Palliative Gastrectomy and Survival in Patients With Metastatic Gastric Cancer

Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n=137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months, P=0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P=0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9. Conclusions. Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.

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2230 Palliative gastrectomy does not prolong survival of metastatic gastric cancer patients with both high CEA and high CA19-9 values at diagnosis

European Journal of Cancer ◽

10.1016/s0959-8049(16)31146-7 ◽

2015 ◽

Vol 51 ◽

pp. S410 ◽

Cited By ~ 1

Author(s):

L.Y. Bai ◽

C.F. Chiu ◽

H.R. Yang ◽

M.D. Yang ◽

L.B. Jeng ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Metastatic Gastric Cancer ◽

Palliative Gastrectomy ◽

Gastric Cancer Patients

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An open-label, multicenter phase II trial of SUNITINIB for patients with chemorefractory metastatic gastric cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0030-1263569 ◽

2010 ◽

Vol 48 (08) ◽

Cited By ~ 1

Author(s):

M Moehler ◽

J Hartmann ◽

F Lordick ◽

S Al-Batran ◽

P Reimer ◽

...

Keyword(s):

Gastric Cancer ◽

Phase Ii ◽

Phase Ii Trial ◽

Metastatic Gastric Cancer ◽

Open Label ◽

Multicenter Phase

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Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.251.rv2 ◽

2016 ◽

Vol 25 (1) ◽

pp. 87-94 ◽

Cited By ~ 31

Author(s):

Kunihiko Izuishi ◽

Hirohito Mori

Keyword(s):

Gastric Cancer ◽

Performance Status ◽

Locally Advanced ◽

Growth Factor Receptor ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy ◽

Advanced Tumor ◽

Esophagogastric Cancer ◽

Previously Treated

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.

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