Management and Outcomes of Gastric Cancer at a Multidisciplinary Cancer Centre in South India

Despite the high incidence of gastric cancer in states throughout India, literature from the Indian context is sparse. Our overall objective was to determine the work-up, management and outcomes of patients with gastric cancer in a high-volume cancer centre in South India. Consecutive patients with a diagnosis of gastric cancer who were assessed in Regional Cancer Centre Trivandrum from January 1, 2018 to December 31, 2019 were included. Follow-up was conducted prospectively in person or by telephone. Patient, staging, disease, treatment, and outcomes data were collected and descriptively reported (mean, standard deviation, median, interquartile range). Overall survival (OS) was determined by the Kaplan-Meier method and factors associated with survival by multivariable Cox regression analyses [hazard ratio (HR), 95% confidence intervals (CI)]. A total of 325 patients were included in the cohort, of which 70% were male (n = 229/325). Mean age was 57.8 ± 11.4 years. Over half (54%, n = 174/325) presented with distant metastatic disease. Ultimately, 104 patients underwent surgical resection of which only 17% (n = 18/104) underwent staging laparoscopy. Most (88%, n = 92/104) underwent an open surgical approach. Most receiving surgery had advanced tumor (T) and nodal (N) stage [T3: 42%, n = 44/104; T4: 30%, n = 31/104; N1: 18%, n = 19/104; N2: 24%, n = 25/104; N3: 21%, n = 22/104], and received systemic therapy (90%, n = 94/104), initiated either prior to (38%, n = 36/94) or after (62%, n = 58/94) surgery. Median follow up for the entire cohort was 52.4 months (interquartile range: 9-73 months). Four-year OS for the entire cohort by clinical stage was as follows: 33% stage 1, 38% stage 2, 26% stage 3, and 2% stage 4. Four-year overall OS for the surgical cohort was 44%. For the entire cohort, the presence of gastric outlet obstruction [versus not, HR 1.85, 95% CI 1.37-2.50, p = 0.001] and stage 4 disease [versus stage 1a, HR 3.67, 95% CI 1.34 - 10.0, p = 0.011] were significantly associated with increased risk of death. For the surgical cohort, only the presence of N3b disease was found to be significantly associated with increased risk of death (versus N0, HR 7.24, 95% CI 2.81-18.66, p < 0.001). Most patients present with distant metastatic disease. Of the patients undergoing surgery, most have advanced disease and receive multimodality therapy, in keeping with guideline recommendations.