Natural History of Gastric Adenocarcinoma and Treatment Outcomes in a United Kingdom-Based Population

Ma, Adler (2024) Natural History of Gastric Adenocarcinoma and Treatment Outcomes in a United Kingdom-Based Population. Doctoral thesis, University of East Anglia.

Preview

PDF Download (6MB) | Preview

Abstract

There are clear unmet needs for effective therapeutic strategies in patients with advanced gastric cancer. Unanswered questions include whether baseline characteristics can predict treatment benefit and enable personalised treatment decisions, and which groups of patients stand to benefit the most from novel therapeutic strategies.
Overarching aims are:
(1) To describe current outcomes in patients with gastric adenocarcinoma (including Siewert III gastro-oesophageal junction adenocarcinoma) in the United Kingdom;
(2) To identify patient and disease factors associated with poor outcomes in this population; and
(3) To highlight unmet needs that may serve as meaningful endpoints in future trials as well as subgroups of patients who might stand to benefit from novel therapeutic modalities.

Findings are presented from a single tertiary centre cohort study of 540 patients with gastric adenocarcinoma between 2011 and 2021. A predictive model for 1-year survival identifies performance status, disease stage, surgical resection and chemotherapy as key prognostic factors. A case is made for gastrectomy and other aggressive modes of treatment in older patients with operable disease and adequate performance status, although intervention may not necessarily be in the best interests of patients with poor performance status. A chain of associations linking suboptimal preoperative optimisation with poor prognosis in surgical patients is demonstrated. Novel adjuvant strategies are therefore needed to optimise outcomes in patients undergoing emergency surgery or with other risk factors for recurrence. The current evidence base is insufficient to inform treatment recommendations for resectable linitis plastica, indicating a need for larger multinational research collaborations. Prognosis in patients with peritoneal disease is poor regardless of baseline characteristics or treatment offered. Intraperitoneal chemotherapy is discussed as a therapeutic modality that may improve outcomes in patients with peritoneal disease.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Kitty Laine
Date Deposited:	30 May 2025 11:17
Last Modified:	30 May 2025 11:17
URI:	https://ueaeprints.uea.ac.uk/id/eprint/99337
DOI:

Downloads

Actions (login required)

View Item