The clinicopathological features, treatment and survival of gastric adenocarcinoma in Omani Arab patients

Background: Gastric carcinoma (GC) is the second most frequent cancer worldwide and the most common cancer in the Sultanate of Oman. The surgical and medical management of GC varies worldwide, and variable ethnic differences in clinicopathological features and survival have been observed. The aim of this work was to study clinicopathological features, management and survival trends of GC in Oman and to assess the impact of aggressive management trends on survival. Methods: A retrospective study of gastric adenocarcinoma cases, treated at three main hospitals in Oman over a 12-year period, was undertaken. The study was divided into period I (1993-1998) and period II (1999-2004), based on the evolution of cancer services. Results: A population of 339 patients was included in the study (M: F ratio 1.9:1). GC was mainly a disease of elderly males with mean ages of 60.3 and 59.3 years for periods I and II, respectively. The most prevalent types of GC observed during periods I and II were distal (60.7% vs. 57.7%), ulcerating (64.3% vs. 63.7%) and intestinal (80.9% vs. 78.4%), with no significant differences between them. The main histopathology was adenocarcinoma with an increase in the signet cell variant (4% to 12.1%, P,0.03) during period II. Advanced stages III and IV constituted 71.1% and 76.5% of all patients in periods I and II, respectively (P, 0.9). More D2 lymph node dissections and increased use of adjuvant chemo-radiotherapy and palliative chemotherapy were noted during period II. Median survival time for the entire cohort was 12.3 months (95% CI 9.7-14.4) with a 5-year overall survival rate of 16.5. The 5-year overall survival for periods I and II was 14% and 19% (P, 0.27), respectively. Conclusion: GC in Oman is seen predominantly in elderly males who display predominately distal, ulcerative lesions with an intestinal-type histology. GC continues to present in advanced stages, with poor prognosis. This fact underscores the need for early diagnosis to achieve a better outcome. There is a need to employ early detection policies of gastric cancer in developing countires as aggressive treatment does not alter the outcome of advanced presentaion.