The role of surgical resection before palliative chemotherapy in advanced gastric cancer

Choi, Yong Won; Ahn, Mi Sun; Jeong, Geum Sook; Lee, Hyun Woo; Jeong, Seong Hyun; Kang, Seok Yun; Park, Joon Seong; Choi, Jin-Hyuk; Son, Sang‐Yong; Hur, Hoon; Han, Sang‐Uk; Sheen, Seung Soo

doi:10.1038/s41598-019-39432-7

Cited by 12 publications

(13 citation statements)

References 38 publications

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“…The IRB decided to waive the informed consent for this study because it was a retrospective study using anonymized data. Studies about third or further line of chemotherapy and palliative surgical resection, which included the majority of the patients of the present study cohort, were previously reported [18,19]. However, the eligibility criteria of the current study were somewhat different from those of the previous ones with longer follow-up of patients [18,19].…”

Section: Study Populationmentioning

confidence: 85%

“…Among them, 60 patients underwent complete resection of tumor lesion(s) without gross residual disease. The reasons for performing palliative surgical resection before chemotherapy were previous described [19]. All the patients with primary metastatic disease were in AJCC stage IV, except for two stage III patients with gross residual disease after resection.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Combination versus single-agent as palliative chemotherapy for gastric cancer

Choi

Kang

et al. 2020

BMC Cancer

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Background: Although combination chemotherapy (CC) is generally recommended in recurrent or primary metastatic gastric cancer (RPMGC), the results of randomized trials are conflicting. Methods: A retrospective review was conducted on 687 RPMGC patients who received palliative chemotherapy. We compared the overall survival (OS) between CC and single-agent chemotherapy (SC) among these patients, and we analyzed the clinicopathological characteristics affecting outcome including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Results: Although 521 patients (75.8%) underwent CC, SC was more frequently performed in elderly patients (57.6%) and ECOG performance status (PS) 2 or 3 (65.8%) patients (p < 0.0001, in each case). The median OS of patients who received CC was significantly longer than that of patients who received SC (11 vs. 8 months, p < 0.0001). No difference in OS between CC and SC was observed in elderly patients (p = 0.583), poor PS (p = 0.810), signet ring cell (p = 0.347), palliative surgical resection (p = 0.307), and high PLR (p = 0.120), with a significant interaction between age and type of regimen (p = 0.012). Moreover, there was no difference in OS between CC and SC after propensity score matching (p = 0.322). Multivariate analysis revealed that palliative resection and ≥ second-line chemotherapy were independently associated with favorable OS (p < 0.0001, in each case), whereas poor PS (p = 0.004), signet ring cell (p < 0.0001), peritoneal metastasis (p = 0.04), high NLR (p = 0.001), and high PLR (p = 0.033) were independent prognostic factors of poor OS. Conclusions: Although CC is the standard of care in RPMGC, SC can be considered a reasonable option in certain subgroups, such as elderly patients.

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Section: Study Populationmentioning

confidence: 85%

Section: Patient Characteristicsmentioning

confidence: 99%

Combination versus single-agent as palliative chemotherapy for gastric cancer

Choi

Kang

et al. 2020

BMC Cancer

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“…Informed consent was waived by the IRB because this study was conducted using medical records of anonymized patients. Some patients (n = 9) in this study cohort were included in previous studies about palliative chemotherapy for RPMGC [4,14,15]. However, the follow-up of the patients was extended in the current study.…”

Section: Patientsmentioning

confidence: 99%

Trastuzumab-based palliative chemotherapy for HER2-positive gastric cancer: a single-center real-world data

et al. 2021

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Background Since the results of the ToGA trial were published, trastuzumab-based chemotherapy has been used as the standard first-line treatment for HER2-positive recurrent or primary metastatic gastric cancer (RPMGC). However, the real-world data has been rarely reported. Therefore, we investigated the outcomes of trastuzumab-based chemotherapy in a single center. Methods This study analyzed the real-world data of 47 patients with HER2-positive RPMGC treated with trastuzumab-based chemotherapy in a single institution. Results With the median follow-up duration of 18.8 months in survivors, the median overall survival (OS) and progression-free survival were 12.8 and 6.9 months, respectively, and the overall response rate was 64%. Eastern Cooperative Oncology Group performance status 2 and massive amount of ascites were independent poor prognostic factors for OS, while surgical resection before or after chemotherapy was associated with favorable OS, in multivariate analysis. In addition, 5 patients who underwent conversion surgery after chemotherapy demonstrated an encouraging median OS of 30.8 months, all with R0 resection. Conclusions Trastuzumab-based chemotherapy in patients with HER2-positive RPMGC in the real world demonstrated outcomes almost comparable to those of the ToGA trial. Moreover, conversion surgery can be actively considered in fit patients with a favorable response after trastuzumab-based chemotherapy.

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“…The survival benefit of early detection of GC in young people has come to a consensus (1,(3)(4)(5)(6)8); however, near-universal findings in young patients with GC have seen a female predominance, higher frequency of advanced lesions, and poor-differentiated tumors at presentation in comparison with older patients (1,(3)(4)(5)(6)8). Surgical resection (radical or palliative gastrectomy) is often performed for patients with potentially resectable lesions in practice, which is associated with a favorable outcome in advanced GC (13). Nevertheless, the role of survival benefits after surgical resection remains unknown in general treatment practice for advanced GC in young adults.…”

Section: Introductionmentioning

confidence: 99%

Three-Tier Prognostic Index in Young Adults With Advanced Gastric Cancer

Chen

Huang²,

Wen

et al. 2021

Front. Oncol.

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PurposeTo characterize clinical features and identify baseline prognostic factors for survival in young adults with advanced gastric cancer (YAAGC).Materials and MethodsA total of 220 young inpatients (age less than or equal to 40 years) with an initial diagnosis of advanced gastric cancer were retrospectively enrolled in this study.ResultsOf a consecutive cohort of 220 patients with YAAGC, the median overall survival (OS) time was 16.3 months. One-year survival rate was 43.6% (95% CI: 36.5 to 50.7). In this cohort, a female (71.4%, n = 157) predominance and a number of patients with poorly differentiated tumors (95.9%, n = 211) were observed. In the univariate analysis, OS was significantly associated with neutrophil–lymphocyte ratio (NLR) (≥3.12), hypoproteinemia (<40 g/L), presence of peritoneal or bone metastases, and previous gastrectomy of primary tumor or radical gastrectomy. In multivariate Cox regression analysis, hypoproteinemia [hazard ratio (HR) 1.522, 95% CI 1.085 to 2.137, p = 0.015] and high NLR level (HR 1.446, 95% CI 1.022 to 2.047, p = 0.021) were two independent poor prognostic factors, while previous radical gastrectomy was associated with a favorable OS (HR 0.345, 95% CI 0.205 to 0.583, p = 0.000). A three-tier prognostic index was constructed dividing patients into good-, intermediate-, or poor-risk groups. Median OS for good-, intermediate-, and poor-risk groups was 36.43, 17.87, and 11.27 months, respectively.ConclusionsThree prognostic factors were identified, and a three-tier prognostic index was devised. The reported prognostic index may aid clinical decision-making, patient risk stratification, and planning of future clinical studies on YAAGC.

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The role of surgical resection before palliative chemotherapy in advanced gastric cancer

Cited by 12 publications

References 38 publications

Combination versus single-agent as palliative chemotherapy for gastric cancer

Combination versus single-agent as palliative chemotherapy for gastric cancer

Trastuzumab-based palliative chemotherapy for HER2-positive gastric cancer: a single-center real-world data

Three-Tier Prognostic Index in Young Adults With Advanced Gastric Cancer

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