J Gastric Cancer.  2016 Jun;16(2):78-84. 10.5230/jgc.2016.16.2.78.

Primary Tumor Resection and Survival in Patients with Stage IV Gastric Cancer

• Müsri FY
• Mutlu H
• KaraaÄŸaç M
• Eryilmaz M
• Gündüz S
• Artaç M

• KMID: 2328073
• DOI: http://doi.org/10.5230/jgc.2016.16.2.78

Abstract

PURPOSE
The aim of this study was to determine whether surgical resection of the primary tumor contributes to survival in patients with metastatic gastric cancer.
MATERIALS AND METHODS
A total of 288 patients with metastatic gastric cancer from the Akdeniz University, Antalya Training and Research Hospital, and the Meram University of Konya database were retrospectively analyzed. The effect of primary tumor resection on survival of patients with metastatic gastric cancer was investigated using the log-rank test. Kaplan-Meier survival estimates were calculated. Multivariate analysis was performed using Cox proportional hazards regression modeling.
RESULTS
The median overall survival was 12.0 months (95% confidence intewrval [CI], 10.4~13.6 months) and 7.8 months (95% CI, 5.5~10.0 months) for patients with and without primary tumor resection, respectively (P<0.001). The median progression-free survival was 8.3 months (95% CI, 7.1~9.5 months) and 6.2 months (95% CI, 5.8~6.7 months) for patients with and without primary tumor resection, respectively (P=0.002).
CONCLUSIONS
Non-curative gastrectomy in patients with metastatic gastric cancer might increase their survival rate regardless of the occurrence of life-threatening tumor-related complications.

Keyword

Stomach neoplasms; Surgery; Mortality

MeSH Terms

Disease-Free Survival
Gastrectomy
Humans
Mortality
Multivariate Analysis
Retrospective Studies
Stomach Neoplasms*
Survival Rate

Figure

• 

  Fig. 1 Progression-free survival curve of patients who had primary tumor resection vs. patients who did not (P=0.002).

• 

  Fig. 2 Overall survival curve of patients who had primary tumor resection vs. patients who did not (P<0.001).

Reference

1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127:2893–2917.

2. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer. 1989; 63:364–367.

3. Feng XY, Chen YB, Chen S, Li YF, Zhou ZW, Li W, et al. Relationship between the number of lymph node detection and prognosis in stage II gastric cancer after D(2) dissection. Zhonghua Wei Chang Wai Ke Za Zhi. 2010; 13:346–349.

4. Shah MA, Kelsen DP. Gastric cancer: a primer on the epidemiology and biology of the disease and an overview of the medical management of advanced disease. J Natl Compr Canc Netw. 2010; 8:437–447.

5. National Comprehensive Cancer Network (NCCN). NCCN Guidelines; Gastric Cancer [Internet]. Fort Washington (PA): NCCN;cited 2015 Dec 13. Available from: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

6. Meza-Junco J, Au HJ, Sawyer MB. Trastuzumab for gastric cancer. Expert Opin Biol Ther. 2009; 9:1543–1551.

7. Kasakura Y, Ajani JA, Mochizuki F, Morishita Y, Fujii M, Takayama T. Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer. J Surg Oncol. 2002; 80:181–185.

8. Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol. 2006; 24:2903–2909.

9. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010; 376:687–697.

10. Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ. Dutch Gastric Cancer Group. Value of palliative resection in gastric cancer. Br J Surg. 2002; 89:1438–1443.

11. Zhang JZ, Lu HS, Huang CM, Wu XY, Wang C, Guan GX, et al. Outcome of palliative total gastrectomy for stage IV proximal gastric cancer. Am J Surg. 2011; 202:91–96.

12. Bozzetti F, Bonfanti G, Audisio RA, Doci R, Dossena G, Gennari L, et al. Prognosis of patients after palliative surgical procedures for carcinoma of the stomach. Surg Gynecol Obstet. 1987; 164:151–154.

13. Huang KH, Wu CW, Fang WL, Chen JH, Lo SS, Wang RF, et al. Palliative resection in noncurative gastric cancer patients. World J Surg. 2010; 34:1015–1021.

14. Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Fujii S, et al. Impact of palliative gastrectomy in patients with incurable advanced gastric cancer. Anticancer Res. 2008; 28:1309–1315.

15. Mariette C, Bruyère E, Messager M, Pichot-Delahaye V, Paye F, Dumont F, et al. Palliative resection for advanced gastric and junctional adenocarcinoma: which patients will benefit from surgery? Ann Surg Oncol. 2013; 20:1240–1249.

16. Badgwell B, Roy-Chowdhuri S, Chiang YJ, Matamoros A, Blum M, Fournier K, et al. Long-term survival in patients with metastatic gastric and gastroesophageal cancer treated with surgery. J Surg Oncol. 2015; 111:875–881.

17. Dittmar Y, Rauchfuss F, Goetz M, Jandt K, Scheuerlein H, Heise M, et al. Non-curative gastric resection for patients with stage 4 gastric cancer: a single center experience and current review of literature. Langenbecks Arch Surg. 2012; 397:745–753.

18. Ouchi K, Sugawara T, Ono H, Fujiya T, Kamiyama Y, Kakugawa Y, et al. Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol. 1998; 69:41–44.

19. Kikuchi S, Arai Y, Morise M, Kobayashi N, Tsukamoto H, Shimao H, et al. Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience. Hepatogastroenterology. 1998; 45:1183–1188.

20. Maekawa S, Saku M, Maehara Y, Sadanaga N, Ikejiri K, Anai H, et al. Surgical treatment for advanced gastric cancer. Hepatogastroenterology. 1996; 43:178–186.

21. Schmidt B, Look-Hong N, Maduekwe UN, Chang K, Hong TS, Kwak EL, et al. Noncurative gastrectomy for gastric adenocarcinoma should only be performed in highly selected patients. Ann Surg Oncol. 2013; 20:3512–3518.