title: Prognosis of patients with gastric carcinoma treated in remote island hospitals in Japan: a multivariable analysis.
abstract: BACKGROUND
  Treating gastric cancer in remote island hospitals remains a major clinical challenge. Factors affecting prognosis of patients treated in general hospitals are still at large. We sought to determine the characteristics of gastric cancer in the Amamiooshima (Amami) archipelago of Japan and also evaluated the independent prognostic factors by the Cox regression analysis.
  
  
  METHODS
  A total of 125 patients treated in four sister hospitals in the Amami were analyzed.
  
  
  RESULTS
  The median age of patients with resection was 74 years and almost 85% patients had diffuse type of cancer. The 5-year overall survival was 34% for all patients and 58% for those who had a resection. Among the several clinicopathological factors, operation method (distal vs. total gastrectomy), splenectomy, lymphatic and venous invasion, T-stage, metastatic lymph node (MLN) size n-stage and UICC N-stage had significant impact on survival. Only MLN size and intraoperative blood loss had independent effect on survival by multivariable analysis.
  
  
  CONCLUSIONS
  Improved perioperative care may yield a reasonable patient survival in elderly patients with gastric carcinoma treated in remote hospitals. Restricting amount of intraoperative blood loss may further improve the patient prognosis and MLN size may serve as a new metric to stage gastric cancers.
authors.affiliation: Naze Tokushukai Hospital, Kagoshima, Amamiooshima, Asahi cho 28-1, Naze 894-0061, Japan. makoto-toneri@m5.dion.ne.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Toneri
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Mitsumoto
authors.forename: Morikazu
authors.initials: M
authors.lastname: Shimabukuro
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sunagawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Itagaki
authors.forename: Shinya
authors.initials: S
authors.lastname: Iida
authors.forename: Taichi
authors.initials: T
authors.lastname: Kondo
authors.forename: Kosho
authors.initials: K
authors.lastname: Matsuura
authors.forename: Junichi
authors.initials: J
authors.lastname: Okeda
authors.forename: Dipok Kumar
authors.initials: DK
authors.lastname: Dhar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome