Abstract

Fatjona Kraja¹, Jusilda Dervishi¹, Adrian Hoti², Erald Karaulli¹, Ilir Akshija³, Enes Hafizi¹, Sabo Ademi¹, Enkeleda Cuedari¹, Henri Kolani⁴, Arvin Dibra⁴, Etmond Celiku⁴, Bledar Kraja⁵

¹University Hospital Center Mother Teresa, Oncology, Tirana, Albania; ²University Hospital Center Mother Teresa, Radiology, Tirana, Albania; ³University Hospital Center Mother Teresa, Statistics, Tirana, Albania; ⁴University Hospital Center Mother Teresa, Surgery, Tirana, Albania; ⁵University Hospital Center Mother Teresa, Gastrohepathology, Tirana, Albania

The aim of the study was to identify the prognostic factors related to survival outcome in Albanian gastric cancer patients.

Demographic, histopathological, treatment and follow up data of 180 nonmetastatic stage IB-III gastric cancer treated in our center during 2016-2019 were retrospectively analyzed, to identify prognostic factor correlated to disease free survival (DFS) and overall survival (OS). Pearson's correlations, logistic regression and age-adjusted models were conducted. Statistical analysis was done using SPSS version 26 (SPSS, Chicago, IL).

Patients’mean age was 58.9± 9.8 years (range 26-80 years). Male to female rate was 3.2:1. Median follow up was 36± 13 months. Four patients (2.2%) had a family history of gastric cancer. Subtotal gastrectomy was performed in 57.8% of the patients, total gastrectomy in 33.9% and 8.3% were considered inoperable. R1 resection was present in 16 patients (8.9%). Incomplete node dissection was performed in 46.1% of the patients, D1 dissection in 6.1% and D2 dissection in 39.4%. The most frequent tumor locations were: 25.6% in antro-pyloric region, 22.2% in antrum, 15% in corpus and 5% in cardia. The main histopathology types were adenocarcinoma 94.4% and signet ring cell carcinoma 5.6%. Grade 3 tumor was present in 63.9% of patients. According to Lauren classification, intestinal type was present in 20% of the patients, diffuse type in 24.4% and mixed type in 55.6%. Fifty five percent of the patients were stage III, 38.4 % stage II and 6.5% stage Ib. Patients had adjuvant treatment in 88.3%, neoadjuvant treatment 8.9%, palliative treatment 1.1% and 35% were treated with adjuvant chemoradiotherapy (CRT). On the close-out date 66.7% were still alive and local control (LC) was 93.3%. DFS was 11.5 ± 11.9 months. No significant correlation was found according age and gender related to OS and DFS, but female patients had a higher risk for progressive disease (PD) compared with male (OR=1.3, 95% CI=0.76-2.4), p=0.3. Upon age-adjusted and multivariable adjustment for all covariates, factors influencing the risk for local recurrence (LR) were vascular invasion (p=0.04) and N stage (p=0.046). Significant correlation was found between the LR and PD (p=0.003). Prognostic factors related to OS and DFS were found: T stage (p=0.006), node stage (p=0.012), vascular invasion (p=0.04), perineural invasion (p=0.03), type of surgery and node dissection, (p<0.001 respectively) and presence of R1 resection (p=0.02). Adjuvant treatment was also an important factor affecting OS and DFS, p=0.032. According to the role of adjuvant RT a positive correlation was observed (OR=3.4, 95%CI=1.1-5.1), p=0.02. 

Different prognostic factors are defined for gastric cancer and our findings were in concordance with the literature. Longer follow up and further sub analysis are needed to determine a panel of prognostic factors, in order to improve gastric cancer management and promote a personalized treatment, according to their risk category.