Surgical Outcomes Of Gastric Cancer Patients Seen At A Safety Net Hospital In An Urban Academic Setting

INTRODUCTION: Gastric cancer remains a significant public health concern, and it is the third leading cause of cancer related deaths worldwide. We evaluated surgical outcomes in gastric cancer patients seen at a safety-net hospital with a high immigrant patient population. METHODS: A retrospective study was conducted to identify patients diagnosed with gastric cancer between 2010 and 2019 (N = 111) at our institution. All cases were histologically confirmed. Data on demographics, pathology, type of gastric cancer, surgery, and chemotherapy were obtained. Kaplan Meier and Cox regression analyses were used to evaluate factors associated with survival. Hazard ratios (HR) and confidence intervals (CI) are reported. RESULTS: Of the 111 patients with gastric cancer included in this study, 41.2% of patients underwent surgery; of which 26.2% were proximal, 52.4% were distal, and 21.4% were total gastrectomies (Table 1). Also, 61.9% of the surgeries were radical, and 38.1% palliative. Likewise, 68.4% had chemotherapy, of which 27.3% was neoadjuvant, 9.1% was adjuvant, and 63.6% was palliative. Gastric adenocarcinoma types were diffuse-type (61%), intestinal-type (33%), and mixed-type (6%). Diffuse-type cancer was more common in the younger population (≤40 years) compared to the older population, >40 years (P = 0.01). Mortality was significantly lower in those who had surgery (HR 0.36 CI 0.18–0.78), chemotherapy (HR 0.43 CI 0.23–0.80) compared to those who did not (P < 0.001). furthermore, patients who had neoadjuvant chemotherapy had a lower mortality compared to those who received palliative chemotherapy (HR 0.37 CI 0.15–0.89). Although survival appeared to be higher in patients with intestinal-type cancer compared to those with diffuse-type cancer who underwent surgery, this difference was not statistically significant (P = 0.136) See Figure 1. CONCLUSION: Gastric cancer surgery was associated with a lower mortality in our patient population. Also, multimodal therapy including surgery, chemotherapy, and neoadjuvant chemotherapy all improved survival outcomes. There was no difference in survival between patients with intestinal-type cancer compared to those with diffuse-type cancer who underwent surgery. In addition, the fact that diffuse-type cancer was more common in the younger population suggest that genetics may play a major role in these gastric cancer subtype. Further research is needed to identify pertinent prognostic indicators in gastric cancer patients.Figure 1Table 1.: Gastric cancer percentages for surgery and chemotherapy