Prognostic Score in Gastric Cancer: The Importance of a Conjoint Analysis of Clinical, Pathologic, and Therapeutic Factors

Abstract

Background: This study was designed to establish a prognostic score for gastric cancer that takes into account factors related to the tumor, the patient, and the treatment.Methods: Two hundred thirty patients with gastric adenocarcinoma admitted to the Department of Abdominal Surgery at Hospital do Caˆncer A. C. Camargo (Sa˜o Paulo) and treated by gastrectomy from January 1992 until December 1996 were included in this retrospective cohort. The prognostic score was created according to the variables identified in the multivariate analysis and by using the regression coefficients generated by the Cox regression.Results: The 5-year overall survival rate was 44.5%. The final multivariate model identified six variables with a significant and independent effect on survival: sex, weight loss, lymphocyte count, tumor-node-metastasis staging, lymphadenectomy, and lymph node ratio. Patients were divided into four groups according to their scores, as follows: group 1, 0 to 3.0; group 2, 3.5 to 5.5; group 3, 6.0 to 8.5; and group 4, 9.0 to 14.0. The 5-year survival rates were 91.5%, 49.3%, 20.3%, and .0% for the score groups 1, 2, 3, and 4, respectively (P < .001). The score was superior in the assessment of prognosis when compared with tumor-node-metastasis staging alone.Conclusions: It is possible to create a prognostic score that simultaneously includes factors related to the tumor, patient, and treatment, thus generating a more effective system in predicting the prognosis than the morphology-based staging systems.

Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: A population-based study in the Netherlands

“…The prognostic significance of older age and more advanced stage in our multivariable analysis is comparable to results of other studies. 16,27,31,34 Other prognostic factors associated with worse survival reported in literature are male gender, positive resection margins, positive lymph nodes or rate of positive lymph nodes. 16,27,31,34 …”

Role of symptoms in diagnosis and outcome of gastric cancer

“…Weight loss has been considered among the potential prognostic factors for gastric cancer by at least 13 studies so far, and in 10 of these it resulted significantly and independently related to the fatal outcome [19,39,40,[42][43][44][45][46][47][48][49][50][51] . It is not possible to calculate life expectancy in gastric cancer patients presenting with weight loss.…”

“…It correlates with malnutrition and impaired immune response. Weight loss does not merely increase postoperative complications, but also reduces the response and increases the toxicity to chemotherapy [45,48,52] . Indeed, it has been shown that 10 d of pre-operative total parenteral nutrition (TPN), which is continued post-operatively, reduces the complication rate and prevents mortality in severely malnourished patients with gastro-intestinal cancer [53] .…”

“…Eight studies have assessed the prognostic value of this sing [39,40,[44][45][46][47]54] and all but one found a strong association with a very low 5-year survival rate (0%-20%) [39,44,54] and also with a very short life span (< 4 mo) [40,46] . The prognostic role of vomiting and gastro-intestinal bleeding is more controversial.…”

Fatores prognósticos nas gastrectomias com linfadenectomia D2 por adenocarcinoma gástrico

“…O sexo do paciente, a presença de perda ponderal, a contagem de linfócitos, o estádio TNM, a realização da linfadenectomia e a razão de linfonodos comprometidos, foram incluídos como variáveis em um escore prognóstico com eficiência significativamente superior, do que em relação ao estadiamento TNM isolado 6 . Schwarz RE, et al 30 , analisando as diferenças nas taxas de sobrevivência em populações etnicamente diferentes, concluíram que os fatores responsáveis para esse aspecto estavam relacionados principalmente ao local da lesão, extensão da ressecção gástrica e a presença de comorbidades.…”