title: Clinicopathologic features and clinical outcomes of gastric cancer that initially presents with disseminated intravascular coagulation: a retrospective study.
abstract: OBJECTIVE
  Few systematic studies have been published on prognosis and clinical outcome of gastric cancer patients with disseminated intravascular coagulation (DIC) as the first presentation of malignancy. We evaluated the clinicopathologic features and clinical outcomes of this population.
  
  
  METHODS
  We reviewed the medical records of patients with metastatic or recurred gastric cancer that initially presented with DIC.
  
  
  RESULTS
  Twenty-one patients were included. Median age was 47 years (range, 24-72 years). Eighteen patients (85.7%) had bone metastasis, and nine patients (42.9%) had hemorrhagic complication of DIC. Fourteen patients received palliative chemotherapy, and seven patients received best supportive care (BSC). The most common factor influencing the decision to abandon the palliative chemotherapy was uncontrolled bleeding (57.1%). The median overall survival (OS) of all patients was 58 days (range, 2-342 days). The OS was significantly shorter in BSC than in the chemotherapy group (median, 16 vs 99 days, P < 0.001). In multivariate analysis, chemotherapy was independently associated with longer OS. In the chemotherapy group, the response to treatment was evaluable in 11 patients: two (18.2%) had a partial response, five (45.5%) had stable disease and four (36.4%) had progressive disease. The OS of patients with progressive disease was significantly longer in the chemotherapy group than in the BSC group (median, 92 vs 16 days, P = 0.009).
  
  
  CONCLUSIONS
  The prognosis is poor with gastric cancer that initially presents with DIC but palliative chemotherapy, compared with BSC, prolongs OS. Therefore, early and intensive management for correctable DIC followed by chemotherapy should be considered in this population.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Rhee
authors.forename: Sae-Won
authors.initials: SW
authors.lastname: Han
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Oh
authors.forename: Seock-Ah
authors.initials: SA
authors.lastname: Im
authors.forename: Tae-You
authors.initials: TY
authors.lastname: Kim
authors.forename: Yung-Jue
authors.initials: YJ
authors.lastname: Bang
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001803:Blood Transfusion; D001859:Bone Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care; D018579:Patient Selection; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult