Ann Surg Treat Res.  2017 Jan;92(1):23-27. 10.4174/astr.2017.92.1.23.

Is noncurative gastrectomy always a beneficial strategy for stage IV gastric cancer?

• Lee CM
• Choi IK
• Kim JH
• Park DW
• Kim JS
• Park SH

• KMID: 2364710
• DOI: http://doi.org/10.4174/astr.2017.92.1.23

Abstract

PURPOSE
The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease.
METHODS
We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated.
RESULTS
A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group.
CONCLUSION
Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.

Keyword

Metastasis; Stomach neoplasms; Gastrectomy; Prognosis

MeSH Terms

Cause of Death
Diagnosis
Drug Therapy
Gastrectomy*
Hemorrhage
Humans
Medical Records
Mortality
Multivariate Analysis
Neoplasm Metastasis
Pneumonia
Prognosis
Recurrence
Stomach Neoplasms*

Figure

• 

  Fig. 1 Scheme of enrollment. IM, the patients underwent chemotherapy for initially metastatic gastric cancer; RM, the patients underwent chemotherapy for metastatic recurrence after surgical treatment.

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  Fig. 2 Comparison of overall survival between IM and RM groups. Overall survival did not differ between the 2 groups (P = 0.569, by log-rank test). IM, the patients underwent chemotherapy for initially metastatic gastric cancer; RM, the patients underwent chemotherapy for metastatic recurrence after surgical treatment.

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