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Gastric cancer in Albania: Epidemiological, clinical and pathological characteristics
Background
Gastric cancer incidence and mortality varies between Mediterranean countries. As the Mediterranean diet is considered one of the healthiest diet, gastric cancer is still the fourth most common cancer and the fourth causes of death from cancer in Albania. The aim of the study was to analyze the epidemiological, clinical and pathological characteristic of gastric cancer in Albania, a Mediterranean country.
Methods
Demographic, clinical and histopathological, data of 306 gastric cancer treated in the Clinic of Oncology at University Hospital Center Mother Teresa, during 2016-2019 were retrospectively analyzed, to identify characteristics and pattern of gastric cancer in Albania. Overall survival (OS) and disease-free survival (DFS) were evaluated. Statistical analysis was done using SPSS version 26 (SPSS, Chicago, IL).
Results
The patients’mean age was 60 ± 10 years (range 26-87 years). Male to female rate was 3.6:1. Forty-one percent of the patient were in the age group 56-65 years old, 30% were over 66 years old and 9% under 45 years old. Data showed a quite homogeneous distribution of the cancer patient in Tirana, coastal and central region with 33%, 26.8% and 29.4% respectively and only 5% in mountain region. Median follow up was 48± 14 months. Eight patients had family history for gastric cancer and 87.5% were under 65 years old. At the diagnosis 19.2% have metastatic disease. Forty percent of the patients were diagnosed with stage III and 29.5% stage II gastric cancer. Sixty-seven percent of the patient’s stage III and IV were 56-75 years old. Total gastrectomy and subtotal resection were performed in 28.7% and 48.4% respectively, and 21.9% were inoperable. Sixteen patients (8.9%) had R1 resection. Incomplete node dissection was done in 62,4% of the patients, 7.2% had D1 dissection and 30.4% had D2 node dissection. Adenocarcinoma was found in 93.8% and 5.9% were signed cell. Most of the patients (61.3%) had well differentiated (G3) gastric cancer. According to the Lauren classification 24.8% were intestinal type, 27.3% diffuse type and 47.9% mix type. Vascular invasion and perineural invasion were present in 54.9% and 55.9%, respectively. Main primary tumor location was in the antro-pyloric region 41.7% and corpus 15.4%. Less frequent location was in cardia 2%. Patients had neoadjuvant treatment in 7.8%, adjuvant treatment 70%, palliative treatment 12.8% and 28.1% were treated with concomitant chemoradiotherapy. The median OS and DFS was 14.8 and 9 months for male and 17 and 7.8 months for female, respectively. No significant correlation was found in age and gender related to OS and DFS, but female patients had a higher risk for progressive disease (PD) compared with male (OR=1.4, 95% CI=0.86-2.4), p=0.3). Positive correlation was found between adjuvant treatment, OS and DFS, p=0.032.
Conclusions
Gastric cancer remains a challenge in early diagnosis and treatment. This study represents the first evaluation on demographic and clinical characteristics of gastric cancer in Albania and its management. Further sub analysis would be necessary to understand factors that may determine the advance stage at diagnosis in order to promote a screening program for the age groups and regions with the higher incidence.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
