title: Survival analysis of patients with gastric cancer undergoing surgery at the iran cancer institute: a method based on multi-state models.
abstract: BACKGROUND
  Gastric cancer is one of the most common causes of cancer deaths all over the world and the most important reason for its high rate of death is its belated diagnosis at advanced stages of the disease. Events occur in patients which are regarded not only as themselves factors affecting patients' survival but also which can be affected by other factors. This study was designed and implemented aiming to identify these events and to investigate factors affecting their occurrence.
  
  
  METHODS
  Data from 330 patients with gastric cancer undergoing surgery at the Iran Cancer Institute from 1995-1999 were analyzed. The survival time of these patients was determined after surgery and the effects of various factors including demographic, diagnostic and clinical as well as medical, and post-surgical varuiables on the occurrence of death hazard without relapse, hazard of relapse, and death hazard with a relapse were assessed.
  
  
  RESULTS
  The median survival time for these patients was 16.3 months and the 5-year survival rate was 21.6%. Based on the results of multi-state model, age and distant metastases affected relapse whereas disease stage, type and extent of surgery, lymph nodes metastases, and number of renewed treatments affected death hazard without relapse. Moreover, age, type and extent of surgery, number of renewed treatments, and liver metastases were identified as factors affecting death hazard in patients with relapse.
  
  
  CONCLUSIONS
  Most cancer studies pay heed to factors which have effect on death occurrence, but some events occur which should be taken into consideration to better describe the natural process of the disease and provide researchers with more accurate data.
authors.affiliation: Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Iran E-mail : mahmoodim@tums.ac.ir.
authors.forename: Ali
authors.initials: A
authors.lastname: Zare
authors.forename: Mahmood
authors.initials: M
authors.lastname: Mahmoodi
authors.forename: Kazem
authors.initials: K
authors.lastname: Mohammad
authors.forename: Hojjat
authors.initials: H
authors.lastname: Zeraati
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hosseini
authors.forename: Kourosh Holakouie
authors.initials: KH
authors.lastname: Naieni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis; D015996:Survival Rate