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BMC Cancer. 2012; 12: 264.
Published online Jun 21, 2012. doi:  10.1186/1471-2407-12-264
PMCID: PMC3434083
Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pylori infection
John Syrios,1 Stavros Sougioultzis,corresponding author1 Ioannis D Xynos,1 Nikolaos Kavantzas,2 Christos Kosmas,3 George Agrogiannis,2 John Griniatsos,4 Ioannis Karavokyros,4 Emmanouil Pikoulis,4 Efstratios S Patsouris,2 and Nikolas Tsavaris1
1Department of Pathophysiology, Oncology Unit, Laikon General Hospital, Athens University School of Medicine, Athens, Greece
21st Department of Pathology, Laikon General Hospital, Athens University School of Medicine, Athens, Greece
32nd Department of Medical Oncology, Metaxa Cancer Hospital, Piraeus, Greece
41st Department of Surgery, Laikon General Hospital, Athens University School of Medicine, Athens, Greece
corresponding authorCorresponding author.
John Syrios: syriosi/at/yahoo.gr; Stavros Sougioultzis: ssougiou/at/med.uoa.gr; Ioannis D Xynos: xynosid/at/gmail.com; Nikolaos Kavantzas: nkavantzas/at/med.uoa.gr; Christos Kosmas: ckosm1/at/ath.forthnet.gr; George Agrogiannis: agrojohn/at/med.uoa.gr; John Griniatsos: johngriniatsos/at/yahoo.com; Ioannis Karavokyros: iokaravokyros/at/msn.com; Emmanouil Pikoulis: mpikoul/at/med.uoa.gr; Efstratios S Patsouris: epatsur/at/med.uoa.gr; Nikolas Tsavaris: tsavari1/at/otenet.gr
Received January 23, 2012; Accepted June 21, 2012.
Abstract
Background
Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit.
Methods
The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis.
Results
The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60–70 vs. 90–100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis.
Conclusion
Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients.
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