Survival outcomes of management in metastatic gastric adenocarcinoma patients

Abstract

Chemotherapy is generally considered as the main treatment for metastatic gastric adenocarcinoma. The role of gastrectomy for metastatic gastric cancer without obvious symptoms is controversial. The objective of this study is to investigate survival outcomes of treatment modalities using a real-world data setting. A retrospective cohort study was designed using the Taiwan Cancer Registry database. We identified the treatment modalities and used Kaplan–Meier estimates and Cox regressions to compare patient survival outcomes. From 2008 to 2015, 5599 gastric adenocarcinoma patients were diagnosed with metastatic disease (M1). The median overall survival (OS) of patients with surgery plus chemotherapy had the longest survival of 14.2 months. The median OS of the patients who received chemotherapy alone or surgery alone was 7.0 and 3.9, respectively. Age at diagnosis, year of diagnosis, tumor grade, and treatment modalities are prognostic factors for survival. The hazard ratios for patients who received surgery plus chemotherapy, surgery alone, and supportive care were 0.47 (95% CI 0.44–0.51), 1.22 (95% CI 1.1–1.36), and 3.23 (95% CI 3.01–3.46), respectively, by multivariable Cox regression analysis when using chemotherapy alone as a referent. Chemotherapy plus surgery may have a survival benefit for some selected gastric adenocarcinoma patients with metastatic disease.

Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone

“…Our current study aimed to explore the surgical treatment strategy for mGC. In-front surgery usually prevents mGC-related complications, such as bleeding, obstruction, or perforation [10,12,28]. Studies have shown that in-front palliative resection can prolong survival in select patients [10,12,29].…”

“…In-front surgery usually prevents mGC-related complications, such as bleeding, obstruction, or perforation [10,12,28]. Studies have shown that in-front palliative resection can prolong survival in select patients [10,12,29]. However, chemotherapy may be interfered with, or postponed due to, surgical morbidities or surgery-related worsening of the patient's general condition.…”

“…The survival benefit of in-front palliative gastrectomy remains controversial [10][11][12]. Our previous retrospective study recruiting patients with mGC between 2000 and 2010 showed that palliative resection followed by palliative chemotherapy (PCT) was associated with a longer survival time compared to surgery alone, chemotherapy alone, or supportive care [10].…”

“…Our previous retrospective study recruiting patients with mGC between 2000 and 2010 showed that palliative resection followed by palliative chemotherapy (PCT) was associated with a longer survival time compared to surgery alone, chemotherapy alone, or supportive care [10]. A retrospective study enrolling 5599 mGC cases from 2008 to 2015 and using the Taiwan Cancer Registry database also indicated that patients that received surgery plus chemotherapy had the longest survival compared to those who received other treatments [12]. However, a phase III study (REGATTA trial) indicated that palliative gastrectomy (D1 lymphadenectomy) followed by chemotherapy did not prolong survival compared to chemotherapy alone for mGC patients with a single risk factor for non-curativeness (liver, peritoneal surface, or para-aortic lymph node metastasis) [11].…”

ESRRG, ATP4A, and ATP4B as Diagnostic Biomarkers for Gastric Cancer: A Bioinformatic Analysis Based on Machine Learning

“…In other words, GC usually has a late diagnosis at an advanced stage, resulting in its proximity to morbidity and mortality ( Asplund et al, 2018 ). The prognosis of locally advanced gastric cancer is poor with a 5-year survival rate of 16.4% ( Katai et al, 2018 ) and median overall survival (OS) of 6–14 months in East Asia after being diagnosed from extensive clinical studies ( Hu et al, 2021 ). In contrast, if GC is diagnosed at an early stage, the 5-year survival rate is about 90% ( Saragoni et al, 2013 ), indicating the importance of early diagnosis and treatment.…”