Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter pylori infection.
BACKGROUND
Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit.


METHODS
The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis.


RESULTS
The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60-70 vs. 90-100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis.


CONCLUSIONS
Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients.
Department of Pathophysiology, Oncology Unit, Laikon General Hospital, Athens University School of Medicine, Athens, Greece.
John
J
Syrios
Stavros
S
Sougioultzis
Ioannis D
ID
Xynos
Nikolaos
N
Kavantzas
Christos
C
Kosmas
George
G
Agrogiannis
John
J
Griniatsos
Ioannis
I
Karavokyros
Emmanouil
E
Pikoulis
Efstratios S
ES
Patsouris
Nikolas
N
Tsavaris
D000230:Adenocarcinoma / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D000368:Aged; D016481:Helicobacter Infections / Q000150:complications; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011003:Ploidies; D011379:Prognosis; D013274:Stomach Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology*