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Prognostic factors associated with survival in a large cohort of gastric cancer patients resected over a decade at a single Italian center: the Cremona experience

  • M. GhidiniEmail author
  • B. M. Donida
  • L. Totaro
  • M. Ratti
  • C. Pizzo
  • I. Benzoni
  • D. Lomiento
  • F. Aldighieri
  • L. Toppo
  • V. Ranieri
  • C. Senti
  • G. Tanzi
  • M. Martinotti
  • R. Passalacqua
  • M. Rovatti
  • G. Tomasello
Research Article
  • 68 Downloads

Abstract

Background

Incidence of gastric cancer (GC) shows different distribution in Italy, with higher incidence in the north and center. We retrospectively analyzed the clinical data of patients resected at the Hospital of Cremona between January 2007 and December 2016. Available clinical variables were linked with survival to identify possible prognostic factors.

Materials and methods

Variables analyzed were age, sex, type of surgery, site, histology, invasion, nodal status, resection margins, grade, HER2 status, Helicobacter pylori infection (neo)adjuvant chemotherapy, adjuvant chemoradiotherapy, neutrophil-to-lymphocyte ratio, number of nodes removed and type of lymphadenectomy. Overall survival (OS) was estimated by the Kaplan–Meier method and differences between groups by the log-rank test. Data on OS were analyzed by Cox regression and the final model was obtained using the step-wise method.

Results

379 patients were considered, out of which 195 were operated from 2007 to 2011 and 184 from 2012 to 2016. Median follow-up was 25.5 months, median OS 31.3 months and time to recurrence 23.2 months. D2 resection rate increased from 36% (period 2007–2011) to 74% in 2012–2016 (p = 0.01) with a higher mean number of nodes collected (20.98 for 2007–2011 and 23.53 for 2012–2016, p = 0.040). Only 37% of patients received a postoperative treatment. At multivariate analysis, variables associated with OS were age (p = 0.002), stage (p < 0.001), resection margins status (p < 0.001), adjuvant chemotherapy (p < 0.010) and tumor location (cardia vs non-cardia) (p = 0.029).

Conclusions

Our analysis shows that completeness of resection and lower stage are strong predictors of long-term survival in GC, providing the rationale for adjuvant and neoadjuvant approaches (chemotherapy, radiotherapy or combined). Cardial GC has worse prognosis compared to distal cancers.

Trial registration number

Service evaluation number 256, protocol 16821/17, date 05 June 2017.

Keywords

Gastric cancer Surgery Lymphadenectomy Gastric adenocarcinoma 

Notes

Acknowledgements

Authors want to thank Dr. Michael Davies (Unique Language Training) for linguistic revision.

Funding

No grants supported this research project.

Compliance with ethical standards

Conflict of interest

Authors have no conflicts of interest to declare.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethics committee

Approval for this project was obtained before the start of the study from the local Institutional Review Board.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  • M. Ghidini
    • 1
    Email author
  • B. M. Donida
    • 1
  • L. Totaro
    • 2
  • M. Ratti
    • 1
  • C. Pizzo
    • 1
  • I. Benzoni
    • 2
  • D. Lomiento
    • 2
  • F. Aldighieri
    • 2
  • L. Toppo
    • 3
  • V. Ranieri
    • 2
  • C. Senti
    • 1
  • G. Tanzi
    • 4
  • M. Martinotti
    • 2
  • R. Passalacqua
    • 1
  • M. Rovatti
    • 2
  • G. Tomasello
    • 1
  1. 1.Department of Oncology, Operative Unit of OncologyASST of Cremona, Hospital of CremonaCremonaItaly
  2. 2.Department of Surgery, Operative Unit of General SurgeryASST of Cremona, Hospital of CremonaCremonaItaly
  3. 3.Department of Medicine, Operative Unit of OncologyASST of Pavia, Hospital of VogheraVogheraItaly
  4. 4.Department of Oncology, Operative Unit of PathologyASST of Cremona, Hospital of CremonaCremonaItaly

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