY) 2024;16(10):8541–51. doi:10.18632/aging.205820.
Park JM, Ryu WS, Kim JH, Park SS, Kim SJ, Kim CS, et al. Prognostic factors for advanced gastric cancer: stage-stratified analysis of patients who underwent curative resection. Cancer Res Treat 2006;38(1):13–8. doi:10.4143/crt.2006.38.1.13.
Feng F, Zheng G, Guo X, Liu Z, Xu G, Wang F, et al. Impact of body mass index on surgical outcomes of gastric cancer. BMC Cancer 2018;18(1):151. doi:10.1186/s12885-018-4063-9.
Lee JH, Park B, Joo J, Kook MC, Kim YI, Lee JY, et al. Body mass index and mortality in patients with gastric cancer: a large cohort study. Gastric Cancer 2018;21(6):913–24. doi:10.1007/s10120-018-0818-x.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377–81. doi:10.1016/j.jbi.2008.08.010.
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95:103208. doi:10.1016/j.jbi.2019.103208.
Daniel WW, Cross CL. Biostatistics: a foundation for analysis in the health sciences. Eleventh edition. Hoboken, NJ: Wiley; 2019.
Green SB. How many subjects does it take to do a regression analysis. Multivar Behav Res 1991;26(3):499–510. doi:10.1207/s15327906mbr2603_7.
Yook JH, Oh ST, Kim BS. Clinicopathological analysis of Borrmann type IV gastric cancer. Cancer Res Treat 2005;37(2):87–91. doi:10.4143/crt.2005.37.2.87.
Lordick F, Carneiro F, Cascinu S, Fleitas T, Haustermans K, Piessen G, Vogel A, Smyth EC. Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022;33(10):1005–20. doi:10.1016/j.annonc.2022.07.004.
Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006;24(18):2903–9. doi:10.1200/JCO.2005.05.0245.
Baba H, Kuwabara K, Ishiguro T, Kumamoto K, Kumagai Y, Ishibashi K, et al. Prognostic factors for stage IV gastric cancer. Int Surg 2013;98(2):181–7. doi:10.9738/INTSURG-D-12-00027.1.
Fujitani K, Yang HK, Mizusawa J, Kim YW, Terashima M, Han SU, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol 2016;17(3):309–18. doi:10.1016/S1470-2045(15)00553-7.
Sathidwiparawong J. Communication for Early-Stage Cancer Patients’ Decision to Choose a Modern Medical Treatment at the Prapokklao Center of Excellence on Cancer Chanthaburi Province. J Prapokklao Hosp Clin Med Educ Cent 2021;38:201–10.
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