Gastric carcinoma: 5 year experience of a single institute.

PURPOSE: Gastric cancer (GC) is the most common cause of cancer death registered in cancer institute. Background clinical information is important for cancer prevention and therefore we here present characteristics and outcome of GC patients, more than half coming from northern parts of Iran. MATERIALS AND METHODS: we retrospectively studied records patients with pathologic diagnosis of GC referred to the Medical Oncology Department of the Cancer Institute from 1998 to 2003. RESULTS: Four hundred and thirteen patients were registered with GC with the average age of 58 and a male to female ratio of 3/1. Tumor stage based on AJCC was stage 2(12.5%), stage 3(22%), stage 4(63%) and 2% unknown. Most common site of involvement was cardia (43%). Median survival time of all patients (with or without treatment) was 10 months overall. Gastrectomy was performed for 214 patients(39% with positive surgical margins), and 175 of the gastrectomised patients received chemotherapy. Median survival with surgery only was 7 months but 20 months with both surgery and chemotherapy. Only 21 patients received neoadjuvant chemotherapy. Median survival of patients who had response to preoperative chemotherapy was 30 months. By multivariate analysis lower extent of disease (p=0.0024), free surgical margin (p=0.0017), and chemotherapy (p=0.001) were associated with better prognosis. CONCLUSIONS: Only curative resection with free margins was associated with a survival benefit in this study. More than 80% of patients were diagnosed in locally advanced or metastatic stage of disease and even with neoadjuvant chemotherapy and salvage surgery the outcome was poor. Clearly more efforts need to be given to early detection of lesions to allow a better cure rate.

Sarcoma in Iran.

PURPOSE: To review the clinical characteristics of 1470 sarcoma cases and to define the factors in patients that predict out come, relapse and survival. METHODS: Retrospective analysis of the database for the period 1991-2002, focusing on demographic, tumor related and treatment related variables, relapse free survival (RFS) and overall survival (OS) using the Kaplan- Meier method. Statistical significance was evaluated using the chi square and t- tests for univariate influence and a Cox regression model for multivariate influence. RESULTS: Mean age was 30 years. The male to female ratio was 3/2 and 23% of the cases were under 16 years of age. Median tumor diameter was 10.5 centimeters. The bone to soft tissue sarcoma ratio was 3/1 in children and 1/3 in adults. Osteosarcoma, Ewing's tumours and rhabdomyosarcomas accounted for 83% of childhood tumors. In adults osteosarcomas, synovial sarcomas and malignant fibrous histocytomas (MFHs) were the most common subtypes. Mean follow up time was 56 months. Of the total, 25% had initial metastasis, 86% received chemotherapy and 41 % underwent radiotherapy. The main prognostic factors for survival were tumor size, margin of surgery, neurovascular involvement in the pathological report, initial metastasis and no complete response to first therapy. Adjuvant radiotherapy, small tumor size, curative surgery with chemotherapy and free surgical margins were significantly associated with reduced recurrence. CONCLUSION: Our patients are characterised by diagnosis with a large tumor size, advanced stage of disease and short survival. A complete response to primary therapy is the main independent variable for overall survival. Earlier diagnosis and an experienced team including surgical, medical and radiotherapy oncologists are needed for a better response and longer survival of patients.