Multidisciplinary treatment for patients with stage IV gastric cancer: the role of conversion surgery following chemotherapy
Open Access
- 15 November 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Cancer
- Vol. 18 (1), 1116
- https://doi.org/10.1186/s12885-018-4998-x
Abstract
With advances in gastric cancer chemotherapy, conversion surgery has drawn attention as a new strategy to improve the outcome of stage IV disease. We investigated the efficacy of conversion surgery following chemotherapy for patients with stage IV gastric cancer. We retrospectively reviewed clinico-pathologic variables and oncologic outcomes for 101 patients with stage IV gastric cancer who were treated with systemic chemotherapy followed by gastrectomy with intension of curative resection from January 2005 to December 2012. In terms of the best response from palliative chemotherapy, complete or partial response were observed in 65 patients (64.4%) in overall. Complete response of metastatic site were observed in 72 (71.3%) and 66 (65.3%) patients as best and pre-operative response, respectively. The overall complete macroscopic resection, rate was 56.4%. Eleven patients (10.9%) received combined metastasectomy. There was no postoperative surgery-related mortality for 1 month. The median overall survival time was 26.0 months. Multivariable analysis identified complete macroscopic resection, chemotherapy response (complete response/partial response) of metastatic sites, and change in CEA level as independent prognostic factors contributing to overall survival. Patients with stage IV gastric cancer who exhibit a good clinical response to chemotherapy might obtain greater survival benefit from gastrectomy following chemotherapy compared with patients who exhibit a poor response to chemotherapy. Prospective, randomized trials are required to determine the best strategy for combining initial chemotherapy with subsequent gastrectomy.Keywords
This publication has 24 references indexed in Scilit:
- Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trialThe Lancet Oncology, 2016
- Worldwide trends in gastric cancer mortality (1980–2011), with predictions to 2015, and incidence by subtypeEuropean Journal Of Cancer, 2014
- Cancer statistics, 2013CA: A Cancer Journal for Clinicians, 2013
- Chemotherapy for the conversion of unresectable colorectal cancer liver metastases to resectionCritical Reviews in Oncology/Hematology, 2011
- Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trialThe Lancet, 2010
- Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 studyThe Lancet Oncology, 2009
- New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)European Journal of Cancer, 2009
- Phase III Study of Docetaxel and Cisplatin Plus Fluorouracil Compared With Cisplatin and Fluorouracil As First-Line Therapy for Advanced Gastric Cancer: A Report of the V325 Study GroupJournal of Clinical Oncology, 2006
- Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancerBritish Journal of Cancer, 1995
- Initial or delayed chemotherapy with best supportive care in advanced gastric cancerAnnals of Oncology, 1994