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Gastrectomy in comprehensive treatment of advanced gastric cancer with synchronous liver metastasis: a prospectively comparative study.

Li Z, Fan B, Shan F, Tang L, Bu Z, Wu A, Zhang L, Wu X, Zong X, Li S, Ren H, Ji J - World J Surg Oncol (2015)

Bottom Line: Multivariate analysis demonstrated that response to chemotherapy was the only independent factor in predicting prognosis.No significant difference in the survival of patients underwent combined hepatic resection when compared with patients performed gastrectomy only.For gastric cancer with synchronous liver metastasis, adjuvant gastrectomy followed by chemotherapy might be beneficial for survival comparing with chemotherapy alone, especially in patients response to initial preoperative chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China. liziyupku@163.com.

ABSTRACT

Background: Systemic chemotherapy is the key treatment for advanced gastric cancer. The benefit of adjuvant surgery following preoperative chemotherapy in gastric cancer with liver metastasis has not been well established.

Methods: Forty-nine gastric cancer patients diagnosed with synchronous liver metastasis initially treated with chemotherapy were categorized into the following two groups: surgery group: 25 patients who underwent gastrectomy and subsequently received postoperative chemotherapy and control group: 24 patients who received chemotherapy alone.

Results: The median overall survival of patients in the surgery group and control group was 20.5 and 9.1 months, respectively, (P = 0.006). The median progression-free survival in the surgery group was 10.9 months, with statistical significance when compared with 5.0 months in the control group (P = 0.001). Multivariate analysis demonstrated that response to chemotherapy was the only independent factor in predicting prognosis. The survival of patients who achieved partial response (PR) was prolonged if they received adjuvant surgery (P = 0.024). No significant difference in the survival of patients underwent combined hepatic resection when compared with patients performed gastrectomy only.

Conclusions: For gastric cancer with synchronous liver metastasis, adjuvant gastrectomy followed by chemotherapy might be beneficial for survival comparing with chemotherapy alone, especially in patients response to initial preoperative chemotherapy.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves for survival in patients with tumor progression. a Comparison of OS between patients with anti-tumor treatment and supportive care after tumor progression. b Comparison of OS between the adjuvant surgery and chemotherapy group among patients with tumor progression who initially reached PR after chemotherapy
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Fig3: Kaplan-Meier curves for survival in patients with tumor progression. a Comparison of OS between patients with anti-tumor treatment and supportive care after tumor progression. b Comparison of OS between the adjuvant surgery and chemotherapy group among patients with tumor progression who initially reached PR after chemotherapy

Mentions: Among all 49 patients, during the 2-year follow-up, 43 patients developed imaging-defined progression. Then, we classified the patients into two groups: one underwent anti-tumor treatment after progression and the other received supportive care after progression. The median OS was 16.3 months in the group underwent anti-tumor treatment, with statistical significance when compared with 5.6 months in the group received supportive care after progression (Fig. 3a, P = 0.001). Among the 43 patients, 16 patients have reached PR after initial chemotherapy. Eleven of the 16 patients underwent adjuvant gastrectomy, while the remaining patients were only treated with chemotherapy. The median OS of the 11 patients was 30.0 months, significantly prolonged than 9.9 months in the remaining ones (Fig. 3b, P = 0.021).Fig. 3


Gastrectomy in comprehensive treatment of advanced gastric cancer with synchronous liver metastasis: a prospectively comparative study.

Li Z, Fan B, Shan F, Tang L, Bu Z, Wu A, Zhang L, Wu X, Zong X, Li S, Ren H, Ji J - World J Surg Oncol (2015)

Kaplan-Meier curves for survival in patients with tumor progression. a Comparison of OS between patients with anti-tumor treatment and supportive care after tumor progression. b Comparison of OS between the adjuvant surgery and chemotherapy group among patients with tumor progression who initially reached PR after chemotherapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491213&req=5

Fig3: Kaplan-Meier curves for survival in patients with tumor progression. a Comparison of OS between patients with anti-tumor treatment and supportive care after tumor progression. b Comparison of OS between the adjuvant surgery and chemotherapy group among patients with tumor progression who initially reached PR after chemotherapy
Mentions: Among all 49 patients, during the 2-year follow-up, 43 patients developed imaging-defined progression. Then, we classified the patients into two groups: one underwent anti-tumor treatment after progression and the other received supportive care after progression. The median OS was 16.3 months in the group underwent anti-tumor treatment, with statistical significance when compared with 5.6 months in the group received supportive care after progression (Fig. 3a, P = 0.001). Among the 43 patients, 16 patients have reached PR after initial chemotherapy. Eleven of the 16 patients underwent adjuvant gastrectomy, while the remaining patients were only treated with chemotherapy. The median OS of the 11 patients was 30.0 months, significantly prolonged than 9.9 months in the remaining ones (Fig. 3b, P = 0.021).Fig. 3

Bottom Line: Multivariate analysis demonstrated that response to chemotherapy was the only independent factor in predicting prognosis.No significant difference in the survival of patients underwent combined hepatic resection when compared with patients performed gastrectomy only.For gastric cancer with synchronous liver metastasis, adjuvant gastrectomy followed by chemotherapy might be beneficial for survival comparing with chemotherapy alone, especially in patients response to initial preoperative chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China. liziyupku@163.com.

ABSTRACT

Background: Systemic chemotherapy is the key treatment for advanced gastric cancer. The benefit of adjuvant surgery following preoperative chemotherapy in gastric cancer with liver metastasis has not been well established.

Methods: Forty-nine gastric cancer patients diagnosed with synchronous liver metastasis initially treated with chemotherapy were categorized into the following two groups: surgery group: 25 patients who underwent gastrectomy and subsequently received postoperative chemotherapy and control group: 24 patients who received chemotherapy alone.

Results: The median overall survival of patients in the surgery group and control group was 20.5 and 9.1 months, respectively, (P = 0.006). The median progression-free survival in the surgery group was 10.9 months, with statistical significance when compared with 5.0 months in the control group (P = 0.001). Multivariate analysis demonstrated that response to chemotherapy was the only independent factor in predicting prognosis. The survival of patients who achieved partial response (PR) was prolonged if they received adjuvant surgery (P = 0.024). No significant difference in the survival of patients underwent combined hepatic resection when compared with patients performed gastrectomy only.

Conclusions: For gastric cancer with synchronous liver metastasis, adjuvant gastrectomy followed by chemotherapy might be beneficial for survival comparing with chemotherapy alone, especially in patients response to initial preoperative chemotherapy.

No MeSH data available.


Related in: MedlinePlus