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Predictive factors and prognosis of upper gastrointestinal bleeding in gastric cancer: A large population-based study
Anya Kiattiweerasak1, Phubordee Bongkotvirawan2, Natsuda Aumpan2,3
1Gastroenterology and Hepatology Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
Insights
Bleeding gastric cancer is common, often presenting at advanced stages with poor survival. Key predictors include male gender, hypertension, chronic kidney disease, and H. pylori infection.
Area of Science:
- Gastroenterology
- Oncology
- Epidemiology
Background:
- Gastric cancer is a leading cause of cancer death globally.
- A significant proportion of gastric cancer patients present with gastrointestinal bleeding.
- Bleeding complicates diagnosis and treatment, impacting patient outcomes.
Purpose of the Study:
- To identify risk factors associated with bleeding in gastric cancer patients.
- To determine the overall survival rates for gastric cancer patients experiencing bleeding.
- To compare clinical characteristics between gastric cancer patients with and without bleeding.
Main Methods:
- Retrospective cohort study conducted between 2007-2022 at a tertiary care center in Thailand.
- Inclusion of 180 gastric cancer patients with detailed review of clinical information, endoscopic findings, and histology.
- Comparison of demographic and clinical data between bleeding and non-bleeding gastric cancer groups, with a minimum 5-year follow-up.
Main Results:
- Out of 180 gastric cancer patients, 65 (36.1%) experienced gastrointestinal bleeding.
- Bleeding gastric cancer patients were more likely to have hypertension (OR 2.51), chronic kidney disease (OR 2.00), and current H. pylori infection (OR 4.39).
- Median overall survival was significantly lower in bleeding gastric cancer patients (7 months) compared to non-bleeders (10 months).
Conclusions:
- Bleeding gastric cancer is a frequent occurrence, often indicative of advanced disease and poor prognosis.
- Predictors for bleeding include male gender, hypertension, chronic kidney disease, and H. pylori infection.
- Timely diagnosis and intervention are crucial for improving clinical outcomes in bleeding gastric cancer.
Background:
Gastric cancer remains the fourth leading cause of cancer-related death worldwide. Significant number of gastric cancer patients presented with bleeding.
Objective:
This study aimed to identify risk factors and overall survival rates of bleeding gastric cancer patients.
Methods:
This retrospective cohort study was conducted between 2007-2022 at tertiary care center in Thailand. Clinical information, endoscopic findings and histological type were extensively reviewed and were compared between bleeders and non-bleeders. Patients were monitored for at least 5 years.
Results:
There were 20,981 patients who underwent upper gastrointestinal endoscopy during study period. Total of 201 gastric cancer patients were included in this study, 21 were excluded due to incomplete medical records. 180 gastric cancer patients were included with mean age of 60.5±14.3 years. There were 65 (36.1%) patients with gastrointestinal bleeding. Hypertension and chronic kidney disease were significantly more common in bleeders than non-bleeders (43.1% vs 23.5%, OR2.51, 95%CI 1.14.-5.52, p = 0.022; and 16.9% vs 5.2%, OR2.00, 95%CI 1.56-6.63, p = 0.025, respectively). current H. pylori infection was also significantly more common in bleeders than non-bleeders (84.6% vs. 55.7%, OR 4.39, 95%CI 1.90-10.12, p<0.001). Median overall survival of bleeders was significantly lower than non-bleeders (7±0.93 vs 10±2.10 months, p = 0.001).
Conclusions:
Bleeding gastric cancer was not an uncommon condition. Majority of patients presented at advanced stage with grave prognosis. Male gender, hypertension, chronic kidney disease, and current H. pylori infection were reliable predictors for bleeding. Early diagnosis and prompt treatment are the key to improve clinical outcome.
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