Survival benefit of gastrectomy for gastric cancer with peritoneal carcinomatosis: a propensity score-matched analysis

Xiuwen Geng, Hao Liu, Tian Lin, Yanfeng Hu, Hao Chen, Liying Zhao, Tingyu Mou, Xiaolong Qi, Jiang Yu, Guoxin Li, Xiuwen Geng, Hao Liu, Tian Lin, Yanfeng Hu, Hao Chen, Liying Zhao, Tingyu Mou, Xiaolong Qi, Jiang Yu, Guoxin Li

Abstract

Peritoneal carcinomatosis (PC) is the most frequent pattern of metastasis in stage IV gastric cancer (GC). The study aims to investigate the efficacy of gastrectomy in GC with PC. Clinicopathological data of 518 stage IV GC patients were retrospectively collected in Nanfang Hospital. Among all cases, 312 GC patients with PC (without other site of metastasis) were eligible. Univariate and multivariate analyses were performed to identify the independent prognostic factors. Propensity score matching analysis was performed to balance the characteristics and treatment-related factors. There was a significantly improved overall survival in gastrectomy group (148 patients) compared with nonresection group (164 patients) (P < 0.001). The 1-year and 2-year survival rates were 49.8% and 21.5% in gastrectomy group, whereas 28.8% and 9.7% in nonresection group, respectively. Further analysis showed that gastrectomy had also improved survival in P1 (P = 0.017) and P2 stage patients (P < 0.001), but not P3 stage (P = 0.495). The modality of gastrectomy plus chemotherapy plus hyperthermic intraperitoneal chemotherapy (HIPEC) showed an optimum survival. In addition, P3 disease, nongastrectomy, nonchemotherapy, non-HIPEC, and age ≥ 60 years were independently associated with poor survival. The gastrectomy plus chemotherapy plus HIPEC modality showed a significant survival benefit for gastric adenocarcinoma patients, particularly in those with P1 and P2 diseases.

Keywords: Chemotherapy; gastrectomy; gastric cancer; peritoneal carcinomatosis.

© 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Selection and grouping of stage IV gastric adenocarcinoma patients with peritoneal carcinomatosis.
Figure 2
Figure 2
Overall survival and survivals of different treatment subgroups of stage IV gastric adenocarcinoma patients with peritoneal carcinomatosis.
Figure 3
Figure 3
Overall survival and P stage subgroup survivals of stage IV gastric adenocarcinoma patients with peritoneal carcinomatosis.

References

    1. Jemal, A. , Siegel R., Xu J., and Ward E.. 2010. Cancer statistics, 2010. CA Cancer J. Clin. 60:277–300.
    1. Chen, S. , Li Y. F., Feng X. Y., Zhou Z. W., Yuan X. H., and Chen Y. B.. 2012. Significance of palliative gastrectomy for late‐stage gastric cancer patients. J. Surg. Oncol. 106:862–871.
    1. Chen, W. , Zheng R., Baade P. D., Zhang S., Zeng H., Bray F., et al. 2016. Cancer statistics in China, 2015. CA Cancer J. Clin. 66:115–132.
    1. Yonemura, Y. , Endou Y., Shinbo M., Sasaki T., Hirano M., Mizumoto A., et al. 2009. Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: selection for cytoreductive surgery. J. Surg. Oncol. 100:311–316.
    1. Bando, E. , Yonemura Y., Takeshita Y., Taniguchi K., Yasui T., Yoshimitsu Y., et al. 1999. Intraoperative lavage for cytological examination in 1297 patients with gastric carcinoma. Am. J. Surg. 178:256–262.
    1. Boku, T. , Nakane Y., Minoura T., Takada H., Yamamura M., Hioki K., et al. 1990. Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer. Br. J. Surg. 77:436–439.
    1. Roviello, F. , Caruso S., Marrelli D., Pedrazzani C., Neri A., De Stefano A., et al. 2011. Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: state of the art and future developments. Surg. Oncol. 20:e38–e54.
    1. Wagner, A. D. , Unverzagt S., Grothe W., Kleber G., Grothey A., Haerting J., et al. 2010. Chemotherapy for advanced gastric cancer. Cochrane Database Syst. Rev. 3:CD004064.
    1. Koizumi, W. , Narahara H., Hara T., Takagane A., Akiya T., Takagi M., et al. 2008. S‐1 plus cisplatin versus S‐1 alone for first‐line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 9:215–221.
    1. Huang, J. , Zhao Y., Xu Y., Zhu Y., Huang J., Liu Y., et al. 2016. Comparative effectiveness and safety between oxaliplatin‐based and cisplatin‐based therapy in advanced gastric cancer: a meta‐analysis of randomized controlled trials Oncotarget doi: 10.18632/oncotarget.9189.
    1. Japanese Gastric Cancer Association . 2011. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112.
    1. Ajani, J. A. , Bentrem D. J., Besh S., D'Amico T. A., Das P., Denlinger C., et al. 2013. Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J. Natl. Compr. Canc. Netw. 11:531–546.
    1. Sugarbaker, P. H. 2010. Surgical responsibilities in the management of peritoneal carcinomatosis. J. Surg. Oncol. 101:713–724.
    1. Chang, Y. R. , Han D. S., Kong S. H., Lee H. J., Kim S. H., Kim W. H., et al. 2012. The value of palliative gastrectomy in gastric cancer with distant metastasis. Ann. Surg. Oncol. 19:1231–1239.
    1. Xia, X. , Li C., Yan M., Liu B., Yao X., and Zhu Z.. 2014. Who will benefit from noncurative resection in patients with gastric cancer with single peritoneal metastasis? Am. Surg. 80:124–130.
    1. Sun, J. , Song Y., Wang Z., Chen X., Gao P., Xu Y., et al. 2013. Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta‐analysis. BMC Cancer 13:577.
    1. Lasithiotakis, K. , Antoniou S. A., Antoniou G. A., Kaklamanos I., and Zoras O.. 2014. Gastrectomy for stage IV gastric cancer. A systematic review and meta‐analysis. Anticancer Res. 34:2079–2085.
    1. Gold, J. S. , Jaques D. P., Bentrem D. J., Shah M. A., Tang L. H., Brennan M. F., et al. 2007. Outcome of patients with known metastatic gastric cancer undergoing resection with therapeutic intent. Ann. Surg. Oncol. 14:365–372.
    1. Moehler, M. , Galle P. R., Gockel I., Junginger T., and Schmidberger H.. 2007. The multidisciplinary management of gastrointestinal cancer. Multimodal treatment of gastric cancer. Best Pract. Res. Clin. Gastroenterol. 21:965–981.
    1. Rudloff, U. , Langan R. C., Mullinax J. E., Beane J. D., Steinberg S. M., Beresnev T., et al. 2014. Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J. Surg. Oncol. 110:275–284.
    1. Fujitani, K. , Yang H. K., Mizusawa J., Kim Y. W., Terashima M., Han S. U., et al. 2016. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non‐curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 17:309–318.
    1. Japanese research society for gastric cancer . 1995. Macroscopic findings Pp. 3–14 in Nishi M., Omori Y., Miwa K., eds. Japanese classification of gastric carcinoma. 1st Englished. Kanehara & Co. Ltd., Tokyo.
    1. Ko, K. J. , Shim J. H., Yoo H. M., SI O., Jeon H. M., Park C. H., et al. 2012. The clinical value of non‐curative resection followed by chemotherapy for incurable gastric cancer. World J. Surg. 36:1800–1805.
    1. Hioki, M. , Gotohda N., Konishi M., Nakagohri T., Takahashi S., and Kinoshita T.. 2010. Predictive factors improving survival after gastrectomy in gastric cancer patients with peritoneal carcinomatosis. World J. Surg. 34:555–562.
    1. Kim, S. W. 2014. The result of conversion surgery in gastric cancer patients with peritoneal seeding. J. Gastric. Cancer 14:266–270.
    1. Li, C. , Yan M., Chen J., Xiang M., Zhu Z. G., Yin H. R., et al. 2010. Survival benefit of non‐curative gastrectomy for gastric cancer patients with synchronous distant metastasis. J. Gastrointest. Surg. 14:282–288.
    1. Yang, K. , Liu K., Zhang W. H., Lu Z. H., Chen X. Z., Chen X. L., et al. 2015. The value of palliative gastrectomy for gastric cancer patients with intraoperatively proven peritoneal seeding. Medicine (Baltimore) 94:e1051.
    1. Gretschel, S. , Siegel R., Estevez‐Schwarz L., Hunerbein M., Schneider U., and Schlag P. M.. 2006. Surgical strategies for gastric cancer with synchronous peritoneal carcinomatosis. Br. J. Surg. 93:1530–1535.
    1. McCarter, M. D. , and Fong Y.. 2001. Role for surgical cytoreduction in multimodality treatments for cancer. Ann. Surg. Oncol. 8:38–43.
    1. Izuishi, K. , and Mori H.. 2016. Recent Strategies for treating stage IV gastric cancer: roles of palliative gastrectomy, chemotherapy, and radiotherapy. J. Gastrointestin. Liver Dis. 25:87–94.
    1. Yang, X. J. , Huang C. Q., Suo T., Mei L. J., Yang G. L., Cheng F. L., et al. 2011. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann. Surg. Oncol. 18:1575–1581.
    1. Glehen, O. , Gilly F. N., Arvieux C., Cotte E., Boutitie F., Mansvelt B., et al. 2010. Peritoneal carcinomatosis from gastric cancer: a multi‐institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann. Surg. Oncol. 17:2370–2377.
    1. Scaringi, S. , Kianmanesh R., Sabate J. M., Facchiano E., Jouet P., Coffin B., et al. 2008. Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: a single western center experience. Eur. J. Surg. Oncol. 34:1246–1252.
    1. Yonemura, Y. , Kawamura T., Bandou E., Takahashi S., Sawa T., and Matsuki N.. 2005. Treatment of peritoneal dissemination from gastric cancer by peritonectomy and chemohyperthermic peritoneal perfusion. Br. J. Surg. 92:370–375.
    1. Yan, T. D. , Black D., Sugarbaker P. H., Zhu J., Yonemura Y., Petrou G., et al. 2007. A systematic review and meta‐analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann. Surg. Oncol. 14:2702–2713.
    1. Glehen, O. , Schreiber V., Cotte E., Sayag‐Beaujard A. C., Osinsky D., Freyer G., et al. 2004. Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer. Arch. Surg. 139:20–26.
    1. Sugarbaker, P. H. , Yu W., and Yonemura Y.. 2003. Gastrectomy, peritonectomy, and perioperative intraperitoneal chemotherapy: the evolution of treatment strategies for advanced gastric cancer. Semin. Surg. Oncol. 21:233–248.
    1. Boerner, T. , Graichen A., Jeiter T., Zemann F., Renner P., März L., et al. 2016. CRS‐HIPEC prolongs survival but is not curative for patients with peritoneal carcinomatosis of gastric cancer. Ann. Surg. Oncol. doi:10.1245/s10434‐016‐5306‐0.
    1. Yonemura, Y. , Bandou E., Kawamura T., Endou Y., and Sasaki T.. 2006. Quantitative prognostic indicators of peritoneal dissemination of gastric cancer. Eur. J. Surg. Oncol. 32:602–606.
    1. Sugarbaker, P. H. 2001. Cytoreductive surgery and peri‐operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndrome. Eur. J. Surg. Oncol. 27:239–243.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere