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Risk Factors for Prognosis in Gastric Carcinoma



Mario Dimitrescu1, Cristina Popescu1



1 Clinics of General Surgery, Floreasca Hospital, Bucharest, Romania

Received: 5 October 2023

Accepted: 12 October 2023

Published: 17 October 2023

Keywords:

Gastric carcinoma, tumor size, mitotic index, survival

Corresponding author:

Mario Dimitrescu, Clinics of General Surgery, Floreasca Hospital, Bucharest, Romania. mdimitrescu2781@gmail.com

doi: 10.5281/zenodo.10424205  

ABSTRACT

Gastric carcinoma, a significant global health concern, continues to present clinical challenges due to its diverse biological behavior and variable outcomes. We aimed to provide a comprehensive analysis of the intricate relationship between tumor diameter and mitotic index in gastric carcinoma. A total of 30 patients who were followed up with a diagnosis of gastric carcinoma and died in our clinic in the last ten years were included in the study. Tumor age and mitotic index information of these patients were obtained by retrospectively scanning the hospital records. The mean age of the patients was 57.7 years. 17 of the patients (56.5%) were male. The mean survival time was 62.1 (28.2) months. There was no difference in mean survival between genders (p=0.412). The mean survival time in patients with a tumor diameter of more than 5 centimeters was significantly lower than in those with a tumor diameter of 5 cm or less (p = 0.011). The mean survival time in those with a mitotic index above 5/50 HPF was found to be significantly lower than in the group with 5/50 HPF and below (p=0.018). Our comprehensive examination of prognostic factors in gastric carcinoma has revealed significant associations between tumor characteristics and patient outcomes. The substantial differences in mean survival times based on tumor diameter and mitotic index underscore the critical roles these factors play in shaping the disease trajectory.

MJE 2023-4-11-13 (Dimitrescu) – Risk Factors for Prognosis in Gastric Carcinoma – doiDOWNLOAD

INTRODUÇÃO / INTRODUCTION

Gastric carcinoma, a significant global health concern, continues to present clinical challenges due to its diverse biological behavior and variable outcomes. Understanding key prognostic factors is essential for refining risk stratification and tailoring therapeutic approaches. Two pivotal parameters, tumor diameter and mitotic index, have emerged as critical indicators in predicting the clinical course of gastric carcinoma (1-3).

Tumor size has long been recognized as a fundamental element in cancer prognosis. In gastric carcinoma, the measurement of tumor diameter provides valuable insights into disease aggressiveness and the potential for metastatic spread. Various studies have explored the correlation between tumor size and patient outcomes, with conflicting findings necessitating a comprehensive evaluation to elucidate the nuanced relationship between tumor diameter and prognosis (4-6).

The mitotic index, reflecting the rate of cell division within a tumor, serves as a dynamic marker of cellular proliferation and tumor activity. In gastric carcinoma, a higher mitotic index often indicates increased tumor aggressiveness and has been associated with unfavorable clinical outcomes. Despite its acknowledged significance, the precise interplay between the mitotic index and prognosis in gastric carcinoma remains an area of ongoing investigation (7-9).

We aimed to provide a comprehensive analysis of the intricate relationship between tumor diameter and mitotic index in gastric carcinoma.

METHODS

A total of 30 patients who were followed up with a diagnosis of gastric carcinoma and died in our clinic in the last ten years were included in the study. Tumor age and mitotic index information of these patients were obtained by retrospectively scanning the hospital records.

Statistical analysis

All statistical analyzes in the study were done using SPSS 25.0 software (IBM SPSS, Chicago, IL, USA). Descriptive data are given as numbers and percentages. Whether continuous variables are suitable for normal distribution was confirmed by the Kolmogorov-Smirnov Test. The differences between the groups in terms of continuous variables were analyzed using Student’s t Test, and the comparison of mean values between multiple groups by variance analysis. The results were evaluated within the 95% confidence interval, and p<0.05 values were considered significant.

RESULTS

The mean age of the patients was 57.7 years. A total of 17 of the patients (56.5%) were male. The mean survival time was 62.1 (28.2) months.

There was no difference in mean survival between genders (p=0.412). The mean survival time in patients with a tumor diameter of more than 5 centimeters was significantly lower than in those with a tumor diameter of 5 cm or less (p = 0.011).

The mean survival time in those with a mitotic index above 5/50 HPF was found to be significantly lower than in the group with 5/50 HPF and below (p=0.018) (Table 1).

Table 5. Comparison of mean survival times by tumor diameter and mitotic index.

 Overall survival (months)p*
MeanSD
Gender  0.412
Men64.132.4 
Women58.424.1 
Tumor diameter (cm)  0.044
≤280.531.2 
2.01-570.324.2 
5.01-9.9951.420.3 
≥1040.122.3 
Tumor diameter (cm)  0.011
≤572.929.4 
>555.126.5 
Mitotic Index (/50 HPF)  0.041
≤565.233.2 
5.01-9.9954.228.3 
≥1034.519.2 
Mitotic Index (/50 HPF)  0.018
≤566.326.6 
>546.227.3 

SD: Standard deviation, HPF: High power field.

DISCUSSION

Gastric carcinoma is a disease that has a high mortality and morbidity rate and is common in society. Survival time in gastric carcinoma is short. Some factors that will provide information about prognosis in these cases are being investigated (10-12). Our investigation demonstrates that factors such as tumor diameter and mitotic index play pivotal roles in providing crucial insights for predicting prognosis and survival.

Previous studies have reported no significant gender-based differences in gastric carcinoma cases (10-13). Male ratios in those cases were reported between 47-55% in some studies (10-17). Notably, we observed no significant gender disparities in terms of overall survival (OS) (p = 0.412). These findings underscore that men and women exhibit similar rates of disease occurrence, mortality, and comparable disease-free and overall survival times.

The observed significant difference in mean survival time between patients with a tumor diameter exceeding 5 centimeters and those with a tumor diameter of 5 centimeters or less (p = 0.011) underscores the pivotal role of tumor size as a prognostic determinant in gastric carcinoma. This finding aligns with the established understanding that larger tumor sizes often correlate with increased disease aggressiveness and poorer outcomes. The implications of this disparity in survival times emphasize the necessity of meticulous risk stratification based on tumor diameter during clinical decision-making. Identifying patients with larger tumor sizes prompts a more vigilant approach, potentially involving more aggressive therapeutic interventions and closer surveillance. Furthermore, these results accentuate the clinical relevance of tumor size assessment in the prognostic landscape of gastric carcinoma, urging clinicians to consider this parameter as a crucial factor in tailoring personalized treatment strategies for improved patient outcomes.

The significant difference in mean survival time observed between individuals with a mitotic index above 5/50 high-power fields (HPF) and those with a mitotic index of 5/50 HPF and below (p = 0.018) underscores the prognostic relevance of mitotic activity in gastric carcinoma. Elevated mitotic indices are indicative of heightened cellular proliferation and increased tumor activity, factors historically associated with more aggressive tumor behavior. The observed discrepancy in survival times reinforces the utility of the mitotic index as a critical parameter in risk stratification and prognostication for gastric carcinoma patients. Clinically, this finding accentuates the importance of incorporating the mitotic index into the decision-making process, guiding the selection of appropriate therapeutic interventions and informing the overall management strategy. The results contribute to the growing body of evidence supporting the significance of mitotic activity in predicting outcomes in gastric carcinoma, thereby paving the way for more tailored and effective approaches to patient care.

In conclusion, our study sheds light on two pivotal prognostic factors in gastric carcinoma: tumor diameter and mitotic index. The significant disparity in mean survival times based on tumor diameter, with patients possessing tumors larger than 5 centimeters exhibiting lower survival rates, underscores the indispensable role of tumor size as a robust prognostic determinant. This aligns with the established correlation between larger tumor sizes and heightened disease aggressiveness. The clinical implications emphasize the imperative need for meticulous risk stratification during decision-making, advocating for heightened vigilance, potentially more aggressive therapeutic interventions, and closer surveillance in patients with larger tumor sizes.

Additionally, the observed significant difference in mean survival time related to the mitotic index underscores the intrinsic prognostic relevance of mitotic activity in gastric carcinoma. Elevated mitotic indices, indicative of increased cellular proliferation and heightened tumor activity, correlate with more aggressive tumor behavior and poorer outcomes. This finding accentuates the clinical importance of incorporating the mitotic index into risk stratification, guiding therapeutic decision-making, and shaping overall management strategies. Collectively, these results contribute to the evolving body of evidence supporting the significance of both tumor diameter and mitotic index in predicting outcomes in gastric carcinoma, paving the way for a more personalized and effective approach to patient care in this complex malignancy.

In summary, our comprehensive examination of prognostic factors in gastric carcinoma has revealed significant associations between tumor characteristics and patient outcomes. The substantial differences in mean survival times based on tumor diameter and mitotic index underscore the critical roles these factors play in shaping the disease trajectory. Larger tumor sizes and elevated mitotic indices are indicative of increased disease aggressiveness, aligning with established patterns in gastric carcinoma. The clinical implications emphasize the need for meticulous risk stratification, guiding tailored therapeutic interventions for improved patient outcomes. These findings contribute to the expanding body of evidence supporting the importance of individualized approaches in managing gastric carcinoma, reflecting a step forward in enhancing prognostic precision and treatment strategies for this complex malignancy.

REFERENCES

  1. Waldum HL, Fossmark R. Types of Gastric Carcinomas. Int J Mol Sci. 2018;19(12):4109. Published 2018 Dec 18. doi:10.3390/ijms19124109
  2. Majeed W, Iftikhar A, Khaliq T, et al. Gastric Carcinoma: Recent Trends in Diagnostic Biomarkers and Molecular Targeted Therapies. Asian Pac J Cancer Prev. 2016;17(7):3053-3060.
  3. Ilson DH. Advances in the treatment of gastric cancer: 2020-2021. Curr Opin Gastroenterol. 2021;37(6):615-618. doi:10.1097/MOG.0000000000000776
  4. Liang Y, Liu L, Xie X, et al. Tumor Size Improves the Accuracy of the Prognostic Prediction of Lymph Node-Negative Gastric Cancer. J Surg Res. 2019;240:89-96. doi:10.1016/j.jss.2019.02.037
  5. Guo P, Li Y, Zhu Z, et al. Prognostic value of tumor size in gastric cancer: an analysis of 2,379 patients. Tumour Biol. 2013;34(2):1027-1035. doi:10.1007/s13277-012-0642-6
  6. Shim CN, Song MK, Kang DR, et al. Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer. Surg Endosc. 2014;28(7):2199-2207. doi:10.1007/s00464-014-3453-6
  7. Kato TA, Haskins JS. Mitotic Index Analysis. Methods Mol Biol. 2023;2519:17-26. doi:10.1007/978-1-0716-2433-3_3
  8. Domingo RA, Tripathi S, Vivas-Buitrago T, Lu VM, Chaichana KL, Quiñones-Hinojosa A. Mitotic Index and Progression-Free Survival in Atypical Meningiomas. World Neurosurg. 2020;142:191-196. doi:10.1016/j.wneu.2020.06.189
  9. Olar A, Wani KM, Sulman EP, et al. Mitotic Index is an Independent Predictor of Recurrence-Free Survival in Meningioma. Brain Pathol. 2015;25(3):266-275. doi:10.1111/bpa.12174
  10. Yin C, Li D, Sun Z, et al. Clinicopathologic features and prognosis analysis of mucinous gastric carcinoma. Med Oncol. 2012;29(2):864-870. doi:10.1007/s12032-011-9825-z
  11. Iwasaki K, Suda T, Takano Y, et al. Postoperative outcomes of gastric carcinoma with lymphoid stroma. World J Surg Oncol. 2020;18(1):102. Published 2020 May 21. doi:10.1186/s12957-020-01878-9
  12. Wang Y, Chen S, Tian W, et al. High-Expression HBO1 Predicts Poor Prognosis in Gastric Cancer. Am J Clin Pathol. 2019;152(4):517-526. doi:10.1093/ajcp/aqz065
  13. Wu CP, Jiang JT, Tan M, et al. Relationship between co-stimulatory molecule B7-H3 expression and gastric carcinoma histology and prognosis. World J Gastroenterol. 2006;12(3):457-459. doi:10.3748/wjg.v12.i3.457
  14. Cheng KS, Tang HL, Chou JW, Yu CJ, Tsou SS, Chou FT. The Clinical Features and Prognosis of Gastric Remnant Carcinoma after Treatment. Hepatogastroenterology. 2014;61(131):587-589.
  15. Kim DY, Joo JK, Ryu SY, Park YK, Kim YJ, Kim SK. Clinicopathological characteristics and prognosis of carcinoma of the gastric cardia. Dig Surg. 2006;23(5-6):313-318. doi:10.1159/000097895
  16. Zheng HC, Takahashi H, Murai Y, et al. Upregulated EMMPRIN/CD147 might contribute to growth and angiogenesis of gastric carcinoma: a good marker for local invasion and prognosis. Br J Cancer. 2006;95(10):1371-1378. doi:10.1038/sj.bjc.6603425
  17. Chen J, Wang A, Ji K, Bu Z, Ji J. Comparison of overall survival of gastric neoplasms containing neuroendocrine carcinoma components with gastric adenocarcinoma: a propensity score matching study. BMC Cancer. 2020;20(1):777. Published 2020 Aug 18. doi:10.1186/s12885-020-07281-7

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