RM-015 Clinicopathological, epidemiological and outcome of treatment of advanced gastric cancer in Egypt: single institution experience

Abstract

Introduction: Gastric cancer is the 3rd cause of cancer related deaths worldwide. In Egypt, it is 12th in position regarding incidence and cancer-related deaths. About 65% of patients present with locally advanced or metastatic disease with 5-year survival rates of 30% and 5% respectively. Several prognostic factors had been identified for gastric cancer including stage, location, pathological subtype, peritoneal deposits, and HER2-neu over-expression. In this retrospective analysis, we are aiming at identifying the clinicopathological, epidemiological and treatment outcome for patients with advanced gastric cancer. Methods: We analyzed the medical records of advanced gastric cancer patients treated at Ain-Shams university hospital from the period of January 2011 till December 2014. Eighty-one patients were included with thirty-eight paraffin blocks were available for retrospective analysis of HER2-neu status. Results: Median age at presentation was 52 (range 25-81). Fifty-five percent were male (45 patients) and 57% were smokers. Most common primary site was antrum (33.5%). 58% of patients presented with good performance status (ECOG <45years), non-smokers, intestinal type carcinoma, patients with metachronous metastasis (more than 6 months DFS) with p value 0.003, 0.0001, 0.03, 0.039 respectively. Sixty-one patients received 1st line chemotherapy. DCF (Docitaxel-cislatin-5FU), 5FU/LCV and ECX (Epirubicin-Cisplatin-Capecitabine) were the most commonly used protocols with objective response rate (ORR) of 44%. There was no statistical significant difference between the 3 protocols in terms of ORR, PFS or OS. Thirty-four patients received 2nd line chemotherapy; mostly Docitaxel-based or Irinotecan-based. The two protocols were similar in terms of ORR, PFS and OS with ORR of 34%. Patients who received >=2 lines of chemotherapy had significantly better survival than one line or no treatment (12, 7 and 6 months respectively; p value 0.002). HER2-neu positivity had negative impact on survival with median OS of 6 and 10 months for positive and negative patients respectively (p 0.014). In a multi-variant analysis, there was no statistically significant difference between different clinicopathological or epidemiological factors and HER2-neu status. Conclusion: Advanced gastric cancer is potentially incurable disease. Several prognostic factors may predict better outcome; including age, smoking history, pathological type and HER2-neu status. As long as the general condition permits, sequential multiple lines of treatment should be offered for the patients to improve survival.