Assessing the real-world experience of treating gastric cancer in Armenia: A retrospective-study.
Authors: Sargsyan Amalya , Bardakhchyan Samvel , Tamamyan Gevorg , Safaryan Liana , Zohrabyan Davit , Harutyunyan Lilit , Avagyan Armen , Arakelyan Jemma , Harutyunyan Martin , Mailyan Mariam , Karapetyan Nune , Rushanyan Marine , Mkhitaryan Sergo , Mkrtchyan Gohar 
Published: June 2023

e16042

Background: Gastric cancer (GC) is a major health issue in Armenia, with late diagnosis in almost 80% of cases leading to poor outcomes. The study aims to assess the real-world experience of treating GC in Armenia and identify factors affecting survival. Methods: This retrospective study assessed the real-world experience of treating GC patients in Armenia from 05.2010 to 05.2022. The data were extracted from medical records of 3 major oncology centers. The factors analyzed in this study included TNM stage, grade, age, histology, Lauren type, and the treatment modality used. Univariate and multivariate Cox regression analyses were performed to determine the potential factors affecting survival. Results: A total of 216 patients with GC were included in the study, with a median age of 61 years (range 18-80 years) and an equal male-to-female ratio. The most common histology was adenocarcinoma (82.4%), followed by signet ring cell carcinoma (10.2%) and mucinous carcinoma (5.6%). The majority of patients were diagnosed with either stage 3 (42%) or stage 4 (39.4%), while 18.5% had stage 2 disease. The median overall survival (OS) was 43.7 mths for patients with stage 2 disease, 31.5 mths for stage 3, and 15.2 mths for stage 4, respectively. Patients who underwent surgery (gastrectomy with resection of all metastatic lesions or just gastrectomy) for stage 4 disease had improved median OS compared to those who did not (20.5 vs 11.2 mths, respectively (p=0.002)). Patients with stage 2-3 GC receiving perioperative chemotherapy (20%) had a better median OS that was not reached, compared to 34 months for those receiving solely adjuvant chemotherapy (80%) (p=0.008). The univariate and multivariate Cox regression analysis showed that the TNM stage was the only significant prognostic factor (p<0.001) for survival, while grade, age, histology, and Lauren type were not significant. Only 9.4% of patients with stage 4 GC were tested for MSI status, and 33% for Her2. Among them just few eligible patients received treatment with targeted therapy or immunotherapy, mostly incompletely and over a few cycles. Conclusions: The results of this study emphasize the importance of early diagnosis and choice of treatment in improving survival outcomes for patients with GC in Armenia. The disease stage at diagnosis was the only significant prognostic factor for survival. In patients with stage 2-3 GC perioperative chemotherapy leads to better survival than adjuvant therapy alone; however, the study found that more than 80% of patients were treated with surgery upfront. The discrepancy may be due to patients being initially referred to surgeons rather than medical oncologists, leading to a lower proportion of patients receiving perioperative treatment. The limited use of targeted and immunotherapeutic agents, due to their high cost and limited accessibility, is a significant barrier to improving survival outcomes for patients with GC in Armenia.