Prognostic Significance of Deprivation in Upper Gastrointestinal Cancer

The aim of this study was to determine the influence of the Index of Multiple Deprivation (IMD) and Health Deprivation (HD) on upper gastrointestinal (UGI) cancer outcome. Consecutive 1185 patients (697 oesophageal, 488 gastric cancer) were studied prospectively. Deprivation scores were calculated using the IMD of the Welsh Government. Mortality data were obtained from the Office for National Statistics (ONS) and this data, as well as survival data, were independently verified by the Welsh Cancer Intelligence and Surveillance Unit. Primary outcome measure was survival from diagnosis. Median survival for gastric cancer patients was 8 months (0.25 to 64) compared with 10 months (0.25 to 62) for oesophageal cancer patients. Open and close laparotomy for all surgical patients was commoner in patients residing in deprived geographical areas with a 6.5% open and close rate in the least deprived IMD quintile versus 13.5% in the most deprived quintile (P=0.006). On post-operative histopathology, IMD was associated with pT (r=-0.146, P=0.043), pN (r =-0.158, P=0.029), and pM stage (r=-0.189, P=0.016). On univariate analysis survival was associated with oesophageal versus gastric tumour site (P=0.028), histopathological cell type (P<0.0001), age (P<0.0001), radiological (r) TNM stage (P<0.0001), radical treatment intent (P<0.0001), IMD (P<0.0001) and HD (P<0.0001). On multivariate analysis age (HR 1.021, 95% CI, 1.014- 1.028, P<0.0001), rTNM stage (HR 1.559, 95% CI, 1.427-1.704 P<0.0001), radical treatment intent (HR 0.338, 95% CI, 0.274-0.418, P<0.0001), and IMD rank (HR 1.000, 95% CI, 1.000-1.000, P=0.084) were associated with duration of survival. In conclusion deprivation is an important prognostic indicator in UGI cancer.