Epidemiology of gastric cancer in the gangetic areas of west bengal

Carcinoma stomach in Eastern India-An audit from a tertiary health care center

BACKGROUND

In spite of declining incidence and fatality over the past decade, stomach cancer still remains a global health issue due to its aggressiveness and heterogeneity. There is wide variation in the epidemiology of stomach cancer, not only worldwide but also among different regions of India. However, there is very limited data available for the Indian population.

AIMS AND OBJECTIVE

This study was aimed at establishing the incidence and role of risk factors, analyzing the symptoms, stage of disease, and mode of various surgical treatments of patients in the eastern region of India, and comparing them with the results of other studies in India and regions outside India.

METHODS AND MATERIAL

An audit of the database of carcinoma stomach patients attending the radiotherapy and surgery outpatient department (OPD) between January 2020 and June 2021 was performed. Demographic, clinical, and treatment-related data were collected and analyzed with respect to other regions of India and the worldwide pattern of carcinoma stomach.

RESULTS

The mean age of the study population was 58 years with male dominance (70%). The antrum was the most common (60%) primary site, and stage III was the most common (47.6%) stage at presentation. Around 73.4% of patients underwent radical surgery. Most patients (50%) had an eventless post-operative period, and 76% received peri-operative chemotherapy. Also, 20% of patients received adjuvant chemoradiation.

CONCLUSION

Our analysis suggests that there are certain differences (like dietary habits), as well as similarities (like socio-demographic factors), among the risk factors of carcinoma in this part of the country than other parts. Further studies into the risk factors and different clinical presentations are required for prevention and early detection.

Sex Disparity in Patients with Gastric Cancer: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis aimed to ascertain whether sex-based differences influence clinicopathological characteristics and survival outcomes of gastric cancer patients.

BACKGROUND

Gastric cancer in females has received less attention than in males. Clinicopathological features and survival outcomes of females with gastric cancer have been reported in several studies with controversial results.

METHODS

We systematically reviewed clinical studies from PubMed, Cochrane Library, Embase, and Web of Science published up to June 2022. The effect sizes of the included studies were estimated using odds ratios (ORs). Heterogeneity was investigated using the χ2 and I ² tests, while sensitivity analyses were performed to identify the source of substantial heterogeneity. All data used in this study were obtained from previously published studies obviating the need for ethical approval and patient consent.

RESULTS

Seventy-six studies with 775,003 gastric cancer patients were included in the meta-analysis. Gastric cancer patients were less likely to be females (P < 0.00001). Female patients were younger in age (P < 0.00001) and showed a higher percentage of distal (P < 0.00001), non-cardia (P < 0.00001), undifferentiated (P < 0.00001), diffuse (P < 0.00001), and signet-ring cell carcinoma (P < 0.00001). Female patients showed better prognosis in both 3-year (P = 0.0003) and 5-year overall survival (OS) (P < 0.00001), especially White patients. However, females were associated with lower 5-year OS relative to males in the younger patients (P = 0.0001).

CONCLUSIONS

In conclusion, gender differences were observed in clinicopathological characteristics and survival outcomes of gastric cancer. Different management of therapy will become necessary for different genders.

Prevalence of Gastric Cancers among Patients Undergoing Upper Gastrointestinal Endoscopies in a Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study

Introduction:

Gastric cancer is a common malignancy of the upper gastrointestinal (UGI) tract. Gastric cancer is a common cause of death worldwide. This research aimed to study the prevalence of gastric cancer among patients undergoing upper gastrointestinal endoscopies.

Methods:

A descriptive, cross-sectional study was conducted in the Department of Medicine at Manipal Teaching Hospital, Nepal, from January 2018 to June 2020. A total of 2640 subjects underwent upper gastrointestinal endoscopies over the study period. Ethical approval was taken from the institutional review committee of Manipal College of Medical Sciences (MEMG/ IRC/ 383/ GA). Data were analyzed by SPSS version 20.

Results:

The prevalence of gastric cancer among patients undergoing UGI endoscopies was 2.4%. The mean age of subjects was 58 ± 12.35 years (range of 31 to 96 years) with male predominance (M: F=1.9:1). Antrum was the most common site for gastric carcinoma. The most common morphology was ulcerative growth (46.9%). Adenocarcinoma (98.4%) was the most common histology, and the majority was of intestinal subtype (56.3%).

Conclusions:

Gastric cancer is not an uncommon finding in patients undergoing UGI endoscopies. Gastric cancers were commonly seen above 50 years of age and predominant in males. Patients with gastric carcinoma usually present late with advanced disease stages and unfavorable histopathology

Diagnostic utility of alarm features in predicting malignancy in patients with dyspeptic symptoms

BACKGROUND

Clinical features are of modest benefit in determining the etiology of dyspepsia. Dyspeptic patients with alarm features are suspected to have malignancy; but the proportions of patients and true cutoff values of various quantitative parameters in predicting malignancy are explored to a lesser extent.

METHODS

This is a prospective observational study of consecutive patients undergoing esophagogastroduodenoscopy (EGD) for dyspeptic symptoms. Patients' alarm features and clinical details were recorded in a predesigned questionnaire. The diagnostic accuracy of alarm features in predicting malignancy was studied.

RESULTS

Nine hundred patients, 678 (75.3%) males, with a mean (standard deviation [SD]) age of 44.6 (13.54) years were enrolled. Commonest indication for EGD was epigastric pain in 614 (68.2%) patients. Dyspepsia was functional in 311 (34.6%) patients. EGD revealed benign lesions in 340 (37.8%) and malignancy in 50 (5.5%) patients. Among the malignant lesions, gastric malignancy was present in 28 (56%) and esophageal malignancy in 20 (40%) patients. Alarm features were present in 206 (22.9%), out of which malignant lesions were seen in 46 (22.3%) patients. Altogether, the alarm features had a sensitivity of 92% and specificity of 81.2% for predicting malignancy. The sensitivity and specificity for weight loss were 76% and 90.8%, while that of abdominal mass were 10% and 99.9% respectively. Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 46.5 years in this population.

CONCLUSIONS

Patients of age group 40 to 49 years with dyspeptic alarm symptoms (predominant weight loss) need prompt endoscopy to screen for malignancy. The alarm features are inexpensive screening tools, found to be useful in India, and should be utilized in countries with similar healthcare conditions and disease epidemiology.

Clinicopathological Characteristics and Incidence of Gastric Cancer in Eastern India: A Retrospective Study

PURPOSE

To study the association of gastric cancer with various clinicopathological traits in eastern India which can be used as an important factor for further analysis, understanding of the diseases and amelioration of patients.

METHODS

The retrospective study includes the patients who underwent subtotal or total gastrectomy from surgical oncology department of Chittaranjan National Cancer Institute (hospital) of West Bengal, India between 2014 and 2018. The study includes 751 gastric cancer patients from Chittaranjan National Cancer Institute. We used electronic hospital records to collect data on various clinical parameters and other information. We used Microsoft Office Excel 2007 spreadsheets for the statistical analyses.

RESULTS

Incidence of gastric cancer is associated with mid age (40-59 years) group male patients and lymph node metastasis. Frequency of gastric cancer is highest in the antrum (42.21%). Of the mid age group gastric cancer patients, 35.02% were having much high risk of developing diffused type of adenocarcinoma (P < 0.00001). Tobacco intake in form of smoking was found as an important risk factor in gastric cancer development with risk ratio and odds ratio of 1.18 and 3.14 respectively.

CONCLUSION

Collectively, the results of the present study confirm that incidence of diffused type of gastric cancer is increasing as an alarming rate in mid age group male patients and tobacco intake in the form of smoking as an independent risk factor for this type of cancer in eastern India. This result can be used to manage gastric carcinoma in future prospective clinical studies and in patient's improvement.

Gender Inequality in Global Burden of Uncorrected Refractive Error

PURPOSE

To explore gender inequality in global burden of uncorrected refractive error (URE) by year, age, and socioeconomic status using disability-adjusted life years (DALYs).

DESIGN

International, comparative burden-of-disease study.

METHODS

Global, regional, and national gender-specific DALY numbers; crude DALY rates; and age-standardized DALY rates caused by URE, by year and age, were extracted from the Global Burden of Disease Study 2015. Human development index (HDI) in 2015 as an indicator of national socioeconomic status was extracted from the Human Development Report. Pearson correlation and linear regression analyses were conducted to investigate the association between socioeconomic status and gender inequality.

RESULTS

Gender inequality in global URE burden has persisted since 1990, through 2015, with little improvement over the decades. Age-standardized DALY rates were 189.8 among male subjects vs 223.0 among female subjects in 1990 and 188.4 vs 225.2 in 2015. Female subjects had higher burden than male subjects of the same age, and gender inequality increased with age. Female-minus-male difference in age-standardized DALY rates (r = -0.562, P < .001; standardized β = -0.562, P < .001) and female-to-male age-standardized DALY rate ratios (r = -0.258, P < .001; standardized β = -0.258, P < .001) were negatively related to HDI.

CONCLUSIONS

Gender inequality in global URE burden has persisted over the past few decades, with female individuals bearing more burden than male individuals. Older age and lower socioeconomic status are related to greater gender inequality. These findings highlight the importance of making gender-sensitive health policy to manage global vision loss caused by URE.

Polymorphisms in ADH1B and ALDH2 genes associated with the increased risk of gastric cancer in West Bengal, India

BACKGROUND

Gastric cancer (GC) is one of the most frequently diagnosed digestive tract cancers and carries a high risk of mortality. Acetaldehyde (AA), a carcinogenic intermediate of ethanol metabolism contributes to the risk of GC. The accumulation of AA largely depends on the activity of the major metabolic enzymes, alcohol dehydrogenase and aldehyde dehydrogenase encoded by the ADH (ADH1 gene cluster: ADH1A, ADH1B and ADH1C) and ALDH2 genes, respectively. This study aimed to evaluate the association between genetic variants in these genes and GC risk in West Bengal, India.

METHODS

We enrolled 105 GC patients (cases), and their corresponding sex, age and ethnicity was matched to 108 normal individuals (controls). Genotyping for ADH1A (rs1230025), ADH1B (rs3811802, rs1229982, rs1229984, rs6413413, rs4147536, rs2066702 and rs17033), ADH1C (rs698) and ALDH2 (rs886205, rs968529, rs16941667 and rs671) was performed using DNA sequencing and RFLP.

RESULTS

Genotype and allele frequency analysis of these SNPs revealed that G allele of rs17033 is a risk allele (A vs G: OR = 3.67, 95% CI = 1.54-8.75, p = 0.002) for GC. Significant association was also observed between rs671 and incidence of GC (p = 0.003). Moreover, smokers having the Lys allele of rs671 had a 7-fold increased risk of acquiring the disease (OR = 7.58, 95% CI = 1.34-42.78, p = 0.009).

CONCLUSION

In conclusion, rs17033 of ADH1B and rs671 of ALDH2 SNPs were associated with GC risk and smoking habit may further modify the effect of rs671. Conversely, rs4147536 of ADH1B might have a protective role in our study population. Additional studies with a larger patient population are needed to confirm our results.

Functional polymorphisms in NR3C1 are associated with gastric cancer risk in Chinese population

Recently promoter of NR3C1 has been found to be high methylated in gastric cancer tissues which might be involved in the initiation of gastric carcinoma development. To test whether the variants in NR3C1 could modify the risk of gastric cancer, we evaluated the association between four SNPs (rs6194, rs12521436, rs33388 and rs4912913) in NR3C1 and gastric cancer risk in a case-control study with 1,113 gastric cancer cases and 1,848 cancer-free controls in a Chinese population. We found a significant association between rs4912913 and gastric cancer risk (OR=1.18, 95%CI=1.05-1.33, P=5.49×10⁻³). We also observed that the A-allele of rs12521436 and rs33388 were significantly associated with a decreased risk of gastric cancer (OR=0.84, 95%CI=0.76-0.94, P=2.78×10⁻³; OR=0.85, 95%CI=0.75-0.97; P=0.018). Finally, we made a joint effect analysis of rs12521436, rs33388 and rs4912913 on risk of gastric cancer (P_Trend=2.83×10⁻⁵). These findings indicate that the variants rs4912913, rs33388 and rs12521436 of NR3C1 may contribute to gastric cancer susceptibility.

Management of gastric cancer in Indian population

Adenocarcinoma stands the most common malignancies in the gastric carcinomas and holds a significant mortality and morbidity rates annually, due to the early vague symptoms among the population and hence the delayed presentation at advanced stages of cancer. In India the screening programs for gastric cancer has been a setback due to various logistics reasons and the data available from reporting is also not content. Our study is a review article featuring the management of gastric cancer in the Indian population. The lifestyle of India population is varied right from its southern region to its northern counterparts, which is due to its diversified culture within the country. Studies have concluded that the northern population tends to have a higher incidence comparatively and the various risk factors associated with the disease has been discussed. Management of the gastric cancer in India remains the same compared to the outside world, though the availability of endoscopic ultrasound and other technical advancements remain sparse in the field of diagnostics and staging of the disease. D2 gastrectomy remains the mainstay of surgery among the Indian population though significant number of patients are deemed inoperable on table. Neo adjuvant Chemotherapy, Radiotherapy and Targeted therapy is yet to be efficiently used across the country according to our study as there is lack of data in our registries. The incidence is decreasing in developing nations and more proximal cancers are reported. However, in India the major population-based cancer registries report an incidence decline only in Mumbai and Chennai. A shift from distal to proximal as the site of disease has not been reported from India. The contribution of the Indian scientific fraternity to the world medical literature for gastric cancer is sparse and it is clear that a lot more is to be done; the possible reason may be a busy clinical schedule or lack of initiatives. There is an urgent need for research in various aspects of gastric cancer from India including epidemiological and therapeutic areas.

Gastric cancer and related epigenetic alterations

Gastric cancer, a malignant and highly proliferative condition, has significantly affected a large population around the globe and is known to be caused by various factors including genetic, epigenetic, and environmental influences. Though the global trend of these cancers is declining, an increase in its frequency is still a threat because of changing lifestyles and dietary habits. However, genetic and epigenetic alterations related to gastric cancers also have an equivalent contribution towards carcinogenic development. DNA methylation is one of the major forms of epigenetic modification which plays a significant role in gastric carcinogenesis. Methylation leads to inactivation of some of the most important genes like DNA repair genes, cell cycle regulators, apoptotic genes, transcriptional regulators, and signalling pathway regulators; which subsequently cause uncontrolled proliferation of cells. Mutations in these genes can be used as suitable prognostic markers for early diagnosis of the disease, since late diagnosis of gastric cancers has a huge negative impact on overall patient survival. In this review, we focus on the important epigenetic mutations that contribute to the development of gastric cancer and the molecular pathogenesis underlying each of them. Methylation, acetylation, and histone modifications play an integral role in the onset of genomic instability, one of the many contributory factors to gastric cancer. This article also covers the constraints of incomplete knowledge of epigenetic factors influencing gastric cancer, thus throwing light on our understanding of the disease.