Systematic treatment in gastric cancer patients with overt bleeding: A propensity score matching analysis

doi:10.5306/wjco.v15.i9.1177

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World Journal of Clinical Oncology

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World J Clin Oncol. Sep 24, 2024; 15(9): 1177-1187
Published online Sep 24, 2024. doi: 10.5306/wjco.v15.i9.1177

Table 1 Baseline characteristics of patients before propensity score matching, n (%)

Variables	Patients with OBBT (n = 41)	Patients without OBBT (n = 130)	P value	SMD
Gender
Male	30 (73.2)	94 (72.3)	0.914	0.019
Female	11 (26.8)	36 (27.7)
Age (range, years)	65 (47-85)	64 (29-83)	0.003	0.486
BMI (range, kg/m²)	21.0 (15.2-27.2)	22.0 (16.0-33.6)	0.153	0.259
Weight loss (range, %)	8.3 (0-37.4)	5.7 (0-26.0)	0.044	0.399
Smoking history
Yes	15 (36.6)	60 (46.2)	0.282	0.195
No	26 (63.4)	70 (53.8)
Drinking history
Yes	7 (17.1)	17 (13.1)	0.521	0.112
No	34 (82.9)	113 (86.9)
¹Chronic disease
Yes	16 (39.0)	42 (32.3)	0.428	0.141
No	25 (61.0)	88 (67.7)
ECOG-PS
0	1 (2.5)	5 (3.8)	0.010	0.473
1	32 (78.0)	119 (91.5)
2	8 (19.5)	6 (4.6)
Primary tumor location
Body	15 (36.6)	74 (56.9)	0.061	0.429
Pylorus	13 (31.7)	24 (18.5)
Cardia	13 (31.7)	32 (24.6)
Cancer stage (AJCC 8^th)
Stage III	9 (22.0)	33 (25.4)	0.656	0.081
Stage IV	32 (78.0)	97 (74.6)

¹Consisting of hypertension, coronary heart disease, cerebral infarction, diabetes, chronic renal failure, and chronic liver disease.

OBBT: Overt bleeding before treatment; SMD: Standard mean difference; BMI: Body mass index; ECOG-PS: Eastern Corporative Oncology Group Performance Status; AJCC: American Joint Committee on Cancer.

Table 2 Baseline characteristics of patients after propensity score matching, n (%)

Variables	Patients with OBBT (n = 32)	Patients without OBBT (n = 61)	P value	SMD
Gender
Male	23 (71.9)	39 (63.9)	0.440	0.171
Female	9 (28.1)	22 (36.1)
Age (range, years)	64.5 (47-80)	67 (29-81)	0.629	0.100
BMI (range, kg/m²)	22.8 (15.9-27.2)	21.8 (16.0-28.1)	0.757	0.066
Weight loss (range, %)	7.5 (0-33.3)	6.5 (0-23.80)	0.671	0.092
Smoking history
Yes	12 (37.5)	22 (36.1)	0.891	0.030
No	20 (62.5)	39 (63.9)
Drinking history
Yes	5 (15.6)	8 (13.1)	0.986	0.072
No	27 (84.4)	53 (86.9)
¹Chronic disease
Yes	13 (40.6)	25 (41.0)	0.973	0.007
No	19 (59.4)	36 (59.0)
ECOG-PS
0	1 (3.1)	2 (3.3)	0.943	0.076
1	29 (90.6)	54 (88.5)
2	2 (6.3)	5 (8.2)
Primary tumor location
Body	12 (37.5)	26 (42.6)	0.891	0.105
Pylorus	9 (28.1)	16 (26.2)
Cardia	11 (34.4)	19 (31.1)
Cancer stage (AJCC 8^th)
Stage III	6 (18.8)	13 (21.3)	0.771	0.064
Stage IV	26 (81.2)	48 (78.7)

¹Consisting of hypertension, coronary heart disease, cerebral infarction, diabetes, chronic renal failure, and chronic liver disease.

OBBT: Overt bleeding before treatment; SMD: Standard mean difference; BMI: Body mass index; ECOG-PS: Eastern Corporative Oncology Group Performance Status; AJCC: American Joint Committee on Cancer.

Table 3 Therapeutic regimen and best response in patients after propensity score matching, n (%)

Characteristics	Total (n = 93)	Patients with OBBT (n = 32)	Patients without OBBT (n = 61)	P value
Therapeutic regimen
Chemotriplet regimen	36 (38.7)	6 (18.8)	30 (49.2)	0.006
¹Chemodoublet-based regimen	54 (58.1)	24 (75.0)	30 (49.2)
²Monotherapy	3 (3.2)	2 (6.3)	1 (1.6)
Radiographic best response
CR or PR	21 (22.6)	11 (34.4)	10 (16.4)	0.157
SD/no CR or no PR	62 (66.7)	18 (56.2)	44 (72.1)
PD	7 (7.5)	3 (9.4)	4 (6.6)
NA	3 (3.2)	0	3 (4.9)
Radical surgery after systematic treatment
Yes	14 (15.1)	5 (15.6)	9 (14.8)	0.911
No	79 (84.9)	27 (84.4)	52 (85.2)

¹Regimen included a chemodoublet regimen, a chemodoublet plus targeted therapy regimen, and a chemodoublet plus immune checkpoints inhibitor regimen.

²Fluorouracil monotherapy or immune check points inhibitor monotherapy.

OBBT: Overt bleeding before treatment; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; NA: Not available.

Table 4 Treatment-related adverse events (≥ 5%) in patients after propensity score matching, n (%)

	Patients with OBBT (n = 32)		Patients without OBBT (n = 61)
	Any grade	Grade ≥ 3	Any grade	Grade ≥ 3
Any TRAEs	32 (100)	13 (40.6)	55 (90.2)	23 (37.7)
Leukopenia/Neutropenia	23 (71.9)	5 (15.6)	39 (64.0)	13 (21.3)
Constipation	18 (56.3)	0	33 (54.1)	0
Peripheral sensory neuropathy	17 (53.1)	1 (3.1)	30 (49.2)	3 (4.9)
Fatigue	16 (50.0)	0	30 (49.2)	0
Decreased appetite	14 (43.8)	1 (3.1)	29 (47.5)	0
Thrombocytopenia	13 (40.6)	6 (18.8)	16 (26.2)	2 (3.3)
Nausea	12 (37.5)	1 (3.1)	27 (44.3)	4 (6.5)
Vomiting	4 (12.5)	2 (6.3)	13 (21.3)	4 (6.5)
Diarrhea	4 (12.5)	2 (6.3)	14 (23.0)	5 (8.2)
Infection	3 (9.4)	0	5 (8.2)	0
Oral mucosal ulcer	2 (6.3)	0	6 (9.8)	2 (3.3)
Febrile neutropenia	1 (3.1)	1 (3.1)	6 (9.8)	6 (9.8)
Liver injury	1 (3.1)	0	4 (6.5)	1 (1.6)

OBBT: Overt bleeding before treatment; TRAEs: Treatment-related adverse events.

Table 5 Analysis of factors related to overt bleeding after treatment, n (%)

Characteristics	χ² test			Binary logistic analysis
Characteristics	Patients with OBAT (n = 16)	Patients without OBAT (n = 77)	P value	OR (95%CI)	P value
Gender
Male	12 (75.0)	50 (64.9)	0.565
Female	4 (25.0)	27 (35.1)
Age (year)
< 65	7 (43.8)	35 (45.5)	0.901
≥ 65	9 (56.3)	42 (54.5)
Smoking history
No	12 (75.0)	47 (61.0)	0.396
Yes	4 (25.0)	30 (39.0)
Drinking history
No	12 (75.0)	68 (88.3)	0.228	Reference
Yes	4 (25.0)	9 (11.7)		8.512 (1.279-56.655)	0.027
¹Chronic disease
No	7 (43.8)	48 (62.3)	0.169	Reference
Yes	9 (56.3)	29 (37.7)		3.929 (0.974-15.855)	0.055
ECOG-PS
0 or 1	14 (87.5)	72 (93.5)	0.346
2	2 (12.5)	5 (6.5)
BMI (kg/m²)
≤ 18.4	2 (12.5)	9 (11.7)	0.668
18.5-23.9	8 (50.0)	47 (61.0)
≥ 24.0	6 (37.5)	21 (27.3)
Weight loss
< 5%	8 (50.0)	31 (40.3)	0.472
≥ 5%	8 (50.0)	46 (59.7)
Primary tumor location
Pylorus	2 (12.5)	23 (29.9)	0.168	Reference
Body	10 (62.5)	28 (36.4)		10.104 (1.287-79.302)	0.028
Cardia	4 (25.0)	26 (33.8)		1.773 (0.209-15.072)	0.600
Cancer stage (AJCC 8^th)
Stage III	4 (25.0)	15 (19.5)	0.734
Stage IV	12 (75.0)	62 (80.5)
OBBT status
No	6 (37.5)	55 (71.4)	0.009	Reference
Yes	10 (62.5)	22 (28.6)		7.015 (1.726-28.505)	0.006
Therapeutic regimen
Chemotriplet regimen	5 (31.3)	31 (40.3)	0.761
²Chemodouble- based regimen	11 (68.8)	43 (55.8)
³Monotherapy	0	3 (3.9)
Grade 3/4 TRAEs
No	10 (62.5)	47 (61.0)	0.913
Yes	6 (37.5)	30 (39.0)
Radiographic best response
CR or PR	2 (12.5)	19 (24.7)	0.149	Reference
SD/no CR or no PR	10 (62.5)	52 (67.5)		2.763 (0.462-16.504)	0.265
PD	3 (18.8)	4 (5.2)		14.039 (1.158-170.260)	0.038
NA	1 (6.3)	2 (2.6)		32.043 (1.248-822.685)	0.038

¹Consisting of hypertension, coronary heart disease, cerebral infarction, diabetes, chronic renal failure, and chronic liver disease.

²Regimen included a chemo-doublet regimen, a chemo-doublet plus targeted therapy regimen, and a chemo-doublet plus immune checkpoints inhibitor regimen.

³Fluorouracil monotherapy or immune checkpoints inhibitor monotherapy.

OBAT: Overt bleeding after treatment; OR: Odds ratio; CI: Confidence interval; ECOG-PS: Eastern Corporative Oncology Group Performance Status; BMI: Body mass index; OBBT: Overt bleeding before treatment; TRAEs: Treatment-related adverse events; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; NA: Not available.

Citation: Yao YH, Zhang H, Xiao Y, Liu ZT, Shi YY, Yu JY, Li Q, Cao BS. Systematic treatment in gastric cancer patients with overt bleeding: A propensity score matching analysis. World J Clin Oncol 2024; 15(9): 1177-1187
URL: https://www.wjgnet.com/2218-4333/full/v15/i9/1177.htm
DOI: https://dx.doi.org/10.5306/wjco.v15.i9.1177