Little evidence is available on the management and cost of treating patients with advanced or metastatic gastric cancer (GC). This study evaluates patient characteristics, treatment patterns, and resource utilization for these patients in Mexico.

Data were collected from three centers of investigation (tertiary level). Patients were ≥18 years of age, diagnosed between 1 January 2009 and 1 January 2015, had advanced or metastatic GC, received first-line fluoropyrimidine/platinum, and had ≥3 months follow-up after discontinuing first-line treatment. Data were summarized using descriptive statistics.

The study sample totaled 180. Patients' mean age was 57.2 years (±12.4) and 57.0% were male; 151 (83.9%) patients received second-line chemotherapy. A total of 16 and 19 regimens were identified in first- and second-line therapy. Of the sample, 51 (28.3%) received third-line therapy, and <10% received more than three lines of active chemotherapy. Supportive care received in first- and second-line chemotherapy, included pain interventions (12.2 and 7.9%), nutritional support (3.3 and 1.3%), radiotherapy (6.1 and 16.6%), and transfusions (13.3 and 10.6%), respectively. Using Mexican Institute of Social Security (IMSS) tariffs, the average total cost per patient-month in first- and second-line therapy was US$1230 [95% confidence interval (CI) 1034-1425] and US$1192 (95% CI 913-1471), respectively. Administration and acquisition of chemotherapy comprised the majority of costs.

This study shows considerable variation in first- and second-line chemotherapy regimens of patients with advanced or metastatic GC. Understanding GC treatment patterns in Mexico will help address unmet needs.

Quality of life questionnaires (QLQ) QLQ-STO22 and QLQ-OES18 are currently available to measure Health-related quality of life (HRQL) in patients with Esophageal (EC) or Gastric cancer (GC). The QLQ-OG25 integrates questions from both questionnaires to be useful for EC, Esophagogastric junction carcinoma (EGJC), and GC. Our aim was to validate the Mexican-Spanish version.

The translation procedure followed European Organization for Research and Treatment of Cancer (EORTC) guidelines. QLQ-C30 and QLQ-OG25 instruments were completed by patients with EC, EGJC, and GC. Patients were divided into three groups: (1) palliative treatment; (2) treatment with curative intent, and (3) survivors. Reliability and validity tests were performed.

One-hundred sixty-three patients were included: 62 women and 101 men (mean age, 54.9 years; range, 22-82 years). Sixty-nine, seventy-three, and twenty-one patients were allocated into groups 1, 2, and 3, respectively. Questionnaire compliance rates were high and were well accepted. Group 3 patients reported better functional HRQL scores and lower symptom scores than patients in groups 2 and 1. Scales in the QLQ-C30 and QLQ-OG25 distinguished among other clinically distinct groups of patients. Cronbach's α coefficients of all multi-item scales of the QLQ-OG25 instrument were >0.7 (range, 0.7-0.83). Multitrait scaling analysis demonstrated good convergent and discriminant validity, even adjusting by location. Test-retest scores were consistent.

The Mexican-Spanish version of the EORTC QLQ-OG25 questionnaire is reliable and valid for HRQL measurement in patients with esophagogastric cancer and can be used in clinical trials in the Mexican community.

To assess gastric cancer survival in relation to dietary intake of methyl donors and the methylenetetrahydrofolate reductase 677C>T (MTHFR 677C>T) polymorphism.

A prospective cohort of 257 incidental, histologically confirmed gastric cancer cases was assembled in January 2004 and followed until June 2006. Patients were recruited from the main oncology and/or gastroenterology units in Mexico City and were queried regarding their sociodemographic information, clinical history, and dietary habits 3 y before the onset of their symptoms. The intake of methyl donors was estimated with a food-frequency questionnaire and the MTHFR 677C>T polymorphisms were determined by polymerase chain reaction/restriction fragment length polymorphism analysis. Cox's multivariate regression models were used to estimate the mortality risk of gastric cancer.

MTHFR 677TT carriers with low folate and vitamin B12 intakes had the lowest survival rate in cases of gastric cancer. High intakes of folate and vitamin B12 before diagnosis was associated with decreased gastric cancer mortality risk in susceptible MTHFR 677TT carriers (mortality risk for folate 0.14, 95% confidence interval 0.04-0.46, P for trend=0.001; mortality risk for vitamin B12 0.23, 95% confidence interval 0.08-0.66, P for trend=0.008).

Folate and related B vitamins may be used as an intervention strategy to improve the survival outcome of gastric cancer.

Indications for gastrectomy in T4 gastric carcinoma (GC) remain controversial. Our aim was to define prognostic factors to select those patients with best chance to benefit from multiorgan resection.

A cohort of patients with T4 GC treated in a 19-year period. Surgical morbidity-associated factors were identified by logistic regression analysis. Prognostic factors were defined by Kaplan-Meier and Cox methods.

Seven hundred eighteen patients were included (gastrectomy performed in 169). Surgical morbidity and mortality were 39% and 10.7%, respectively. Surgical morbidity were associated to extent of gastrectomy, age, serum albumin, and lymphocyte count (P = 0.0001). Presence of metastasis (hazard ratio [HR], 1.68; 95% confidence interval [95% CI], 1.19-2.36), albumin <3 g/dl plus lymphocytes <1,000 cells/mm(3) (HR, 2.9; 95% CI, 1.8-4.6), presence of ascites (HR, 2.1; 95% CI, 1.06-4.2), age >or=50 (HR, 1.37; 95% CI, 1.02-1.8), and unresectable disease (HR, 2.6; 95% CI, 1.7-4.1) defined poor survival (P = 0.00001).

Performing a multiorgan resection must be balanced between chances for long-term survival and surviving a potentially fatal operation. Absence of metastases, serum albumin levels >3 g/dl, and accomplishment of R0 resection select patients with high probability of benefit from multiorgan resection.

Health-related quality of life (HRQL) is a fundamental outcome in surgical oncology and culturally valid tools are essential for this purpose. Our aim was to validate the Mexican-Spanish versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire QLQ-C30 and the QLQ-STO22 disease-specific questionnaire module in Mexican patients with gastric cancer (GC). The translation procedure followed EORTC guidelines. Both instruments were completed by patients with GC and analyses were performed within three clinically distinct groups: (1) patients undergoing palliative treatment, (2) patients undergoing treatment with curative intent, and (3) GC survivors. Tests for reliability and validity were performed. One hundred and fifty patients (mean age 54.2 years) completed both questionnaires. Sixty-seven, 55, and 28 patients were allocated to groups 1, 2, and 3, respectively. Compliance rates were high, and questionnaires were well-accepted. Survivors of treatment for GC reported better functional HRQL scores and lower symptom scores than patients in group 2 who were currently undergoing treatment. Patients selected for potentially curative treatment had better HRQL than group 1 (palliative treatments). Scales in the QLQ-C30 and QLQ-STO22 distinguished between other clinically distinct groups of patients. Cronbach's alpha coefficients of 14 scales of both questionnaires were >0.7. Multitrait scaling analysis demonstrated good convergent and discriminant validity. Test-retest scores were consistent. We conclude that the Mexican-Spanish versions of EORTC QLQ-C30 and QLQ-C22 questionnaires are reliable and valid for HRQL measurement in patients with GC and are therefore recommended for use in clinical trials of Mexican community.

Adenocarcinoma of the esophagogastric junction (EGJ) is rapidly increasing in the west. Our aim is to define the prognostic factors and treatment of EGJ carcinoma in Mexico, particularly the location after the Siewert's classification.

A retrospective cohort of patients suffering from EGJ adenocarcinoma treated from 1987 to 2000. The Kaplan-Meier and the Cox's models were used to define prognostic factors.

Two hundred and thirty-four patients were included, 90 females and 144 males. Surgical resection was possible in 68 cases only (29%). Significant prognostic factors were tumor node metastasis (TNM) stage [stages I-II: risk ratio (RR) is 1; stage III RR is 1.3, 95% confidence interval (CI) 0.75-2.4; stage IV RR, 2.04, 95% CI 1.1-3.7], gender (male RR = 1.47, 95% CI 1.05-2.05), metastatic lymph node ratio (no resection: RR = 1; ratio 0.2-1 RR=0.67, 95% CI 0.39-1.14; ratio 0-0.19 RR = 0.42, 95% CI 0.23-0.76) and seralbumin (3 mg/dL or less RR = 2.05 95% CI 1.3-3.2; 3.1-3.4 mg/dL RR = 1.9 95% CI 1.2-3.03; 3.5-3.8 mg/dL RR = 1.3 95% CI 0.8-1.9; 3.9 mg/dL or more: RR = 1) (model P = 0.0001).

EGJ adenocarcinoma is a highly lethal neoplasia and the location after the Siewert' classification is not a prognostic factor. In Mexico, TNM clinical stage, serum albumin, gender, surgical resection and metastatic lymph node ratio are significant prognostic factors. Curative treatment is infrequent but radical resection is associated to longer survival. Consequently, the management must consider quality of life and surgical morbidity.

The definition of prognostic factors in gastric carcinoma (GC) remains controversial. The potential of serum albumin as a prognostic factor for GC is emphasized because the technique to measure it is simple as well as being cheap and widely available. Our aim was to define the prognostic role of serum albumin in GC.

A cohort treated from January 1987 to December 2002 was studied. Relevant clinical, pathological and therapeutic variables were recorded. Kaplan-Meier and Cox's methods were used to define prognostic factors associated with cancer-related survival.

One thousand and twenty-three patients were included. Serum albumin did impact survival, showing a dose-response effect. This effect was present after adjustment for other prognostic factors, including Tumor-Node-Metastasis (TNM) stage, surgical resection and type of lymphadenectomy. In multivariate analysis, TNM stage [Stage Ia and Ib Hazard Ratio [HR] 1, Stage II HR 1.6 (95% confidence interval [CI], 0.56-4.7), Stage IIIa HR 4.4 (95% CI 1.7-11.3), Stage IIIb HR 5.6 (95% CI 2.6-17.2), Stage IV HR 6.8 (95% CI 2.7-17.5), high albumin HR 1, medium albumin HR 1.2 (95% CI 0.8-1.7), low albumin HR 1.2 (95% CI 0.8-1.8), very low albumin HR 1.8 (95% CI 1.3-2.6), D2 dissection HR 1, D1 dissection HR 1.9 (95% CI 1.3-2.97), and no resection HR 3.7 (95% CI 2.4-5.7)] were the most significant prognostic factors associated to survival (model P = 0.00001).

Pretherapeutic serum albumin level is a significant prognostic factor, which should be evaluated along with other well-defined prognostic factors in decisions concerning therapy for GC.