Advanced-Stage Presentation of Gastric Cancer in India: Clinical, Endoscopic, and Socioeconomic Determinants
Samanvith Patlori, Ebby George Simon, Jaison Jacob Mathew, Ajith Thomas, Anoop John, Rajeeb Jaleel, Reuben Thomas Kurien, Sudipta Dhar Chowdhury, Anuradha ChandramohanAbstract
Gastric cancer remains a major cause of cancer-related mortality in India because of advanced-stage presentation at diagnosis. Data on socioeconomic status, diagnostic delays, and endoscopic factors contributing to late stage disease remain limited. We aimed to characterize the clinicodemographic, endoscopic, and pathological profile of patients with newly diagnosed gastric cancer and identify factors associated with advanced-stage disease.
In this cross-sectional study, adults with newly diagnosed gastric adenocarcinoma presenting to a tertiary care center in South India between February 2023 and January 2024 were enrolled. Demographic, socioeconomic, clinical, endoscopic, pathological, and staging data were collected using a structured pro forma.
Factors associated with advanced-stage disease were evaluated using univariate analysis and multivariable logistic regression. A two-sided p-value of < 0.05 was considered statistically significant.
A total of 110 patients were recruited (mean age 53.7 ± 14 years; 70.9% male), of whom 74.5% belonged to the lower socioeconomic group. The median symptom duration prior to diagnosis was 3 months (interquartile range 2–4). Abdominal pain (46.4%) and vomiting (21.8%) were the most common presenting symptoms. A positive family history of gastric cancer in first-degree relatives was present in 12.7% of patients. Advanced-stage disease was observed in 81.8% of patients, with peritoneal metastasis being the most common metastatic site (32.7%). Post-endoscopy gastric cancer (PEGC) was identified in 6.4% of patients. On multivariable analysis, lower socioeconomic status was independently associated with advanced-stage disease, whereas PEGC was independently associated with early-stage disease.
Advanced-stage presentation remains common in gastric cancer. Lower socioeconomic status was independently associated with advanced-stage disease, while PEGC was associated with earlier-stage disease.