Does surgery have a role in managing incurable gastric cancer?

Abstract

Although the incidence of gastric cancer is decreasing, the outcomes of this disease are among the poorest of all solid-organ tumours, predominantly due to the frequent presence of stage IV metastatic disease at primary presentation. Stage IV gastric cancer is incurable and carries a very poor prognosis (5-year survival rate of ∼4%); palliative chemotherapy remains the standard of care, but increasing evidence indicates that palliative surgery can provide a prognostic and symptomatic benefit, particularly in combination with chemotherapy and/or radiotherapy. Ongoing prospective trials should further clarify the efficacy of palliative surgery in comparison with other treatment modalities. Until such data are available, surgery should not be offered as a standard first-line treatment, but can be considered in selected cases after thorough multidisciplinary discussions involving the patient. Patient selection for both gastrectomy and nonresectional surgery must include consideration of various factors that predict quality of life after surgery. This Perspectives summarizes the available evidence and discusses the utility of palliative surgery in relation to other therapeutic modalities in the management of incurable gastric cancer.

CA125 is a potential biomarker to predict surgically incurable gastric and cardia cancer

“…[12] Current strategies usually define stage 0 to III gastric cancer as curable, which is suitable for radical resection. For patients of stage IV, the curative opportunity may be limited, as it is reported that up to 50% of patients without metastatic disease who undergo “curative” surgical resection present with recurrent disease within 5 years.…”

Downregulated miR-31 level associates with poor prognosis of gastric cancer and its restoration suppresses tumor cell malignant phenotypes by inhibiting E2F2

“…To date, more than 70% of gastric cancer occurs in the developing world [3] and gastric cancer new case and mortality were the highest in China according to the WHO world cancer report 2014. Although recent advancement in gastric cancer early detection, therapy, and prevention partly enhanced survival rate of early gastric cancer, Stage IV gastric cancer is still incurable with a very poor 5-year survival rate of approximately 4~5% [4]. The curative procedure of gastric cancer is still not satisfactory because the early gastric cancer was difficulty to discover in clinic [5].…”

Epigenetic Silencing of the MLH1 Promoter in Relation to the Development of Gastric Cancer and its use as a Biomarker for Patients with Microsatellite Instability: a Systematic Analysis

“…Lauren’s classification identifies two main histotypes of GC, intestinal and diffuse [2]. GC patients remain a primary clinical challenge despite recent improvements in the diagnostic, surgical, and therapeutic opportunities for GC [3, 4]. …”