Questionnaires for 993 patients with gastric cancer
diagnosed during 2004, from 16 centers, were evaluated.
Twenty two questionnaires were excluded since the data
for these patients have been duplicated. Thus, the analysis
included 971 patients.
Patient characteristics
Six hundred forty three of the 971 patients were male,
(male-female ratio: 2/1), the mean age was 57±12.99 years,
and 67.3% of the patients were living in urban and 32.7%
were living in rural areas. About three forth of the patients
had low socioeconomic status. Smoking and alcohol consumption
rates were 48.5% and 13.6%, respectively. Anemia
was present in 62.4% of the patients before the diagnosis
of the malignancy. Most of the tumors were located in
distal and middle stomach (distal 39%, middle 36.5% vs.
proximal 24.5%). Three hundred sixteen patients had been
evaluated for H. pylori gastritis and 86 (27.2%) were H.
pylori positive. Approximately, half of the patients had the
history of empirical ulcer treatment. The mean time from
the beginning of the symptoms to the diagnosis was
4.28±10.89 months. The resectability rate for the disease
was 54.1%. The demographic information for the patients
is summarized in table 1.
Table 1: Patients’ characteristics
Evaluation of the patients by geographical regions
Approximately half of the patients were from CAR.
There was no difference in the rate of smoking history,
location of the tumor and presence of intestinal metaplasia
among geographical regions. The characteristics of the
patients according to geographical regions were summarized
in table 2.
Table 2: Characteristics of the patients according to six geographical regions
The mean age of patients at diagnosis in SAR were
smaller than those in other geographic regions (53.85±10.59
years vs. 62.64±13.62 years, p=0.0001). The resectability
rate of the patients in EAR group and SAR group (21.8%
and 39.2%, respectively) was found to be lower than other
groups (p=0.0001). The mean time from the beginning of
symptoms to the diagnosis of gastric cancer in MR group
and in MTR group, which were longer than in other groups,
were 8.56±15.71 months and 8.43±14.19 months, respectively
(p=0.005).
The SAR group had more patients from the low socioeconomic
status (p=0.0001). The majority of patients both
in EAR group and in SAR group had Social Solidarity
Fund as health care provider (p=0.00001). Living in rural
area was more common in BSR group and in SAR group
than in other groups (p=0.00001), and the alcohol consumption
was more common among the patients in MR group
and MTR group (23.5%), when compared with those in
other groups (p=0.0001).
Anemia had been more frequently detected in MR group
(70.7%, p=0.015). While signet ring cell adenocarcinoma was the most common histology in MR group (34.3%),
adenocarcinoma was the most common histology in SER
group (94.2%) (p=0.001). The rate of atrophic gastritis
were higher in MTR group (50%) and in MR group (30.8%)
(p=0.003). The frequency of H. pylori infection was the
highest in CAR group (12.1%) (p=0.003). The empirical
ulcer treatment before the diagnosis of cancer was more
commonly employed in EAR group (85.3%) and SAR
group (85.2%) when compared with other groups (p=0.0001).
The Comparison of Western Turkey with Eastern Turkey
There was no statistically significant difference in
gender, age, smoking, anemia, location of the tumor, and
frequency of the atrophic gastritis between two groups. The
time from beginning of symptoms to the diagnosis was
longer in WT group than in ET group (6.98 months vs. 4.24
months, p=0.0001). In addition, the rate of tumor resectability
was higher in WT group than ET group (63.4% vs.
31.6%, respectively, p=0.0001). The empirical ulcer treatment
was more commonly employed in ET group than in
WT group (52.4% vs. 78.2%, p=0.0001). However, smoking
rate was not different in both groups (48.6% vs. 49.2%,
p=0.932), and alcohol consumption was more common in
WT group (15.5% vs. 6.9%, p=0.043).
Socioeconomic status, health care providers and living
area
SSK was the most common health care provider among
the patients living in cities (36.8%, p=0.0001). Socioeconomic
status was lower in ET group when compared with
WT group (53.6% vs. 32.3%, p=0.0001). As a health care
provider, the Social Solidarity Fund was more common
among patients living in rural area, and in ET group than
in WT group (45.1% vs. 9.1%, p=0.0001, and 54.4% vs.
24.0%, p=0.00001, respectively).
Location of tumor, histology, atrophic gastritis, intestinal
metaplasia and H. pylori infection
Although the incidence of proximal tumors were higher
in WT group, the difference was not statistically significant
(26.9% vs. 20.9%, p=0.201). Signet ring cell carcinoma
were significantly more common in WT group compared
with ET group (19.0% vs. 12.6%, p=0.003). There was not
significant difference in the rate of atrophic gastritis between
two groups (21.7% vs. 13.9%, p=0.070). However, H. pylori
infection and intestinal metaplasia were more common in
ET group (75% vs. 40.5%, p=0.003, and 68.4% vs. 18.1%,
p=0.0001, respectively).
Univariate analysis revealed that the rate of resectability
was significantly higher in distally located gastric tumors
than the other locations (41.7% in distal tumors, 36.6% in
middle tumors and 21.7% in upper tumors, p=0.053). The
resectability rate was lower in the patients with atrophic
gastritis, intestinal metaplasia, or H. pylori infection (19.8%,
p=0.0001, 24.6%, p=0.001, and 27.0%, p=0.0001, respectively).
The incidence of anemia was higher in distal tumors
(62%, p=0.011), and lower in the patients with atrophic
gastritis (23.4%, p=0.030). Also, the rate of empirical ulcer
treatment was lower among the patients with H. pylori
infection (19.1%, p=0.007), atrophic gastritis (26.0%,
p=0.010) and intestinal metaplasia (26.1%, p=0.009) when
compared with other clinicopathological features.
Table 3: Characteristics of the patients residing in western and eastern Turkey
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