Predictive factors and prognosis of upper gastrointestinal bleeding in gastric cancer: A large population-based study (UGIB-GC trial)

Anya Kiattiweerasak; Phubordee Bongkotvirawan; Natsuda Aumpan; Yoshio Yamaoka; Muhammad Miftahussurur; Ratha-Korn Vilaichone

doi:10.1371/journal.pone.0291926

Predictive factors and prognosis of upper gastrointestinal bleeding in gastric cancer: A large population-based study (UGIB-GC trial)

PLoS One. 2023 Sep 20;18(9):e0291926. doi: 10.1371/journal.pone.0291926. eCollection 2023.

Authors

Anya Kiattiweerasak¹, Phubordee Bongkotvirawan², Natsuda Aumpan^{2

3}, Yoshio Yamaoka^{4

5

6}, Muhammad Miftahussurur⁷, Ratha-Korn Vilaichone^{2

3

7}

Affiliations

¹ Gastroenterology and Hepatology Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
² Center of Excellence in Digestive Diseases and Gastroenterology Unit, Department of Medicine, Thammasat University, Pathumthani, Thailand.
³ Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand.
⁴ Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan.
⁵ Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan.
⁶ Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, United States of America.
⁷ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Abstract

Background: Gastric cancer remains the fourth leading cause of cancer-related death worldwide. Significant number of gastric cancer patients presented with bleeding.

Objective: This study aimed to identify risk factors and overall survival rates of bleeding gastric cancer patients.

Methods: This retrospective cohort study was conducted between 2007-2022 at tertiary care center in Thailand. Clinical information, endoscopic findings and histological type were extensively reviewed and were compared between bleeders and non-bleeders. Patients were monitored for at least 5 years.

Results: There were 20,981 patients who underwent upper gastrointestinal endoscopy during study period. Total of 201 gastric cancer patients were included in this study, 21 were excluded due to incomplete medical records. 180 gastric cancer patients were included with mean age of 60.5±14.3 years. There were 65 (36.1%) patients with gastrointestinal bleeding. Hypertension and chronic kidney disease were significantly more common in bleeders than non-bleeders (43.1% vs 23.5%, OR2.51, 95%CI 1.14.-5.52, p = 0.022; and 16.9% vs 5.2%, OR2.00, 95%CI 1.56-6.63, p = 0.025, respectively). current H. pylori infection was also significantly more common in bleeders than non-bleeders (84.6% vs. 55.7%, OR 4.39, 95%CI 1.90-10.12, p<0.001). Median overall survival of bleeders was significantly lower than non-bleeders (7±0.93 vs 10±2.10 months, p = 0.001).

Conclusions: Bleeding gastric cancer was not an uncommon condition. Majority of patients presented at advanced stage with grave prognosis. Male gender, hypertension, chronic kidney disease, and current H. pylori infection were reliable predictors for bleeding. Early diagnosis and prompt treatment are the key to improve clinical outcome.

Copyright: © 2023 Kiattiweerasak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Gastrointestinal Hemorrhage / epidemiology
Gastrointestinal Hemorrhage / etiology
Humans
Hypertension*
Male
Middle Aged
Prognosis
Renal Insufficiency, Chronic*
Retrospective Studies
Stomach Neoplasms* / complications

Grants and funding

This study was supported by Thailand Science Research and Innovation Fundamental Fund, Bualuang ASEAN Chair Professorship at Thammasat University and Center of Excellence in Digestive Diseases, Thammasat University. This study was also supported by Japan Agency for Medical Research and Development (AMED) [e-ASIA JRP]. The funding sources of this study have no influence or involvement in the process of designing, conducting, analyzing, interpreting results, writing report, and deciding to submit this manuscript for publication.