A descriptive analysis of gastric cancer with an immunohistochemical Study of Ki67 and p53 as prognostic factors.: Bahrain experience

Mohmmed Awadh; Aysha Darwish; Huda Alqatari; Fatema M. Buzaid; Abdulla Darwish

doi:10.15537/smj.2023.44.12.20230246

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Figure 1
- Frequency of total number of diagnoses per year from 2009-2019.
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Figure 2
- Mortality rates according to demographics, clinical findings, and diagnoses.
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Figure 3
- Mortality and death after diagnosis.

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Table 1

- Frequencies and associations of demographics and clinical findings with the diagnosis of gastric cancer.

Characteristics	Intestinal type adenocarcinoma n=9	Signet ring cell adenocarcinoma n=36	Gastrointestinal stromal tumor n=2	Diffuse large B-cell lymphoma n=5	MALToman=1	P-value
Gender
Female	4 (44.0)	22 (61.0)	0 (0.0)	2 (40.0)	0 (0.0)	0.192
Male	5 (56.0)	14 (39.0)	2 (100)	3 (60.0)	1 (100)	0.192
Age group
<50	2 (22.0)	8 (22.0)	0 (0.0)	2 (40.0)	0 (0.0)	0.567
50-60	1 (11.0)	10 (28.0)	1 (50.0)	3 (60.0)	0 (0.0)
61-70	3 (33.5)	10 (28.0)	1 (50.0)	0 (0.0)	1 (100)
>70	3 (33.5)	8 (22.0)	0 (0.0)	0 (0.0)	0 (0.0)
H. pylori
No	2 (22.0)	33 (92.0)	2 (100)	5 (100)	0 (0.0)	<0.01^**
Yes	7 (78.0)	3 (8.0)	0 (0.0)	0 (0.0)	1 (100)	<0.01^**
Intestinal metaplasia
No	4 (44.0)	33 (92.0)	2 (100)	5 (100)	1 (100)	0.017^*
Yes	6 (56.0)	3 (8.0)	0 (0.0)	0 (0.0)	0 (0.0)	0.017^*
Anemia
No	5 (56.0)	9 (25.0)	1 (50.0)	2 (40.0)	0 (0.0)	0.339
Yes	4 (44.0)	27 (75.0)	1 (50.0)	3 (60.0)	1 (100)	0.339
Abdominal pain
No	4 (44.0)	8 (22.0)	0 (0.0)	0 (0.0)	0 (0.0)	0.403
Yes	5 (56.0)	28 (78.0)	2 (100)	5 (100)	1 (100)	0.403
Surgery
No	1 (11.0)	14 (39.0)	0 (0.0)	1 (20.0)	1 (100)	0.183
Yes	2 (22.0)	12 (33.0)	2 (100)	2 (40.0)	0 (0.0)
Unknown	6 (67.0)	10 (28.0)	0 (0.0)	2 (40.0)	0 (0.0)
Chemotherapy
No	1 (11.0)	15 (41.5)	2 (100)	1 (20.0)	1 (100)	0.193
Yes	2 (22.0)	11 (30.5)	0 (0.0)	2 (40.0)	0 (0.0)
Unknown	6 (67.0)	10 (28)	0 (0.0)	2 (40.0)	0 (0.0)
Esophago-gastroduodenoscopy
Mass	4 (44.5)	17 (47.0)	2 (100)	3 (60.0)	1 (100)	0.822
Ulcer	4 (44.5)	17 (47.0)	0 (0.0)	2 (40.0)	0 (0.0)
Unknown	1 (11.0)	2 (6.0)	0 (0.0)	0 (0.0)	0 (0.0)
Mortality
Alive	2 (22.0)	7 (19.0)	1 (50.0)	4 (80.0)	0 (0.0)	0.042^*
Dead	7 (78.0)	29 (81.0)	1 (50.0)	1 (20.0)	1 (100)	0.042^*

Values are presented as numbers and Percentages (%).

↵* Significant at p<0.05.
↵** Significant at p<0.01. P-value was calculated using Fisher’s exact test.

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Table 2

- Frequencies and associations of demographics, clinical findings, and diagnosis with immunostaining (Ki67).

Parameters		<25% (Very low) n=1	25%-50% (Low) n=5	51%-75% (Moderate) n=21		>75% (High) n=16	P-value
Gender	Female	0 (0.0)	4 (80.0)	8 (38)		9 (56.0)	0.200
Gender	Male	1 (100)	1 (20.0)	13 (62)		7 (44.0)
Age group	<50	0 (0.0)	3 (60.0)	3 (14)		4 (25.0)	0.572
	50-60	0 (0.0)	1 (20.0)	6 (29)		6 (37.0)
	61-70	1 (100)	1 (20.0)	7 (33)		3 (19.0)
	>70	0 (0.0)	0 (0.0)	5 (24)		3 (19.0)
H. pylori	No	1 (100)	5 (100)	14 (67)		14 (87.5)	0.352
H. pylori	Yes	0 (0.0)	0 (0.0)	7 (33)		2 (12.5)
Intestinal metaplasia	No	1 (100)	5 (100)	17 (81)		14 (87.5)	0.747
Intestinal metaplasia	Yes	0 (0.0)	0 (0.0)	4 (19)		2 (12.5)
Anemia	No	0 (0.0)	1 (20.0)	5 (24)		9 (56.0)	0.129
Anemia	Yes	1 (100)	4 (80.0)	16 (76)		7 (44.0)
Abdominal pain	No	0 (0.0)	2 (40.0)	3 (14)		4 (25.0)	0.424
Abdominal pain	Yes	1 (100)	3 (60.0)	18 (86)		12 (75.0)
Surgery	No	0 (0.0)	1 (20.0)	11 (52)		5 (31.0)	0.535
	Yes	1 (100)	2 (40.0)	6 (29)		5 (31.0)
	Unknown	0 (0.0)	2 (40.0)	4 (19)		6 (38.0)
Chemotherapy	No	1 (100)	2 (40.0)	10 (48)		5 (31.0)	0.785
	Yes	0 (0.0)	1 (20.0)	7 (33)		5 (31.0)
	Unknown	0 (0.0)	2 (40.0)	4 (19)		6 (38.0)
Esophago-gastroduodenoscopy	Mass	1 (100)	2 (40.0)	12 (57)		10 (62.5)	0.798
	Ulcer	0 (0.0)	3 (60.0)	7 (33.5)		6 (37.5)
	Unknown	0 (0.0)	0 (0.0)	2 (9.5)		0 (0.0)
Mortality	Alive	1 (100)	0 (0.0)	2 (9.5)		8 (50.0)	0.006^**
Mortality	Dead	0 (0.0)	5 (100)	19 (90.5)		8 (50.0)
Diagnoses of gastric cancer (% of diagnosis cases):
Intestinal type adenocarcinoma (n=6)	Yes	0 (0.0)	0 (0.0)	3 (50.0)	3 (50.0)		0.869
Intestinal type adenocarcinoma (n=6)	No	1 (3)	5 (13.5)	18 (49)	13 (35.0)
Signet ring cell adenocarcinoma (n=29)	Yes	0 (0.0)	5 (17)	16 (55)	8 (28.0)		0.054
Signet ring cell adenocarcinoma (n=29)	No	1 (7)	0 (0.0)	5 (36)	8 (57.0)
Gastrointestinal stromal tumor (n=2)	Yes	1 (50.0)	0 (0.0)	1 (50.0)	0 (0.0)		0.058
Gastrointestinal stromal tumor (n=2)	No	0 (0.0)	5 (12)	20 (49)	16 (39)
Diffuse large B-cell lymphoma (n=5)	Yes	0 (0.0)	0 (0.0)	0 (0.0)	5 (100)		0.024^*
Diffuse large B-cell lymphoma (n=5)	No	1 (3)	5 (13)	21 (55)	11 (29)
MALToma (n=1)	Yes	0 (0.0)	0 (0.0)	1 (100)	0 (0.0)		> 0.05
MALToma (n=1)	No	1 (2)	5 (12)	20 (48)	16 (38)

Values are presented as numbers and percentages (%).

↵** Significant at p<0.01.
↵* Significant at p<0.05. P-value was calculated using Fisher’s exact test. Ten patients’ paraffin blocks were not available.

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Table 2

- Frequencies and associations of demographics, clinical findings, and diagnosis with p53-immunostain.

Demographics		Negative n=12	Diffuse positive n=2	Focal positive n=29	P-value
Gender	Female	7 (58.0)	1 (50.0)	13 (45.0)	0.747
Gender	Male	5 (42.0)	1 (50.0)	16 (55.0)	0.747
Age group	<50	1 (8.5)	1 (50.0)	8 (27.5)	0.268
	50-60	4 (33.0)	1 (50.0)	8 (27.5)
	61-70	6 (50.0)	0 (0)	6 (21.0)
	>70	1 (8.5)	0 (0)	7 (24.0)
H. pylori	No	10 (83)	1 (50.0)	23 (79.0)	0.632
H. pylori	Yes	2 (17.0)	1 (50.0)	6 (21.0)	0.632
Intestinal metaplasia	No	12 (100)	1 (50.0)	24 (83.0)	0.127
Intestinal metaplasia	Yes	0 (0.0)	1 (50.0)	5 (17.0)	0.127
Anemia	No	3 (25.0)	2 (100)	10 (34.5)	0.150
Anemia	Yes	9 (75.0)	0 (0)	19 (65.5)	0.150
Abdominal pain	No	2 (17.0)	1 (50.0)	6 (21.0)	0.632
Abdominal pain	Yes	10 (83.0)	1 (50.0)	23 (79.0)	0.632
Surgery	No	6 (50.0)	0 (0.0)	11 (38.0)	0.150
	Yes	5 (42.0)	0 (0.0)	9 (31.0)
	Unknown	1 (8.0)	2 (100)	9 (31.0)
Chemotherapy	No	7 (58.0)	0 (0.0)	11 (38.0)	0.127
	Yes	4 (33.5)	0 (0)	9 (31.0)
	Unknown	1 (8.5)	2 (100)	9 (31.0)
Esophago-gastroduodenoscopy	Mass	9 (75.0)	1 (50.0)	15 (52.0)	0.521
	Ulcer	3 (25.0)	1 (50.0)	12 (41.0)
	Unknown	0 (0)	0 (0)	2 (7.0)
Mortality	Alive	2 (17.0)	1 (50.0)	8 (28.0)	0.467
Mortality	Dead	10 (83.0)	1 (50.0)	21 (72.0)	0.467
Diagnoses of gastric cancer (percentage of diagnosis cases):
Intestinal type adenocarcinoma (n=6)	Yes	1 (17.0)	1 (17.0)	4 (67.0)	0.377
Intestinal type adenocarcinoma (n=6)	No	11 (30.0)	1 (3.0)	25 (68.0)	0.377
Signet ring cell adenocarcinoma (n=29)	Yes	9 (31.0)	1 (3.5)	19 (65.5)	0.747
Signet ring cell adenocarcinoma (n=29)	No	3 (21.0)	1 (7.0)	10 (71.0)	0.747
Gastrointestinal stromal tumor (n=2)	Yes	1 (50.0)	0 (0)	1 (50.0)	0.550
Gastrointestinal stromal tumor (n=2)	No	11 (27.0)	2 (5.0)	28 (68.0)	0.550
Diffuse large B-cell lymphoma (n=5)	Yes	0 (0)	0 (0)	5 (100)	0.453
Diffuse large B-cell lymphoma (n=5)	No	12 (32)	2 (5)	24 (63.0)	0.453
MALToma (n=1)	Yes	1 (100)	0 (0.0)	0 (0.0)	0.326
MALToma (n=1)	No	11 (26)	2 (5.0)	29 (69)	0.326

Values are presented as numbers and percentages (%). **Significant at p<0.01. *Significant at p<0.05. P-value was calculated using Fisher’s exact test. Ten patients’ paraffin blocks were not available.