Outcomes of gastrectomy following upfront chemotherapy in advanced gastric cancer patients with a single noncurable factor: a cohort study
Received 29 October 2018
Accepted for publication 22 January 2019
Published 5 March 2019 Volume 2019:11 Pages 2007—2013
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Dr Ahmet Emre Eskazan
Wei Li,1 Huiqin Jiang,1 Yiyi Yu,1 Yan Wang,1 Zhiming Wang,1 Yuehong Cui,1 Kuntang Shen,2 Zhenbin Shen,2 Yong Fang,2 Tianshu Liu1,3
1Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China; 2Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; 3Center of Evidence-Based Medicine, Fudan University, Shanghai, China
Purpose: Chemotherapy is the standard care for patients with incurable advanced gastric cancer. Whether or when the addition of gastrectomy to chemotherapy improves survival of advanced gastric cancer patients with a single noncurable factor remains controversial. We aimed to evaluate the superiority of gastrectomy following chemotherapy vs chemotherapy alone regarding overall survival (OS) in these patients.
Patients and methods: Patients with advanced gastric cancer from January 2008 to December 2014 were retrieved from our prospectively acquired database and retrospectively analyzed. The patients with a single noncurable factor were grouped in terms of cancer treatment: chemotherapy alone or gastrectomy following chemotherapy.
Results: Four hundred and fourteen patients (333 chemotherapy alone and 81 gastrectomy following chemotherapy) were included in this study. Kaplan–Meier survival curve showed a significant difference on median OS between chemotherapy-alone group and the gastrectomy plus chemotherapy group (10.9 vs 15.9 months, P<0.01). After propensity score analysis (n=126), chemotherapy plus surgery (81 patients) also showed survival benefit over chemotherapy alone (35 patients) (15.9 vs 10.0 months, P<0.01). Furthermore, stratified analyses indicated that patients with liver metastasis,
Conclusion: This study suggests that gastrectomy after chemotherapy could lead to survival benefit over chemotherapy alone in advanced gastric cancer patients with a single nonresectable factor if the disease was controllable by chemotherapy.
Keywords: gastric cancer, palliative surgery, overall survival, propensity score analysis
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