Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: A large population‐based study

Abstract

Background Stage IV gastric signet ring cell carcinoma (SRCC) is a type of malignant gastric cancer (GC) with poorer survival compared to metastatic non‐SRCC gastric cancer (NOS). However, chemotherapy alone was unable to maintain long‐term survival. This study aimed to evaluate survival benefit of palliative gastrectomy plus chemotherapy (PG+C) for metastatic gastric SRCC. Methods We obtained data on gastric cancer patients between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Statistical methods included χ2 tests, Kaplan‐Meier curves, COX models, propensity score matching (PSM) and subgroup analysis. Results Among 27 240 gastric cancer patients included, 4638 (17.03%) were SRCC patients. The proportion of patients with younger age, female gender, poorly differentiated grade and M1 stage was higher in SRCC than in NOS (P < .001). Multivariate analysis revealed that multiple metastatic sites (HR = 1.39, 95% CI: 1.14‐1.69, P = .001) was associated with increased mortality risk in metastatic SRCC. Median survival time was improved in metastatic SRCC receiving PG+C compared to PG/C alone (13 vs 7 months, P < .001). Notably, in subgroup analysis, 13 of 17 groups of metastatic SRCC patients with PG+C had prolonged overall survival compared to chemotherapy alone, especially for those with only one metastatic site (HR = 0.61, 95% CI: 0.51‐0.73, P < .001). Conclusions Our results suggested that there exists at least a selective group of stage IV gastric SRCC patients, who could benefit from palliative gastrectomy followed by chemotherapy compared to chemotherapy alone. Further prospective trials are needed to support our conclusion.

The Impact of Intervention on Survival of Elderly Patients with Gastric Cancer at IV Stage: A SEER Population-Based Study.

“…Although Katai et al [10] reported nonideal short-term survival after surgery in elderly patients ten years ago, some recent studies have demonstrated that the postoperative morbidity and mortality in elderly patients are comparable with those in younger patients [19,22], which may be attributable to advances in nutritional support, anesthesia, surgical instruments and skills. The benefits of surgery plus CT for the survival of GC patients with stage IV disease were also clearly identified [12,26,27,32]. The postoperative complication rate was not different between elderly populations of different ages, which suggested that the benefits of surgical intervention would not decrease with age.…”

Gastric cancer mesenchymal stem cells regulate PD-L1-CTCF enhancing cancer stem cell-like properties and tumorigenesis

“…GC is one of the most common malignancies worldwide and currently accounts for 8.2% of all new cancer cases. Despite significant progress in detection and therapeutic strategies over the past decade, the 5-year survival rate of GC patients remains low 26 , 27 . CSCs are a very small subpopulation of cancer cells residing in TME and are believed to contribute to tumor initiation, heterogeneity, propagation, and therapeutic resistance owing to their abilities of self-renewal and multidirectional differentiation 28 - 30 .…”

Improving survival of stage II‐III primary gastric signet ring cell carcinoma by adjuvant chemoradiotherapy

“…26 Another study from Shi et al showed that survival benefits (HR = 0.28, 95% CI: 0.24, 0.32) of postoperative chemotherapy in 2815 stage IV GSRC patients. 27 Wei's study reported that postoperative radiotherapy can provide a better survival in locally advanced GSRC patients (HR = 0.788, 95% CI: 0.64, 0.94). 26 This result provides the evidence for application of adjuvant RT on treatment of GSRC patients.…”