Surgical and Survival Outcome Following Truly Palliative Gastrectomy in Patients with Incurable Gastric Cancer

Recently, many strategies have been reported for the effective treatment of gastric cancer. However, the strategy for treating stage IV gastric cancer remains controversial. Conducting a prospective phase III study in stage IV cancer patients is difficult because of heterogeneous performance status, age, and degree of cancer metastasis or extension. Due to poor prognosis, the variance in physical status, and severe symptoms, it is important to determine the optimal strategy for treating each individual stage IV patient. In the past decade, many reports have addressed topics related to stage IV gastric cancer: the 7th Union for International Cancer Control (UICC) TNM staging system has altered its stage IV classification; new chemotherapy regimens have been developed through the randomized ECF for advanced and locally advanced esophagogastric cancer (REAL)-II, S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer (SPIRITS), trastuzumab for gastric cancer (ToGA), ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD), and ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW) trials; and the survival efficacy of palliative gastrectomy has been denied by the reductive gastrectomy for advanced tumor in three Asian countries (REGATTA) trial. Current strategies for treating stage IV patients can be roughly divided into the following five categories: palliative gastrectomy, chemotherapy, radiotherapy, gastric stent, or bypass. In this article, we review recent publications and guidelines along with above categories in the light of individual symptoms and prognosis. Abbreviations: APC: argon plasma coagulation; AVAGAST: anti-angiogenic antibody bevacizumab, the avastin in gastric cancer; BSC: best supportive care; CF: cisplatin and fluorouracil; CRP: C-reactive protein; DCF: docetaxel, cisplatin, and 5-FU; FISH: fluorescent in-situ hybridization; GJ: gastrojejunostomy; GPS: Glasgow Prognostic Score; HER: human epidermal growth factor receptor; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; OS: overall survival; PS: performance status; QOL: quality of life; RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; RCTs: randomized controlled trials; REAL: randomized ECF for advanced and locally advanced esophagogastric cancer; REGARD: ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; REGATTA: reductive gastrectomy for advanced tumor in three Asian countries; SEER: Surveillance Epidemiology and End Results; SEMS: self-expandable metal stents; SPIRITS: S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer; ToGA: trastuzumab for gastric cancer; TTP: time-to-progression; VEGFR: vascular endothelial growth factor receptor.

Download Full-text

Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer

Medicina ◽

10.3390/medicina57030198 ◽

2021 ◽

Vol 57 (3) ◽

pp. 198

Author(s):

Ji Yeon Park ◽

Byunghyuk Yu ◽

Ki Bum Park ◽

Oh Kyoung Kwon ◽

Seung Soo Lee ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Tumor Resection ◽

Palliative Resection ◽

Primary Tumors ◽

Palliative Intent ◽

Palliative Gastrectomy ◽

Gastric Cancer Patients ◽

The Impact

Background and Objectives: The prognosis of metastatic or unresectable gastric cancer is dismal, and the benefits of the palliative resection of primary tumors with noncurative intent remain controversial. This study aimed to evaluate the impact of palliative gastrectomy (PG) on overall survival in gastric cancer patients. Materials and Methods: One hundred forty-eight gastric cancer patients who underwent PG or a nonresection (NR) procedure between January 2011 and 2017 were retrospectively reviewed to select and analyze clinicopathological factors that affected prognosis. Results: Fifty-five patients underwent primary tumor resection with palliative intent, and 93 underwent NR procedures owing to the presence of metastatic or unresectable disease. The PG group was younger and more female dominant. In the PG group, R1 and R2 resection were performed in two patients (3.6%) and 53 patients (96.4%), respectively. The PG group had a significantly longer median overall survival than the NR group (28.4 vs. 7.7 months, p < 0.001). Multivariate analyses revealed that the overall survival was significantly better after palliative resection (hazard ratio (HR), 0.169; 95% confidence interval (CI), 0.088–0.324; p < 0.001) in patients with American Society of Anesthesiologists Physical Status (ASA) scores ≤1 (HR, 0.506; 95% CI, 0.291–0.878; p = 0.015) and those who received postoperative chemotherapy (HR, 0.487; 95% CI, 0.296–0.799; p = 0.004). Among the patients undergoing palliative resection, the presence of <15 positive lymph nodes was the only significant predictor of better overall survival (HR, 0.329; 95% CI, 0.121–0.895; p = 0.030). Conclusions: PG might lead to the prolonged survival of certain patients with incurable gastric cancer, particularly those with less-extensive lymph-node metastasis.

Download Full-text

SPan-1 Is a Useful Prognostic Marker for Patients with Stage IV Gastric Cancer Who Underwent Palliative Gastrectomy: A Retrospective Multivariate Study

World Journal of Surgery ◽

10.1007/s00268-013-2016-7 ◽

2013 ◽

Vol 37 (7) ◽

pp. 1681-1687

Author(s):

Naoshi Kubo ◽

Masaichi Ohira ◽

Katsunobu Sakurai ◽

Takahiro Toyokawa ◽

Hiroaki Tanaka ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Marker ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy ◽

Multivariate Study

Download Full-text

Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

World Journal of Surgery ◽

10.1007/s00268-005-0129-3 ◽

2005 ◽

Vol 30 (1) ◽

pp. 21-27 ◽

Cited By ~ 66

Author(s):

Reza F. Saidi ◽

Stephen G. ReMine ◽

Paul S. Dudrick ◽

Nader N. Hanna

Keyword(s):

Gastric Cancer ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy

Download Full-text

Palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis

Cancer Management and Research ◽

10.2147/cmar.s179368 ◽

2018 ◽

Vol Volume 10 ◽

pp. 4759-4771 ◽

Cited By ~ 1

Author(s):

Pei Wu ◽

Pengliang Wang ◽

Bin Ma ◽

Songcheng Yin ◽

Yuen Tan ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Meta Analysis ◽

Palliative Gastrectomy

Download Full-text

Multidisciplinary Approach in Improving Survival Outcome of Early-Stage Gastric Cancer

Journal of Surgical Research ◽

10.1016/j.jss.2020.05.058 ◽

2020 ◽

Vol 255 ◽

pp. 285-296

Author(s):

Xuefei Wang ◽

Junjie Zhao ◽

Zhenbin Shen ◽

Mark Fairweather ◽

Peter C. Enzinger ◽

...

Keyword(s):

Gastric Cancer ◽

Multidisciplinary Approach ◽

Early Stage ◽

Survival Outcome

Download Full-text

Predictors of survival outcome following radical gastrectomy for gastric cancer

ANZ Journal of Surgery ◽

10.1111/ans.15011 ◽

2019 ◽

Vol 89 (1-2) ◽

pp. 84-89 ◽

Cited By ~ 1

Author(s):

Su-Ann Lui ◽

Wee Boon Tan ◽

Bee Choo Tai ◽

Wei Peng Yong ◽

Yar Soe Mu ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Outcome ◽

Radical Gastrectomy

Download Full-text

Palliative Gastrectomy and Survival in Patients With Metastatic Gastric Cancer

Clinical and Translational Gastroenterology ◽

10.14309/ctg.0000000000000048 ◽

2019 ◽

Vol 10 (5) ◽

pp. e00048 ◽

Cited By ~ 1

Author(s):

Qin Li ◽

Jiahua Zou ◽

Mingfang Jia ◽

Ping Li ◽

Rui Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Metastatic Gastric Cancer ◽

Palliative Gastrectomy

Download Full-text

Clinicopathological Characteristics and Prognosis of Proximal and Distal Gastric Cancer during 1997–2017 in China National Cancer Center

Journal of Oncology ◽

10.1155/2019/9784039 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 5

Author(s):

Lulu Zhao ◽

Huang Huang ◽

Dongbin Zhao ◽

Chengfeng Wang ◽

Yantao Tian ◽

...

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Tumor Location ◽

Clinicopathological Characteristics ◽

Survival Outcome ◽

Cancer Center ◽

Poor Survival ◽

Node Metastasis ◽

Distal Gastric Cancer

Background. The prognostic relevance of gastric tumor location has been reported and debated. Our study was conducted to examine the differences in clinicopathological features, prognostic factors, and overall survival (OS) between patients with proximal gastric cancer (PGC) and distal gastric cancer (DGC). Patients and Methods. Patients with PGC or DGC were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) during 1997–2017. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models. Results. We reviewed 16,119 cases of gastric cancer patients, including 6,479 of PGC and 9,640 of DGC. PGC patients presented as older patients (61.5 versus 56.4 years, P<0.001) and more males (82.9% versus 68.2%, P<0.001). Compared with DGC, PGC was more likely to be in later pT stage (pT3 and pT4, 65.0% versus 52.8%, P<0.001) and lymph node metastasis (54.8% versus 50.9%, P<0.001). In univariate analysis, PGC patients had a worse survival outcome in stage I (Hazard ratio [HR] = 2.04, 95% CI: 1.42-2.94) but a better prognosis in stage IV (HR = 0.85, 95% CI: 0.73-0.98) when compared to DGC patients. However, multivariate analysis demonstrated that PGC was not an independent predictor for poor survival (HR = 1.07, 95% CI: 1.00-1.14). Results from multivariate analysis also revealed that pT4, lymph node metastasis, distant metastasis, no gastrectomy, and Borrmann IV were independent predictors associated with poor survival for both PGC and DGC patients. Additional prognostic factors for PGC patients included underweight (BMI < 18.5) (HR = 1.29, 95% CI: 1.06-1.58), linitis plastica (HR = 2.13, 95% CI: 1.25-3.65), and overweight (23 ≤ BMI <27.5) (HR = 0.80, 95% CI: 0.71-0.90). During the 20-year study period, the 5-year OS increased significantly for both PGC and DGC, with the increase rate of 91.7% and 67.7%, respectively. Conclusion. In China, PGC significantly differed from DGC in clinicopathological characteristics and prognostic factors. However, there was no significant relationship between survival outcome and gastric tumor location.

Download Full-text