Distal Gastrectomy for Symptomatic Stage IV Gastric Cancer Contributes to Prognosis with Acceptable Safety Compared to Gastrojejunostomy

Background: The prognostic prolongation effect of reduction surgery for asymptomatic stage IV gastric cancer (GC) is unfavorable; however, its prognostic effect for symptomatic stage IV GC remains unclear. We aimed to compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV GC. Methods: This multicenter retrospective study analyzed record-based data of patients undergoing palliative surgery for symptomatic stage IV GC in the middle or lower-third regions between January 2015 and December 2019. Patients were divided into distal gastrectomy and gastrojejunostomy groups. We compared clinicopathological features and outcomes after propensity score matching (PSM). Results: Among the 126 patients studied, 46 and 80 underwent distal gastrectomy and gastrojejunostomy, respectively. There was no difference in postoperative complications between the groups. Regarding prognostic factors, surgical procedures and postoperative chemotherapy were significantly different in multivariate analysis. Each group was further subdivided into groups with and without postoperative chemotherapy. After PSM, the data of 21 well-matched patients with postoperative chemotherapy and 8 without postoperative chemotherapy were evaluated. Overall survival was significantly longer in the distal gastrectomy group (p = 0.007 [group with postoperative chemotherapy], p = 0.02 [group without postoperative chemotherapy]). Conclusions: Distal gastrectomy for symptomatic stage IV GC contributes to prognosis with acceptable safety compared to gastrojejunostomy.

Successful Conversion Surgery for Stage IV Gastric Cancer after Nivolumab Monotherapy as Third-Line Chemotherapy

There are few reports of conversion surgery (CS) after nivolumab monotherapy because it is considered as a third-line standard chemotherapy for unresectable or recurrent gastric cancer. Here, we report a rare case of stage IV gastric cancer effectively treated with CS after nivolumab monotherapy as a third-line chemotherapy. A 73-year-old man was referred to our hospital with loss of appetite and abdominal discomfort. Stage IV gastric cancer with liver metastasis was diagnosed via upper gastrointestinal endoscopy and CT. Twelve courses of capecitabine, cisplatin, and trastuzumab were administered as the first-line treatment, 25 courses of paclitaxel plus ramucirumab as the second-line treatment, and 31 courses of nivolumab monotherapy as the third-line treatment. After 31 courses of nivolumab monotherapy, CT showed that the primary tumor shrank with no liver metastasis or ascites. Diagnostic laparoscopy was performed with no peritoneal dissemination (P0), and the peritoneal lavage cytology was negative (CY0). CS was performed with total gastrectomy and D2 lymph node dissection (R0 resection). The pathological diagnosis was U, Ant-Less, Type 2, 70 × 63 mm, poorly differentiated adenocarcinoma (ypT3N0M0 ypStage IIA). R0 resection was performed, and the histological response was grade 1a. The patient did not show recurrence for 9 months after CS.

Identifying Benefit Factors Associated With Primary Tumor Resection in Patients With Stage IV Gastric Cancer: a Propensity Score-matched Analysis

Background: At present, the beneficial factors related to surgery at the primary tumor site in patients with stage IV gastric cancer (GC) are unclear. We developed a new selection process to determine the beneficial factors associated with primary tumor surgery.Methods: Patients with stage IV GC were screened from the Surveillance, Epidemiology, and End Results (SEER) database and were divided into surgery and non-surgery groups. The Kaplan-Meier method was used to estimate the survival curve before and after the propensity score-matched analysis (PSM). We believe that patients in the surgery group who have a longer median cancer-specific survival (CSS) time than those in the non-surgery group can benefit from surgery. Use Multivariate Logistic regression analysis to determine the benefit factors related to surgery.Results: A total of 7259 patients with stage IV GC were included, of which 29.95% (2174) underwent primary tumor surgery. After PSM, the median CSS of the surgery group and the non-surgery group was 12 months and 7 months, respectively (p < 0.001). Multivariate COX regression analysis showed that age, T stage, primary tumor site, histological classification, histological grade, and chemotherapy were independently correlated with CSS. We included the independent related factors affecting CSS in COX analysis in the multivariate Logistics regression model. The results showed that T stage, histological grade, and chemotherapy were related to surgical benefit.Conclusion: The surgery to the primary tumor site can prolong the survival time of patients with stage IV GC, and surgeons should screen patients before surgery. Our results show that patients with T stage T4b and histological grade GIII/GIV do not benefit from surgery, while patients receiving chemotherapy can benefit from surgery.