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Efficacy of Splenectomy for Proximal Gastric Cancer with Greater Curvature Invasion or Type 4 Tumor: a Propensity Score Analysis of a Multi-Institutional Dataset

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Abstract

Background

Splenectomy for proximal gastric cancer was found to have no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). However, since tumor with invasion to the greater curvature and Type 4 tumor were excluded in JCOG0110, the benefit of splenectomy for these tumors is not known.

Methods

A multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014 was created. From the dataset, 114 eligible patients with proximal advanced gastric cancer with invasion to the greater curvature or Type 4 tumor were enrolled. There were 60 patients in the gastrectomy with splenectomy (Spx) group and 54 patients in the spleen-preserving (Prs) group. To balance the essential variables, propensity score analysis was performed, estimating the propensity score with a logistic regression model. Adjusted overall survival (OS) and adjusted disease-free survival (DFS) were estimated using the inverse probability of treatment weighting (IPTW) method.

Results

There were significant differences in age, performance status, comorbidity, macroscopic type, and clinical T stage between the Spx and Prs groups. The model for estimating the propensity score was well adapted (c-statistic: 0.830, 95%CI: 0.754–0.906). Adjusted OS was identical between the two groups (HR = 1.089, 95%CI: 0.759–1.563; p = 0.644). The DFS curve of Prs group was consistently tended to be lower than Spx, but the difference was not significant (HR = 0.813, 95%CI: 0.572–1.156; p = 0.249).

Conclusions

The efficacy of splenectomy was minimal for proximal advanced gastric cancer even with invasion to the greater curvature or Type 4 tumor.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Seiji Ito

  2. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan

    Mitsuro Kanda, Chie Tanaka, Michitaka Fujiwara & Yasuhiro Kodera

  3. Department of Surgery, Komaki Municipal Hospital, Komaki, Japan

    Yoshinari Mochizuki & Daisuke Kobayashi

  4. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan

    Hitoshi Teramoto

  5. Department of Surgery, Konan Kosei Hospital, Konan, Japan

    Kiyoshi Ishigure

  6. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan

    Toshifumi Murai

  7. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan

    Takahiro Asada

  8. Department of Surgery, Okazaki City Hospital, Okazaki, Japan

    Akiharu Ishiyama

  9. Department of Surgery, Tosei General Hospital, Seto, Japan

    Hidenobu Matsushita

  10. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan

    Kenta Murotani

Authors
  1. Seiji Ito
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  2. Mitsuro Kanda
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  3. Yoshinari Mochizuki
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  14. Yasuhiro Kodera
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Corresponding author

Correspondence to Seiji Ito.

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Conflicts of interest

Dr. Ito reports grants from MSD, grants from Ono Pharma, personal fees from Taiho Pharma, personal fees from Astra Zeneca, outside the submitted work. Dr. Kodera reports grants from Taiho Pharma, grants from Chugai Pharma, grants from Takeda, grants from MSD, grants from Nihon Kayaku, grants from Yakult, grants from Lilly Japan, grants from Ono Pharma, grants from Kaken Pharma, grants from Covidien, grants from EA Pharma, grants from Novartis, grants from KCI, grants from Maruho, grants from Daiichi Sankyo, grants from Otsuka, grants from Tsumura, grants from Sawai, personal fees from Taiho Pharma, personal fees from Chugai Pharma, personal fees from Lilly Japan, personal fees from Johnson & Johnson, personal fees from Takeda, personal fees from Yakult, personal fees from Otsuka, personal fees from Ono Pharma, personal fees from Covidien, personal fees from MSD, grants from Bristol, grants from Sanofi, outside the submitted work. Other authors have nothing to disclose.

Informed consent

Written, informed consent for use of clinical data was granted when required by the Institutional Review Board at each participating institute. In some institutions, opt-out recruitment was employed according to the policy of the Japanese government because this clinical research was conducted using only retrospective clinical data without intervention. The purpose, design, and objectives of the study were posted on the homepage of the Nagoya University Graduate School of Medicine to provide an opportunity for patients to decline to contribute to our study.

Human and animal rights

This study conformed fully to the ethical guidelines of the World Medical Association Declaration of Helsinki–Ethical Principles for Medical Research Involving Human Subjects.

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Ito, S., Kanda, M., Mochizuki, Y. et al. Efficacy of Splenectomy for Proximal Gastric Cancer with Greater Curvature Invasion or Type 4 Tumor: a Propensity Score Analysis of a Multi-Institutional Dataset. World J Surg 45, 2840–2848 (2021). https://doi.org/10.1007/s00268-021-06173-6

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  • DOI: https://doi.org/10.1007/s00268-021-06173-6

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