Clinico-Pathological Spectrum of Adenocarcinoma of Stomach Presenting With Gastric Outlet Obstruction With Special Reference to Her 2 Neu and P53 Status in A Tertiary Care Hospital in Eastern Part of India

Abstract Introduction: There are approximately 990,000 new cases of gastric cancer each year, accounting for 6.8% of all malignant tumors and 738,000deaths, accounting for 8.8% of all cancer deaths6.The average incidence of gastric carcinoma is 32.1 per 100,000 among males and 13.2 among females in Eastern Asia. A nationally representative survey in 2010 found that a total of 556400 deaths occur due to cancer in India and the mortality rate of stomach cancer is 12.6% in India7. The role of cancer biomarkers is to identify tumor cells at early stages and predict treatment response, ultimately leading to a favorable therapeutic outcome 11. Her-2 gene is a proto-oncogene that is located on chromosome 17q21 & its overexpression in stomach carcinoma varies with differentiation (moderately differentiated greater than poorly differentiated) and histologic type (intestinal-type greater than diffuse type)12. Ognjenovic and colleagues showed significant correlation between HER2 protein expression and intragastric localisation of gastric carcinoma (P = 0.005), and the tumour grade of differentiation (P = 0.034). There was also a positive correlation between HER2 protein expression pattern and positive lymph nodes in patients with gastric carcinoma (P = 0.03)13. Over-expression of p53 was associated with worse overall survival (OS) as well as well-known prognostic factors such as vascular invasion and lymph nodemetastasis16. Present study would help to correlate between HER2 neu and P53 expression with clinico-pathological characteristics of adenocarcinoma of stomach patients presenting with gastric outlet obstruction in the study population. Aim and objectives · To study modes of presentation of gastric outlet obstruction. · To study the distribution of histological findings of adenocarcinoma of stomach causing gastric outlet obstruction. · To study the Her 2 and P53 status of adenocarcinoma stomach causing gastric outlet obstruction. Materials and Methods: Hospital based prospective observational study conducted in Department of gastroenterology, school of digestive and liver diseases, IPGMER & SSKM hospital, Kolkata with in a period of one and half year. Data was analysed by JASP software version using appropriate statistical tests. Results: Out of 60 patients, 42 (70 %) were males, 18 (30%) were females. M: F ratio was 2.3: 1. Median age of included patients (N=60) was 56.5 years with range 20-80 years. A significant proportion {(n=33) (55%)} of the patients were in the range of 40-60 years. Majority of patients {(n=45) (75%)} presented with vomiting, abdominal pain & early satiety. Ulcero-proliferative growth was found among significant proportion (95 %) of the patients. Upper gastro-intestinal endoscopy shows a significant proportion {(n=39) (65%)} of the lesions in body and antro-pyloric region together as compared to antro-pyloric region alone. Diffuse type of lesions was found in a significant proportion (55%) of patients. Tubular variety was found in 45%. A significant proportion (96 %) of patients was found Her 2 neu status negative. Her 2 neu 2+ status & her 2 neu 3 + status was found among 2 % & 2 % respectively. All the patients were found negative P 53 status. A significant proportion 18 (30%) of the patients had no nodal involvement. Involvement of 1 node was found in 15 (25 %) of patients. More than 1 node involvement was found in 15 (25%) of patients. More than 2 nodal involvements was found in 12 (20%) of patients. Distal gastrectomy with gastrojejunostomy is done for 15 patients. Sub-total gastrectomy with gastrojejunostomy is done for 12 patients. Total gastrectomy with esophago-jejunostomy is done for 3 patients. Feeding jejunostomy performed for 6 patients who had diffuse infiltration to surrounding structures. Following surgery all of them received chemotherapy. Neoadjuvant chemotherapy given to 12 patients and scheduled for surgical resection and anastomosis. Resection was not feasible among 06 patients & they received chemotherapy only. Chemotherapy & resection both are not feasible among 06 patients. A statistically significant correlation (P <0.05) was found between younger age group (less than 40years) and diffuse variety of adenocarcinoma stomach. No statistically significant result was found between HER 2 & node status. Conclusion: Most of the previously conducted studies are retrospective and include small number of patients. This is a prospective observational study with bigger sample size as compared to most of the previously stated studies. Abbreviation: HER-Human Epidermal Growth Factor Receptor.