Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13316-13324
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13316
Long-term outcomes after radical gastrectomy in gastric cancer patients with overt bleeding
Lei Wang, Xu-An Wang, Jia-Qi Hao, Li-Na Zhang, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong
Lei Wang, Xu-An Wang, Jia-Qi Hao, Mao-Lan Li, Xiang-Song Wu, Hao Weng, Wen-Jie Lv, Wen-Jie Zhang, Lei Chen, Hong-Gang Xiang, Jian-Hua Lu, Ying-Bin Liu, Ping Dong, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Li-Na Zhang, Department of Biostatistics, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Author contributions: Wang L, Wang XA and Hao JQ contributed equally to this work; Wang L, Wang XA, Hao JQ, Liu YB and Dong P conceived this research and participated in research design, writing of the manuscript, performance of the research, data analysis and manuscript revision; Zhang LN, Li ML, Wu XS, Lv WJ, Weng H, Zhang WJ, Chen L, Xiang HG and Lu JH participated in research design, data analysis and manuscript revision; all authors approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.
Informed consent statement: Informed consent is given by patients preoperatively and registered in the electronic patient file. All included patients accepted the possibility to collect their patient data.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ping Dong, MD, Associate Professor, Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. dongping1050@163.com
Telephone: +86-21-25076315 Fax: +86-21-65030840
Received: June 5, 2015
Peer-review started: June 8, 2015
First decision: August 26, 2015
Revised: August 31, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: December 21, 2015
Processing time: 192 Days and 21.6 Hours
Abstract

AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding (OB).

METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival (OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic (Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location (upper, middle and lower).

RESULTS: We identified 939 patients. Of these, 695 (74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases (20.3% vs 22.1%, P = 0.541). Follow-up examination was performed on 653 patients (94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate (68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics (P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB (84.6%) than in those without OB (48.1%, P < 0.01) and that AJCC stages I-II (56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors (30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB (P > 0.05) for middle or lower gastric cancer.

CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.

Keywords: Gastric cancer; Overt bleeding; Tumor location; Prognosis; Pathological stage

Core tip: Data regarding the clinicopathological characteristics and long-term outcomes of gastric cancer patients presenting with overt bleeding (OB) are extremely limited. Our result showed that the prognosis of gastric cancer patients with OB was no worse than the prognosis of those without OB. In fact, upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB. This provided a new insight into the intrinsic nature of gastric cancer with OB.