title: Long-term outcomes after radical gastrectomy in gastric cancer patients with overt bleeding.
abstract: OBJECTIVE
  To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding (OB).
  
  
  METHODS
  Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival (OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic (Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location (upper, middle and lower).
  
  
  RESULTS
  We identified 939 patients. Of these, 695 (74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases (20.3% vs 22.1%, P = 0.541). Follow-up examination was performed on 653 patients (94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate (68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics (P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB (84.6%) than in those without OB (48.1%, P < 0.01) and that AJCC stages I-II (56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors (30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB (P > 0.05) for middle or lower gastric cancer.
  
  
  CONCLUSIONS
  Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Xu-An
authors.initials: XA
authors.lastname: Wang
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Jia-Qi
authors.initials: JQ
authors.lastname: Hao
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Zhang
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Mao-Lan
authors.initials: ML
authors.lastname: Li
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Xiang-Song
authors.initials: XS
authors.lastname: Wu
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Weng
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Lv
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Zhang
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Hong-Gang
authors.initials: HG
authors.lastname: Xiang
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Lu
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
authors.affiliation: Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Dong
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002681:China; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Gastric cancer; Overt bleeding; Pathological stage; Prognosis; Tumor location