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  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 4_suppl ( 2022-02-01), p. 204-204
    Abstract: 204 Background: In Peru, colon cancer is the 5th most common cause of cancer and the sixth most deadly. Currently, surgery remains as the only curative therapy, however, there is risk of recurrence. Adjuvant chemotherapy has become a useful tool to improve progression-free survival (PFS) and overall survival (OS). In this study, we determine the current survival of our stage III colon cancer patients, submitted to adjuvant chemotherapy, and if this is similar to the evidence seen in large international studies; also, we analyze if delay of adjuvant chemotherapy has impact on survival. Methods: This descriptive cross-sectional study involved 162 patients with stage III colon cancer who underwent a resection surgery and received adjuvant fluoropyrimidine-based chemotherapy. They were evaluated, according to the TNM classification (tumor, nodule), as low risk (T1-T3, N1) and high risk (T4, N2). We also classified patients, according to the weeks of delay from surgery to adjuvant chemotherapy, into subgroups of 6, 8 and 10 weeks. Results: The mean age was 63.7 years, 63 patients were women (38.9%), 99 patients (61.1%) were men. Only 38.3% of patients started adjuvant chemotherapy in the first 6 weeks after surgery, and 85.8% of patients, in the first 10 weeks; the median time from surgery to initiation of adjuvant chemotherapy was 7.0 weeks. We estimated that, at 3 years, the median PFS is 73.5% (95% CI: 65.8-82.1). The 3-year PFS in the low-risk group was 82.9% (95% CI: 72.3-95.0) and 67.3% (95% CI: 57.2-79.2) in the high-risk group. It was estimated that at 3 years, the median OS is 81.1% (95% CI: 75.2-87.5). The 3-year OS in the low-risk group was 87.9% (95% CI: 80.4-96.2) and 76.0% (95% CI: 67.8-85.3) in the high-risk group. Conclusions: The PFS and OS in Peruvian population is similar to data evidenced in international historical studies such as the IDEA trial. This study, also, suggests that starting adjuvant treatment within 10 weeks does not present an impact on OS and PFS in our population.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
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  • 2
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    American Society of Clinical Oncology (ASCO) ; 2023
    In:  Journal of Clinical Oncology Vol. 41, No. 16_suppl ( 2023-06-01), p. e18735-e18735
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. e18735-e18735
    Abstract: e18735 Background: Quality of life (QoL), defined as a state of physical, psychological and social well-being that provides satisfaction to the patient to be able to perform daily activities, has become a very important aspect in the evaluation of cancer patients. The aim of the study was to assess the QoL of cancer patients during cancer treatment. Methods: Patients undergoing intravenous systemic treatment within three months of diagnosis were identified as eligible patients. A total of 315 patients were selected of out-patient chemotherapy and hospitalization services were included between January and December 2022. QoL was measured using the EQ-5D-5L Quality of Life Questionnaire. The health personnel previously explained the questionnaire to the patient and then were applied electronically through tablets. The questionnaire had 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression; each dimension has 5 levels from no problems (level 1) to extreme problems (level 5). The Visual Analogue Scale (VAS) respondent’s self-rated health, this scale is numbered from 0 (“worst health you can imagine”) to 100 (“best health you can imagine”). Level 1 vs other levels were compared and Odds ratio, chi-square and ANOVA were used to determine associated factors. Results: A total of 315 patients were included, the mean of age was 53 (18-92) and 79.1% were women. Most patients (92%) were in good performance status (Zubrod 0-1). The proportion of patients in out-patient chemotherapy service (89%) was higher than in hospitalization service (11%). A total of 48% of patients received systemic treatment with curative intention and 52%, palliative. Chemotherapy was the most common treatment (78%). Compared to gastrointestinal and central nervous system tumors; the gynecological and thorax (GTC) (OR: 2.62; 95%CI: 1.32-5.21) and genitourinary cancers (GU) (OR: 4.57; 95%CI: 1.23-16.89) had worse mobility; GTC (OR: 3.50; 95%CI: 1.69-7.24); melanoma, breast cancer, and soft tumors (MBSC) (OR: 2.14; 95%CI: 1.12-4.11) had worse self-care; and GTC (OR: 4.00; 95%CI: 1.53-10.43) had more pain/discomfort. Besides, all patients in the out-patient chemotherapy service had worse mobility (OR: 3.15; 95%CI: 1.03-9.58) and more problems during their usual activities (OR: 3.52; 95%CI: 1.27-9.76), compared to hospitalization service. In regards to the VAS, there were differences between men and women (83.05±15.49 vs 76.08±21.13, p = 0.010 respectively) and services (78.32±19.64 vs 62.94±26.15, p = 0.011 ou-patient chemotherapy vs hospitalization, respectively). Conclusions: Our study indicates that patients with gynecologic, thoracic and genitourinary neoplasms have a poorer QoL than other diagnoses during their systemic treatments. The reasons behind this finding require further research.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
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  • 3
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. e15158-e15158
    Abstract: e15158 Background: The literature reports that longer interval between the end of neoadjuvantchemoradiotherapy (CRT) and surgery is associated with a better rate of pathologic complete response (pCR) in rectal cáncer. Optimal interval remains to be defined. The effects of the extended time intervals on the prognosis are not clear. The objective was to assess whether extended time intervals ( 〈 8, 8-12, 〉 12-20 and 〉 20 weeks) between the end of neoadjuvant CRT and surgery improve overall survival (OS), disease-free survival (DFS) and pathological outcomes Methods: Aretrospective study was conducted for 124 patients with rectal adenocarcinoma without evidence of metástasis (T1-4/N0-2/M0) at the time of diagnosis that underwent surgery with curative intent after neoadjuvant CRT with capecitabine and obtained R0 or R1 resection between January 2010 to December 2014 at National Cancer Institute of Peru. Patients undergoing emergency surgery and R2 resection have been excluded. Survival curves were calculated according to Kaplan-Meier method and compared with log-rank test Results: Of the 124 patients, 72 were women (58.1%). The average age was 59.5 years. All received neoadjuvant CRT. Rates of pCR in the four groups were 25.0%, 10.3%, 7.7% and 17.2%, respectively. No significant difference was found between the association of the radial (P = 0.418) and distal edge (P = 0.487), with time interval groups and similarly with resected (P = 0.308) and compromised nodules (p = 0.783). The median OS follow-up time was 39.5 months and for DFS was 34 months. No significant differences were observed in OS (p = 0.739) and DFS (p = 0.902) according to the four groups studied. Conclusions: We found that amplifying the time interval at 31.9 weeks did not change the mean radial and distal edge. It does not affect the mean of resected and compromised nodules and does not improve overall survival and disease-free survival. The present study is the only one that reports these results at these time intervals. It allows to extend the intervals of time for future studies that finally will define the best time interval for the surgery.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
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  • 4
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    American Society of Clinical Oncology (ASCO) ; 2017
    In:  Journal of Clinical Oncology Vol. 35, No. 15_suppl ( 2017-05-20), p. e15576-e15576
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. e15576-e15576
    Abstract: e15576 Background: The benefit of chemoradiotherapy(CRT) or chemotherapy (CT) for gastric cancer with high metastatic lymph node involvement after complete radical D2 resection is still controversial, previous studies had reported better disease free survival (DFS) but no differences in overall survival (OS). Our aim was to compare DFS and OS between CRT and CT. Methods: Retrospectively, 201 medical records were reviewed from patients with advanced gastric cancer (nodes +ve) after complete radical D2 resection between 2008 and 2012 at Instituto Nacional de Enfermedades Neoplasicas (Peru). Patients received CRT (5FU and RT as Macdonald’s protocol) or CT (capecitabine 2g/m2/14days + oxaliplatin 135mg/m2/day1 q21d for 6months). We describe clinical and pathological characteristics, DFS/OS with univariate and multivariate cox analysis were performed. Results: Mean age was 54.4years [19-83] and 17.9% were 〈 40years. Distal localization (46%), high histological grade (69.7%) and poorly cohesive subtype (38.3%) were most frequent characteristics among patients, 140(69.7%) and 130(64.7%) were T4 and N3, respectively. From 201 patients, 134 underwent to CRT and 67 to CT, with no clinical differences between groups. We observed a significant higher nodal ratio in CT group (0.27 vs 0.35, p = 0.009). 69.5% patients completed treatment with CRT, while only 54.5% in CT (p = 0.04). At 5years median of follow-up, 66 (49.3%) and 26(38.8%) recurrences were documented in CRT and CT groups, respectively. Median DFS were 19 and 23 months in CRT and CT group (HR:1.04, 95%CI:0.7-1.4, p = 0.8), while median OS were 25 and 26 months, respectively (HR:1.07, 95%CI:0.75-1-5, p = 0.6). At multivariate analysis, higher T stage and nodal ratio were associated to worse DFS, and patients who completed treatment were associated to better DFS (HR:0.59, 95%CI:0.4-0.8, p = 0.004). Higher T stage and nodal ratio had significant negative impact on OS. Conclusions: We found a benefit of CT over CRT in gastric cancer with high metastatic lymph nodes, however in our population it was not statistically significant, indeed further larger clinical trials are needed. In this study, higher T stage and nodal ratio were associated to worse prognosis.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
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  • 5
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. e15565-e15565
    Abstract: e15565 Background: Outcomes in gastric cancer (GC) are still dismal even with complete D2 resection surgery and chemotherapy (CT), therefore identification of prognostic factors is critical to stratify patients at risk of recurrence or death. Nodal ratio (NR) has been recognized as a valuable prognostic factor and neutrophil to lymphocyte ratio (NLR) as systemic inflammation biomarker in some neoplasms. We evaluate overall survival (OS) combining NR and NLR among completely resected GC patients with D2 lymph node dissection in a Peruvian population. Methods: We reviewed retrospectively 791 medical records from GC pts with complete radical D2 resection between 2008 and 2012 at Instituto Nacional de Enfermedades Neoplasicas. We grouped according NR in 〈 0.2(Low), 0.2-0.5(Intermediate) and 〉 0.5(High), and NLR with cut-off 〈 3 and ≥3. We evaluated overall survival combining NR and NLR, also univariate and multivariate cox analysis were performed. OS was based on national registry and cannot evaluate DFS as long most patients return to their primary hospitals to follow-up. Results: Mean age was 60y [rank: 19-89]. Most frequent characteristics were distal localization (52.4%), intestinal subtype (52.6%) and poor differentiated histology (53%). From 791 patients, 156, 194 and 441 were diagnosed at I, II and III CS, respectively. Most patients had nodal involvement (66.8%), 21% and 28.4% received RT and CT, respectively. NLR 〈 3 was associated to early disease (p 〈 0.05). In nodal ratio groups, 68.9% had low, 23% intermediate and 8.1% high ratio, no differences were observed with NLR. At 5years median follow up, patients with NLR 〈 3 and low nodal ratio had better 5-year OS in this nodal group (71% vs 58% on NLR≥3; HR:0.75, 95%CI:0.49-0.94, p = 0.016]), and patients with intermediate and high nodal ratio had worse outcomes (25 and 15% 5year OS, respectively) without differences with NLR. Multivariate analysis showed higher nodal ratio had negative impact on OS. Conclusions: Neutrophil to lymphocyte ratio 〈 3 was associated to better OS in patients with low nodal ratio ( 〈 0.2), indeed this approach could be usefull to identify high risks patients with early disease in further studies.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
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  • 6
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    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e15068-e15068
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e15068-e15068
    Abstract: e15068 Background: The incidence of colorectal cancer (CRC) in Peru has increased in the last decades. Approximately 20% of patients with CRC already have metastases at diagnosis, and this figure has been stable over the last two decades. The lack of data makes it more difficult to manage our patients. The metastatic setting and patients with second primary malignancies are complicated scenarios. The objective of our study was to explore and describe the metastasis patterns and the second primary malignancies’ frequency in CRC patients. Methods: We retrospectively reviewed the electronic medical records of 609 patients with CRC from one specialized Peruvian cancer center between 2006 and 2016. For the evaluation of the metastasis pattern, we selected 198 patients with metastasis at debut and the patients who had relapse of the disease. Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. We evaluated the metastasis pattern according to primary tumour sidedness, age, CEA, histological grade, histological type. A survival analysis was performed with Kaplan Meier method, comparing the curves with Log Rank test for metastasectomy, biological therapy and number of sites with metastatic disease. A multivariate analysis was performed using the Cox regression model with the statistically significant variables found in the univariate analysis. Results: At the time of diagnosis, stage IV disease accounted for 15.3% (93) of all CRC cases. 105 (stage I-III) pts had relapse disease. Regardless of the primary tumor site, the most common site for metastatic spread was the liver (42.9%), lung (12.6%), carcinomatosis (18.2%). Pts who underwent metastasectomy presented a better OS [HR, 0.284; 95% CI, 0.123-0.657; p 〈 0.05], as well as pts who received biologic therapy [HR, 0.641; 95% CI, 0.416-0.990; p 〈 0.05] and a greater number of sites with metastatic disease had worst OS [HR, 1.878; 95% CI, 1.181-2.985; p 〈 0.05] The incidence of SPM following CRC was 48/609 (7.8%), the more frequent localizations were: breast, prostate and lung with 14.6% each, then kidney 10.4%, bladder 8.3%. Conclusions: In mCRC metastasectomy, biological therapy and number of sites with metastatic disease play an important role in OS. The more frequent localizations with SPM were breast, prostate and lung.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
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  • 7
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    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e15111-e15111
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e15111-e15111
    Abstract: e15111 Background: The incidence of colorectal cancer (CRC) in Peru has increased in the last decades. Needing to use all the possible tools for an accurate diagnosis and early treatment. Neutrophil-to-lymphocyte ratio (NLR) has been associated as poor prognostic factor in OS and PFS in CRC. There is no data that support this statement in Latin America. It is of a special utility in our country the detection of a simple and reproducible prognostic biomarker that guides the use of more advanced tests. Our objective was to explore the factors associated with OS in the local-locally advanced and metastatic settings. Methods: We retrospectively reviewed the electronic medical records of 609 patients with CRC from one specialized Peruvian cancer center between 2006 and 2016 Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. We divided our population into two groups: Local-locally advanced (L-LA) (516 pts) and debut metastatic- recurrence (M-R) (108 pts). We performed a ROC curve analysis to determine an appropriate cut-off value for NLR in both groups (L-LA:NLR ≥3, M-R:NLR ≥5). A univariate survival analysis was performed with Kaplan Meier method, comparing the curves with Log Rank test. A multivariate analysis was performed using the Cox regression model with the statistically significant variables found in the univariate analysis. Results: Pts with high NLR had significantly shorter OS in L-LA [HR, 12.1; 95% CI,5.019-29.211; p 〈 0.001] M-R [HR, 5.382; 95% CI,2.835-10.217; p 〈 0.001] than pts with low NLR. In the multivariate model, NLR retained a significant association with OS in both groups. Cox regression demonstrated that in L-LA setting sex, histologic grade and lymph node involvement; and in M-R setting sidedness, histologic grade, LVI and metastasectomy performed were independently risk factors for a shorter OS. Conclusions: High NLR is associated with poor prognosis (with our cut-offs L-LA:NLR ≥3, M-R:NLR ≥5). There are other variables to be considered that affect the OS, as: sex, histologic grade and lymph node involvement, sidedness, histologic grade, LVI and metastasectomy performed.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
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  • 8
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    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 4_suppl ( 2012-02-01), p. 150-150
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 4_suppl ( 2012-02-01), p. 150-150
    Abstract: 150 Background: Adjuvant chemoradiotherapy is the standard treatment in Western countries in gastric cancer patients submitted to curative resection. INT 0116 pivotal trial established adyuvant chemoradiation as the standar care for resected high risk adenocarcionoma of the stomach in US however was hampered by suboptimal surgery. There is controversial data about efficacy of this adjuvant therapy in patients who have undergone D2 lymphadenectomy predominantly. In our hospital D2 lymphadenectomy is standar surgery for gastric cancer. Methods: Retrospective study with gastric adenocarcinoma patients stage II to IV M0 who underwent curative resection at Instituto Nacional de enfermedades Neoplasicas Lima- Peru between 2001 and 2006 Standard treatment at institution is D2 lymphadenectomy. Chemoradiotherapy according to INT 0116 was given like adjuvant therapy. Survival curves were calculated according to Kaplan-Meier method and compared with log-rank test. Multivariate analysis of prognostic factors related to survival was performed by Cox proportional hazards model adjusted for age, stage and adjuvant chemoradiotherapy. Results: 84 patients were included 60.3% male and 39.3% female. Median age was 40.5 years old. The patologic stage were T1-T2 (12.3%), T3-T4 ( 50% ), N0-N1 (10.7%), N2-N3 (89.3%). D2 lymphadenectomy was performed in all patients. The 3-year DFS was 17% and 3-year overall survivall was 23.9% years.However when we analized by subgroups the overal survival was significantly longer in group N1 ( 61%) and N2 (58.9%) that N3 (18.3%) and DFS were N1 (60%), N2 (55%) and N3 (16.3%). Conclusions: Adjuvant chemoradiotherapy decreased risk of death and relapse in patients with node positive N1-N2 , who underwent curative resection with D2 lymphadenectomy, but recurrence was most frecuent in N3 node positive, maybe is necesary improve the chemotherapy in this group of patientes for dicrease the rate of relapse.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
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  • 9
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    American Society of Clinical Oncology (ASCO) ; 2017
    In:  Journal of Clinical Oncology Vol. 35, No. 15_suppl ( 2017-05-20), p. e15171-e15171
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. e15171-e15171
    Abstract: e15171 Background: To estimate the cost-utility of Panitumumab compared to Cetuximab (Erbitux®) and Bevacizumab (Avastin®) for the first-line therapy of metastatic colorectal cancer in the Peruvian health system Methods: A cost-utility analysis was performed using a Markov's model based in epidemiological parameters, metastatic colorectal cancer (mCRC) associated costs, and the efficacy of therapy using specific monoclonal antibodies against wild-type RAS mCRC. The costs of biological agents were estimated from the payers' viewpoint, using a 3.5% discount rate. The model includes the transition between five health states (mCRC, surgery, remission, progression, and death), and each cycle lasts for one month in a 3-year temporal horizon Results: The results of the model indicate that Bevacizumab and Panitumumab were cost–effective compared with Cetuximab. Therapy using Bevacizumab for a three-year period cost PEN 178,950.96 less than Panitumumab, but generated 0.91 less QALYs. The incremental cost-effectiveness ratio (ICER) showed that Cetuximab had extended dominance when compared to Panitumumab and Bevacizumab. This means that Panitumumab is more expensive, but it leads to a greater clinical benefit. Conclusions: Using the best published data available, these results suggest that the clinical effectiveness of Panitumumab and Bevacizumab translates into a favorable cost-utility ratio; and it particularly generates savings. The use of Panitumumab is associated to a longer survival, more QALYs gained and more months in remission.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
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  • 10
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 4_suppl ( 2018-02-01), p. 160-160
    Abstract: 160 Background: Gastric cancer (GC) is one of the most frequent malignancies in developing countries. In Peru, it is the fourth most incident cancer, and the sixth one in Brazil. Mortality is still high. The chance of relapse of patients with non-metastatic disease undergoing surgery is more than 50%. It is suspected that Latin American patients present worse evolution compared to those treated in Asia or in developed countries, therefore it is fundamental to study factors related to the prognosis and evolution of patients with GC in our continent. We aimed to evaluate the outcome of adjuvant treatment for GC in patients from two countries with different racial miscegenation and eating habits, and correlate this with clinicopathological features. Methods: We retrospectively analyzed 187 patients with GC who underwent curative surgery and received CRT at AC Camargo Cancer Center (ACCCC) in Brazil and Instituto Nacional de Enfermedades Neoplasicas (INEN) in Peru. CRT was defined as MacDonald protocol. Primary endpoint was overall survival (OS). Cox regression model was performed in order to calculate hazard ratio (HR) and 95% confidence intervals (95%CI). Results: Median follow up time was 51 and 20 months in Brazil and Peru, respectively. Median age of our cohort was 54 years-old. Male sex was predominant in both countries (Brazil: 54.7%; Peru: 56.9%). Diffuse subtype also was predominant (Brazil: 58.3%; Peru: 55.1%). Median OS was 103.9 and 45.2 months in Brazil and Peru respectively (p 〈 0.001). In the multiple analysis, we found that pathological stage (I/II vs. III; HR = 4.1, 95%CI 1.4-11.7; p = 0.009) was independent prognostic factor adjusted by country of treatment, histological subtype, localization, age and gender. Conclusions: Survival differences exist between Brazil and Peru. We observed that patients from Peru had more advanced pathological stage after surgery. This difference suggests a possible prognostic factor in OS. Ethnic/genetic factors, eating habits and other clinicopathological or molecular factors may also explain different prognosis. Future studies are warranted to determine these prognostic factors in Latin American gastric cancer patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
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