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Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pylori infection

John Syrios1, Stavros Sougioultzis1*, Ioannis D Xynos1, Nikolaos Kavantzas2, Christos Kosmas3, George Agrogiannis2, John Griniatsos4, Ioannis Karavokyros4, Emmanouil Pikoulis4, Efstratios S Patsouris2 and Nikolas Tsavaris1

Author Affiliations

1 Department of Pathophysiology, Oncology Unit, Laikon General Hospital, Athens University School of Medicine, Athens, Greece

2 1st Department of Pathology, Laikon General Hospital, Athens University School of Medicine, Athens, Greece

3 2nd Department of Medical Oncology, Metaxa Cancer Hospital, Piraeus, Greece

4 1st Department of Surgery, Laikon General Hospital, Athens University School of Medicine, Athens, Greece

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BMC Cancer 2012, 12:264  doi:10.1186/1471-2407-12-264

Published: 21 June 2012



Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit.


The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis.


The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60–70 vs. 90–100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis.


Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients.