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Curative-Intent Surgery for Stage IV Advanced Gastric Cancer: Who Can Undergo Surgery and What Are the Prognostic Factors for Long-Term Survival?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A retrospective study was performed to evaluate the predictive factors for performing curative-intent surgery and prognostic factors for long-term survival of patients undergoing surgery for stage IV gastric cancer.

Patients and Methods

Between 2001 and 2017, 271 patients with stage IV gastric cancer with distant metastasis who underwent systemic chemotherapy were enrolled. Logistic regression analysis was performed to evaluate predictive factors for curative-intent surgery. Cox proportional hazards regression model was applied for patients who were subsequently treated with curative-intent surgery to identify prognostic factors for long-term survival.

Results

Curative-intent surgery was performed in 48 patients (17.7%). Median survival time was significantly longer in the surgery group than in the nonsurgery group (53 vs. 11 months, p < 0.0001). R0 resection was performed in 35 patients (72.9%). The three-year overall survival (OS) rates of the R0, R1, and R2 surgery groups were 75.4%, 33.3%, and 25.0%, respectively (p = 0.0002). Logistic regression analysis revealed that lymphogenous distant metastasis alone (odds ratio = 3.276, p = 0.004), positive lavage cytology alone (6.394, 0.014), doublet or triplet chemotherapy (4.064, 0.034), and high Glasgow prognostic score (0.276, 0.001) were independent predictive factors for performing curative-intent surgery. Among patients undergoing surgery, the Cox proportional hazards regression model for OS showed that R0 surgery was an independent prognostic factor for favorable OS (hazard ratio 0.188, p = 0.022).

Conclusions

Patients with lymphogenous distant metastasis alone, P0CY1 alone, good immunonutritional status, and doublet/triplet chemotherapy are candidates for performing effective curative-intent surgery. R0 surgery is crucial for improving long-term survival after surgery.

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Funding

This work is not supported by any financial assistance grants.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama City, Kanagawa, Japan

    Sho Sato MD, PhD, Chikara Kunisaki MD, PhD, Yusaku Tanaka, Kei Sato MD, PhD, Hiroshi Miyamoto MD, PhD & Norio Yukawa MD, PhD

  2. Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan

    Sho Sato MD, PhD, Takashi Kosaka MD, PhD, Hirotoshi Akiyama MD, PhD & Itaru Endo MD, PhD

  3. Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan

    Toshihiro Misumi PhD

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  1. Sho Sato MD, PhD
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  2. Chikara Kunisaki MD, PhD
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  3. Yusaku Tanaka
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Correspondence to Chikara Kunisaki MD, PhD.

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Sato, S., Kunisaki, C., Tanaka, Y. et al. Curative-Intent Surgery for Stage IV Advanced Gastric Cancer: Who Can Undergo Surgery and What Are the Prognostic Factors for Long-Term Survival?. Ann Surg Oncol 26, 4452–4463 (2019). https://doi.org/10.1245/s10434-019-07790-1

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  • DOI: https://doi.org/10.1245/s10434-019-07790-1

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