Abstract
Aims
The prognosis of patients with gastric cancer and stage IV factors is poor. However, several recent studies have identified that curative surgery followed by S-1 chemotherapy for cytology positive (CY1) only patients contributed to a better prognosis. This study was designed to compare the prognosis between curative and palliative gastrectomy followed by chemotherapy in CY1 only stage IV gastric cancer.
Methods
Between 2001 and 2016, 1507 patients underwent gastrectomy for gastric cancer. Of these, 51 consecutive patients with only CY1 factor who underwent gastrectomy followed by chemotherapy were enrolled in this study.
Results
(1) Twenty three (45%) patients underwent curative D2 or D2+ gastrectomy, and the remaining 28 (55%) patients underwent palliative gastrectomy, followed by S-1 based or another historical recommended chemotherapy postoperatively. (2) Compared with patients undergoing palliative gastrectomy, patients undergoing curative gastrectomy had a significantly better prognosis (P = 0.042; median survival time: curative vs. palliative, 22.6 months vs. 11.8 months) and a lower incidence of recurrences (P = 0.091). Two- and five-year overall survival rates of patients following curative gastrectomy were 48.2% and 18.2%, respectively. A multivariate analysis showed that venous invasion [P = 0.006; hazard ratio (HR), 3.70 (95% CI: 1.27–9.43)] and curative gastrectomy [P < 0.005; HR, 0.28 (95% CI: 0.12–0.87)] were independent prognostic factors.
Conclusion
Curative gastrectomy followed by chemotherapy might be justified to improve the prognosis of patients with only CY1 Stage IV gastric cancer.
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Shuhei Komatsu, Yasuhiro Shioaki, Hirotaka Furuke, Atsuki Ohta, Ryota Tsuji, Sachie Tanaka, Tatsuya Kumano, Ken-ichiro Imura, Katsumi Shimomura, Jun Ikeda, Fumihiro Taniguchi, Yasuo Ueshima, Chol Joo Lee, Eiichi Deguchi, Eito Ikeda, Eigo Otsuji performed the research and analyzed the data, and Shuhei Komatsu wrote the paper.
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Informed consent was obtained from all individual participants included in the study.
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This study was institutionally approved by Kyoto First Red Cross Hospital.
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Komatsu, S., Shioaki, Y., Furuke, H. et al. Is curative gastrectomy justified for gastric cancer with cytology positive as the only stage IV factor?. Langenbecks Arch Surg 404, 599–604 (2019). https://doi.org/10.1007/s00423-019-01791-0
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DOI: https://doi.org/10.1007/s00423-019-01791-0