Selective Gastric Cancer Patients with Peritoneal Seeding Benefit from Gastrectomy after Palliative Chemotherapy: A Propensity Score Matching Analysis

Abstract

Background: The present study aimed to explore whether gastric cancer patients with peritoneal seeding after receiving palliative chemotherapy could benefit from gastrectomy and to identify patients with peritoneal seeding who should be selected to receive gastrectomy.Methods: A total of 201 gastric cancer patients were diagnosed with peritoneal seeding and received palliative chemotherapy. Propensity score matching (PSM) was performed to balance the selection bias.Results: After PSM, compared with non-gastrectomy group, gastrectomy group had a longer median overall survival (OS) (23.60 vs. 13.80 moths; P=0.034). Patients with R0 resection had a median OS of 43.60 months compared with 11.27 months in patients who underwent R1/2 resection (P<0.001). The median OS times between the R1/2 resection and non-gastrectomy groups were not different (P=0.139). Subgroup analysis revealed that only patients receiving more than 4 periods of first-line chemotherapy benefited from gastrectomy (P=0.018), whereas patients receiving 1-4 periods of first-line chemotherapy did not (P=0.275). Multivariate analysis showed that gastrectomy (P=0.012) and the period of first-line chemotherapy (P<0.001) were independent prognostic factors. The overall postoperative morbidity was 3.03% (1/33) in the gastrectomy group, and no treatment-related death was observed.Conclusions: The present study indicated that gastrectomy after palliative chemotherapy is a safe procedure and showed a survival benefit for gastric cancer patients with peritoneal seeding. Moreover, clinically curative R0 gastrectomy and more than 4 periods of palliative chemotherapy resulted in better clinical outcomes.

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

“…In this study, we have implemented a propensity score modeling, producing a matched cohort based on baseline characteristics, as well as the extent of initial biological disease, before palliative chemotherapy and response to chemotherapy. Our findings were consistent with previous studies that advocated conversion surgery if R0 resection could be achieved, even after adjusting for potential confounding factors [9,10,12,21,22]. It is noteworthy that patients who underwent conversion surgery exhibited a longer survival rate after additionally excluding early disease progression in the chemotherapy only group.…”

“…It is noteworthy that patients who underwent conversion surgery exhibited a longer survival rate after additionally excluding early disease progression in the chemotherapy only group. In addition, a shorter duration of preoperative chemotherapy was an independent predictor of DFS from conversion surgery, which was contradictory to the previous study [21]. This might in part be attributable to better chemotherapy efficacy in the subgroup of patients with a shorter duration of preoperative chemotherapy, leading to tumor shrinkage that facilitated conversion surgery [23].…”

Palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis

“…The HRs and 95% CIs for OS could be determined directly 7 , 16 – 18 or indirectly 19 – 27 from 13 studies. Nearly, all the studies supported palliative gastrectomy combined with chemotherapy, but only two obtained separated results 16 , 18 when we combined all the HRs for OS in the selected trials, and the results showed that the treatment effect was statistically significant (HR=0.43, 95% CI=0.29–0.65, P <0.001, Figure 2 ), where palliative gastrectomy plus chemotherapy reduced the risk of death by 57% compared with chemotherapy alone.…”

“…Five studies of M1 stage gastric cancer reported the actual sites of metastasis. Three trials 19 , 20 , 22 described patients with peritoneal dissemination and two trials 21 , 24 described patients with liver metastasis. For OS, the pooled HR for peritoneal dissemination was 0.46 (95% CI=0.28–0.73, P =0.001, I 2 =61%, Figure 8 ) and the pooled HR for liver metastasis was 0.46 (95% CI=0.33–0.65, P <0.001, I 2 =0%, Figure 9 ).…”

Development of a prognostic index for gastric cancer with liver metastasis at the initial diagnosis: A single center retrospective study.

“…Several retro-emotherapy can bring any survival benefit for advanced gastric cancers with a single noncurable factor [17]. In another study of GC with peritoneal metastasis, results showed that patients who gained disease control after chemotherapy had a longer median OS in the gastrectomy group than patients in the non-gastrectomy group [18]. All of these results suggest that response to first-line chemotherapy needs to be a factor for consideration when discriminating the subgroup of patients most likely to benefit from radical or palliative surgery.…”