109 Background: Metastatic gastric cancer has poor survival. The purpose of this study was to compare outcomes of metastatic gastric cancer patients stratified by surgery and radiation therapy. Methods: The SEER database was accessed to identify AJCC M1 stage IV (6th ed) gastric cancer patients between 2004 thru 2008. Patients were divided into 4 groups; group 1: no surgery or radiation; group 2: radiation alone; group 3: surgery alone; group 4: surgery and radiation. Survival analysis was determined by Kaplan-Meier and log-rank analysis. Multivariate analysis (MVA) was analyzed by Cox proportional hazard ratio model. Results: We identified 5072 patients. Surgery and/or radiation were associated with a survival benefit. Median and 2 year survival for groups 1, 2, 3, and 4 was 7 months and 8.2%, 8 months and 8.9%, 10 months and 18.2%, and 16 months and 31.7%, respectively (p<0.00001). MVA for all patients revealed that surgery and radiation were associated with decreased mortality while T-stage, N-stage, age, signet ring histology, and peritoneal metastases were associated with increased mortality. In patients treated with surgery, MVA showed that radiation was associated with decreased mortality while T-stage, N-stage, age, removing <15 lymph nodes, signet ring histology, and peritoneal metastases was associated increased mortality. Age was the only prognostic factor in nonsurgical patients. Conclusions: Surgery and radiation are associated with increased survival in a subset of patients with metastatic gastric cancer. Prospective trials will be needed to address the role and sequence of surgery and radiation in metastatic gastric cancer.
Role of radiation therapy in primary breast diffuse large B-cell lymphoma in the Rituximab era: a SEER database analysis