Real-world survival outcome in gastric cancer in a resource limited setting – an Indian experience

Gastric cancer is a less often talked about but a largely prevalent malignancy in India. According to the Globocan 2020 data, mortality due to gastric cancer has reduced and is the 4th leading cause of death due to cancer, worldwide. In India, it remains the 6th most common cancer to be diagnosed in both sexes and the 6th leading cause of death due to a malignancy according to the latest Globocan 2020 data. In the state of Tamil Nadu, India, the Cancer Registry Project recorded an increasing trend in the incidence of gastric cancer with approximate 4000 patients diagnosed in 2017, making gastric cancer the third most common cancer to occur in the state. This study was conducted to highlight the unmet need of documenting survival in a resource limited setting of a largely prevalent cancer.

This was an observational study conducted in a tertiary care centre, Government Stanley Medical College, Chennai, Tamil Nadu, India. All the manual records of the patients with gastric cancer from January 1, 2017 to January 31, 2023 were analysed. The aim of the study was to estimate survival and determine the effect of risk factors like age, gender, habits and stage at presentation on the outcome. Pearson Chi-Square test and Fisher's Exact test were used to establish significance. Kaplan Meier curve and Mantel-Cox log rank test was used to determine survival.

A total of 252 patients were studied. The mean age of the study population was 55.6+12.1 years. Majority of the patients were above the age of 60 years (33.3%). Around 2/3rd of the study population was male (65.9%) with a male to female ratio of 1.9:1. Habits like smoking and alcohol consumption were found only in the male subset of patients. 68 cases were smokers (27%) and 95 were alcohol consumers (37.7%). At presentation, around half the patients were found to have metastasis (46%). The majority of patients in the non-metastatic setting were diagnosed at stage 3 (21.9%). The stage at presentation (p=0.007) and the presence of upfront metastasis (p=0.018) were important risk factors which had an effect on the survival. Age, gender, smoker and alcohol consumption status did not have a statistically significant effect on survival. The median overall survival in this study was 11.0+1.1 months with the median overall survival in the non-metastatic setting of 17.0+3.9 months and in the metastatic setting of 8.0+1.0 months (p < 0.001). The limitation of the study was the high percentage of cases that were lost to follow up, 86 patients (34.1%).

The median overall survival of gastric cancer in this study stands at less than 1 year. The stage at presentation and the upfront presence of metastasis are statistically significant risk factors that influence the survival in gastric cancer patients. The results of this study reduce a knowledge gap that can propel us to identify the risk factors that can improve survival in gastric cancer.

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