Year 2024 / Volume 116 / Number 3
Original
Mortality in patients with unresectable gastric cancer complicated with tumor bleeding

132-139

DOI: 10.17235/reed.2023.9508/2023

Edgardo Amaya-Fragoso, Angélica Hernández-Guerrero, José Guillermo de la Mora Levy, Mauro Eduardo Ramírez-Solís, Juan O. Alonso-Lárraga, Luis Guillermo Beltrán-Galindo,

Abstract
Background: gastric cancer (GC) is a gastrointestinal (GI) neoplasia which often complicates with GI bleeding. It is uncertain if bleeding worsens mortality in this group of patients. Aims: to compare 30- and 90-day mortality in patients with unresectable GC (uGC) and tumor bleeding versus patients with the same neoplasia without bleeding. Methods: a retrospective analysis of patients with uGC, with and without tumor bleeding was performed. Survival analysis for 30- and 90-days mortality was performed using Cox regression. Logistic regression was used to identify risk factors associated with mortality and first bleeding episode. Results: 202 patients were included in the analysis (105 cases). Mortality at 90 days was 37.14 % for cases and 20.62 % for controls (p = 0.04). There was a significant difference in hazard ratio (HR) at 90 days for cases compared to controls (HR 1.95, 95 % CI 1.14-3.34, p = 0.02). Cases without palliative chemotherapy had the highest 90-days mortality (HR 5.43, 95 % CI 2.12-13.87, p < 0.01), compared to controls treated with chemotherapy. Predictors for first tumor bleeding were clinical stage IV (OR 2.93, 95 % CI 1.04-8.26, p = 0.04), Helicobacter pylori infection (OR 2.80, 95 % CI 1.35-5.80, p < 0.01) and histologic intestinal-subtype (OR 2.14, 95 % CI 1.07-4.30, p = 0.03). Conclusions: tumor bleeding increases 90-days mortality in patients with uGC. Prevention of the first bleeding episode might improve outcome in these patients and the recognition of high-risk patients might help decision-making.
Lay Summary
Gastric cancer is the fourth most common neoplasia and tumor bleeding accounts for 5% of all gastrointestinal bleedings; it is uncertain if bleeding increases mortality in this group of patients. We retrospectively analyzed a group of 202 patients with unresectable gastric cancer with and without tumor bleeding. We found that patients with Helicobacter pylori infection, intestinal histologic subtype and advanced clinical stage were at a higher risk for presenting a first episode of bleeding, while patients with normal albumin levels were protected from presenting this complication. We also found that proton pump inhibitors did not reduced the risk of bleeding. Tumor bleeding increased mortality at 90 days compared to patients without bleeding, but not at 30 days.
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Amaya-Fragoso E, Hernández-Guerrero A, de la Mora Levy J, Ramírez-Solís M, Alonso-Lárraga J, Beltrán-Galindo L, et all. Mortality in patients with unresectable gastric cancer complicated with tumor bleeding. 9508/2023


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Publication history

Received: 02/02/2023

Accepted: 25/04/2023

Online First: 12/05/2023

Published: 04/03/2024

Article revision time: 77 days

Article Online First time: 99 days

Article editing time: 396 days


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