Clinicopathological characteristics and survival outcomes of gastric cancer: a retrospective study from Guatemala (2014–2017)
Hugo Castro-Salguero1, Bremilin Ramírez-Najarro2, Jorge Tello-Mérida3, Lourdes Castro-Salazar4 and Luis García-Aceituno1
1Medical Oncologist , Department of Medical Oncology, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala City 01015, Guatemala
2Medical Oncologist Resident, Department of Medical Oncology, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala City 01015, Guatemala
3Oncological Surgeon, Department of Oncological Surgery, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala City 01015, Guatemala
4Faculty of Medicine, Universidad Francisco Marroquin, Guatemala City 01015, Guatemala
Abstract
Background: Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, with a disproportionate burden in low- and middle-income countries. Guatemala reports among the highest mortality rates in Central America, yet institutional data remain limited.
Methods: This retrospective cohort study included 307 patients with histologically confirmed gastric adenocarcinoma treated at the Guatemalan Social Security Institute between 2014 and 2017. Demographic, clinicopathological and treatment variables were analysed. Overall survival (OS) was estimated using Kaplan–Meier methods and compared using the log-rank test. Cox proportional hazards models identified independent prognostic factors.
Results: The median age at diagnosis was 63 years; 86% of patients were aged >40 years, and 66.4% were male. At presentation, 53.7% had stage IV disease. The median OS was 8.4 months overall. Survival differed significantly by stage (p < 0.001), with median OS of 61.7 months (stage I), 43.9 (stage II), 14.2 (stage III) and 4.6 (stage IV). In multivariate analysis, underweight status (HR 1.55; 95% CI 1.08–2.22; p = 0.04), gastroesophageal tumour location (HR 1.48; 95% CI 1.02–2.16; p = 0.04), poorly differentiated histology (HR 2.05; 95% CI 1.42–2.88; p < 0.001) and advanced stage (stage IV HR 9.47; p < 0.001) were independently associated with mortality.
Conclusion: GC in Guatemala is predominantly diagnosed at advanced stages and associated with poor survival. Strengthening early detection, nutritional assessment and access to multimodal treatment is urgently needed in resource-limited settings.
Keywords: gastric cancer, adenocarcinoma, survival analysis, prognostic factors, HER2 status, low- and middle-income countries, Guatemala
Correspondence to: Hugo Castro-Salguero
Email: hugoraulcastro@gmail.com
Published: 18/08/2026
Received: 04/11/2025
Publication costs for this article were supported by ecancer (UK Charity number 1176307).
Copyright: © the authors; licensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction
Gastric cancer (GC) remains among the most common malignancies worldwide and a leading cause of cancer mortality, particularly in low- and middle-income countries [1, 2]. In Central America, Guatemala reports one of the highest mortality rates globally, and recent reviews have highlighted the persistent burden of GC across the region [3]. These disparities are driven by late diagnosis, limited access to specialised care and structural health system challenges [4, 5]. Few institutional studies have characterised the clinicopathological features and outcomes of patients in Guatemala. This study aims to describe survival outcomes and identify prognostic factors in a retrospective cohort.
HER2 status was available in 139 patients; 17.3% were positive. HER2 expression was not significantly associated with OS. Among all patients, 34 received neoadjuvant chemotherapy, 72 received adjuvant chemotherapy, 83 received palliative chemotherapy, 47 received surgery alone and 71 received best supportive care. Median OS for the entire cohort was 8.4 months. OS by stage was 61.7 months (stage I), 43.9 (stage II), 14.2 (stage III) and 4.6 (stage IV) (p < 0.001).
Table 1. Baseline demographic and clinicopathological characteristics and univariate survival analysis of patients with GC (n = 307).
Table 2. Multivariate Cox proportional hazards analysis of prognostic factors for OS.
Figure 1. OS in patients with GC.
Discussion
This study demonstrates a high burden of advanced GC and poor survival outcomes in Guatemala. Over half of patients presented with stage IV disease, reflecting delays in diagnosis and limited access to early detection strategies. These findings are consistent with previous epidemiological studies from Central America [5].
Survival outcomes were markedly lower than those reported in high-income countries. Recent advances in systemic therapy with fluorouracil, leucovorin, oxaliplatin and docetaxel, [7] including immune checkpoint inhibitors, have improved outcomes globally. CheckMate 649 demonstrated improved OS with nivolumab plus chemotherapy in advanced GC, [8], while KEYNOTE-859 confirmed a survival benefit with pembrolizumab combined with chemotherapy [9]. However, access to these therapies remains limited in low-resource settings, contributing to persistent disparities.
HER2 expression was not significantly associated with OS. Trastuzumab-based therapy has demonstrated survival benefit in HER2-positive disease, although access remains limited in low-resource settings [10].
Poorly differentiated histology also predicted worse survival. Similar prognostic differences between histological grades have been previously reported [11].
Underweight status was associated with worse survival, consistent with previous reports linking cachexia and hypermetabolism with adverse outcomes in advanced cancer patients [12].
Although ethnicity appeared to be associated with survival in univariate analysis, this effect was not independent after adjustment, suggesting that observed differences may be mediated by socioeconomic or healthcare access factors.
These findings underscore the need for national strategies focused on early detection, improved surgical standards, nutritional support and expanded access to systemic therapy.
Conclusion
GC in Guatemala is characterised by late-stage presentation and poor survival. Addressing structural health system barriers and improving access to early diagnosis and modern oncologic care are critical priorities.
Conflicts of interest
The authors declare no conflicts of interest.
Funding
This study received no external funding.
Ethical approval
Ethics approval: IGSS IRB (Ref. 2014-ONC-012), dated: 24/April/2014.
Data availability
Available upon request.
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