Clinic and laboratuary parameter's importance at local advanced and/or metastatic stomach cancer patients

Objectives: In this study, we investigated prognostic effect of clinic, laboratory ond pathologic features on local advanced and/or metastatic gastric and gastro-esophageal cancers.Patients and Methods: Clinical, laboratory and pathological findings of 115 patient who applied to Gazi University Medicine School?s Hospital Medical Oncology Department with advanced (inoperative) or metastatic gastric cancer between June 2005 and January 2011 was evaluated retrospectively. The data of the patients who did not come to the follow-up controls are updated through first by getting the phone numbers from Ankara City Census Bureau and then by calling these patients in December 2011. The effects of age, gender, performance status, histopathologic and laboratory findings such as serum alkaline phosphates, liver transaminases, total bilirubin, sodium, calcium, albumin, hemoglobin, number leukocytes and platelets, tumor marker parameters on patients? survival are analysed.Results: In this study, 66.1 % of the patients (n=76) were male, and the M/F ratio was 1,9. The median age of patients was 63 years (27-89) and age had no effect on survival. 26% of patients had proximal and in the 74% of patients had distal gastric cancer. Histopathologic types of gastric cancer in this patient population were as follows; adenocarcinoma 56.6% (n=65), signet ring cell carcinoma 27.8% (n=32) and adenosquamous carcinoma 1.7% (n=2). Median survival time of patients with signet ring cell was significantly shorter than patients who had other histopathologic gastric cancer types (p=0.009). Tumor localisation had no effect on survival (p>0.05). One hundred and two patients (88.7%) had stage IV disease. In three patients who had local advanced disease at diagnosis, metastasis developed during follow-up. Metastasis developed mostly in liver (53%, n=61) and peritoneum (46%, n=53). Fifty-four (47%) patients receieved palliative chemotherapy. Altough 20% risk reduction palliative chemotherapy had no statistical significant effect on survival. Palliative radiotherapy had been applied to 16.5% (n=19) of the patients (13% stomach, 1.7% bone metastasis, 1.7% brain metastasis. There was no radiotherapy data in about 14 (14.8%) of the patients. According to our analysis palliative radiotherapy increased survival rate significantly (p=0.006). Results of the laboratory parameters at diagnosis were as follows; median serum alkaline phosphatase level 94 IU/l (range, 22 - 868), median AST 20 U/L (0-40 U/L), median ALT 16 U/L (0-40 U/L), median total bilirubin 0.52 mg/dl (0,3-1,2 mg/dl), median albumin 4gr/dl (3,5-5 g/dl), median calcium 8.9 gr/dl (8,2-10,6 mg/dl), median sodium 139 (126-148 mmol/l), median hemoglobin 11.5 (5.2-16.6) gr/dl, median platelet 307 x10.e6/ul (22-868), median leucocyte 8100 x10.e6/ul (3600-34100). Multivariate analysis of laboratory parameters showed that basal ALP, AST and ALT levels were significantly effect on survival (p=0.022, p=0.016, p=0.02 respectively) however serum total bilirubin, CEA, CA 19.9, CA 72.4, hemoglobin levels, leukocyte and platelet counts had not effect on survival. Increasing serum calcium level was associated with decreaed survival rate but this was not statistically significant (p=0.076). Seventy-eight (67.8%) patient had died while we do our analysis. The median survival time was 11.4 months (95% CI, 6.97 -15.9).Conclusion: There is no prognostic parameter showing which patients obtained better survival results with chemotharapy in local advanced and metastatic gastric cancer patients. ALP, AST, ALT and calcium values? effect on survival is detected and its usage as prognostic parameter is found in this study.