The long-term survival of stage IV gastric cancer patients with conversion therapy

Kazuya Yamaguchi, Kazuhiro Yoshida, Toshiyuki Tanahashi, Takao Takahashi, Nobuhisa Matsuhashi, Yoshihiro Tanaka, Kazuaki Tanabe, Hideki Ohdan, Kazuya Yamaguchi, Kazuhiro Yoshida, Toshiyuki Tanahashi, Takao Takahashi, Nobuhisa Matsuhashi, Yoshihiro Tanaka, Kazuaki Tanabe, Hideki Ohdan

Abstract

Purpose: A retrospective study was performed to clarify the role of conversion therapy (surgery with a prospect of R0 resection performed in initially unresectable metastatic cancer that responded to the chemotherapy) in stage IV gastric cancer (GC).

Patients and methods: We treated 259 stage IV GC patients with systemic chemotherapy at Gifu and Hiroshima University Hospitals between 2001-2013. Of these, 84 patients who were subsequently treated by surgery were classified into four categories according to our previously published classification of stage IV GC, and short- and long-term outcomes were analyzed.

Results: Surgery was performed in 84 patients, of which 7 were performed following the neoadjuvant chemotherapy, whereas the other 77 that excluded neoadjuvant chemotherapy cases were considered the conversion therapy. The postoperative mortality and morbidity were comparable with those reported clinical trials. The MSTs of the patients with/without surgery for each category were 28.3/5.8 months for category 1, 30.5/11.0 months for category 2, 31.0/18.5 months for category 3 and 24.7/10.0 months for category 4. The MST of the R0 resected patients (41.3 months) was far better than that of the R1-2 resected patients (21.2 months). The MSTs of the patients with R0/R1-2 resection were 56.2/16.3 months for category 2, 33.3/29.6 months for category 3 and 40.7/17.8 months for category 4.

Conclusion: There were long-term survivors who underwent conversion therapy for stage IV GC. Adequate selection of stage IV GC patients for conversion therapy may be an important role for the surgical oncologist in the new era.

Keywords: Adjuvant surgery; Chemotherapy; Conversion therapy; Gastric cancer; Metastatic gastric cancer.

Conflict of interest statement

Conflict of interest

K. Yoshida has received grants, personal fees and nonfinancial support from Chugai Pharmaceutical Co., Ltd., during the conduct of the study; grants and personal fees from Taiho Pharmaceutical Co., Ltd.; grants and personal fees from Pfizer Inc.; grants and personal fees from Yakult Honsha Co., Ltd.; grants from Bristol-Myers Squibb; grants from Kyowa Hakko Kirin Co., Ltd., outside the submitted work; honoraria from Taiho Pharmaceutical Co., Ltd.; Pfizer Inc.; Chugai Pharmaceutical Co., Ltd.; Kyowa Hakko Kirin Co., Ltd.; Yakult Honsha Co., Ltd.; and had a consultant or advisory relationship to Taiho Pharmaceutical Co., Ltd., and La Roche, Ltd. All remaining authors declared that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and in compliance with the Helsinki Declaration of 1964 and later versions. Both hospitals disclose information to the patients. Participating patients were excluded only when they specified that they were unwilling to participate.

Figures

Fig. 1
Fig. 1
Consort diagram. A total of 259 patients were enrolled in the present cohort study, and 84 received conversion therapy. #1: DCS, docetaxel/cisplatin/S-1 therapy. #2: Others, XP(+Tmab) 4 patients, S-1/CPT-11 1 patient, cisplatin/paclitaxel 1 patient
Fig. 2
Fig. 2
Survival curve of all patients enrolled in the present analysis. Survival curve of the patients who received and did not receive conversion therapy. The MST of the patients with conversion surgery and NAC patients (resected) was 30.5 months, and it was 11.3 months in those without conversion surgery (unresected). The MST of R0 resected patients (R0 surgery) was 41.3 months and that of patients with R1 and R2 resection (R1–2 surgery) was 21.2 months
Fig. 3
Fig. 3
Survival curve of the patients according to the new categories of classification for stage IV GC. The MST of patients with operation (n = 7) in category 1 was 28.3 months, while that of patients without surgery (n = 2) was 5.8 months. In category 2, the MST with conversion therapy (n = 42) was 30.5 months and that of patients without surgery (n = 93) was 11.0 months. The MST of category 3 patients with surgery (n = 16) was 31.0 months and that of patients without surgery (n = 15) was 18.5 months. The MST of category 4 patients with surgery (n = 19) was 24.7 months and that of patients without surgery (n = 65) was 10.0 months

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Source: PubMed

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