Palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis

Abstract

BackgroundWhether palliative gastrectomy combined with chemotherapy can improve the survival of patients with advanced gastric cancer remains controversial. We performed a meta-analysis to clarify whether palliative gastrectomy plus chemotherapy can benefit patients with incurable advanced gastric cancer and to explore the best candidates in this patient population.MethodsWe searched the literature systematically using electronic databases including PubMed, EMBASE, and the Cochrane Library. And HRs and their 95% CIs were used to express the results for overall survival (OS) and progression-free survival (PFS).ResultsOne randomized controlled trial with 175 patients and 12 cohort studies with 2,193 patients were analyzed. The pooled HR for OS (HR=0.43, 95% CI=0.29–0.65, P<0.001), subgroup analysis of stage M1 (HR=0.53, 95% CI=0.40–0.72, P<0.001), peritoneal dissemination (HR=0.46, 95% CI=0.28–0.73, P=0.001), and liver metastasis (HR=0.46, 95% CI=0.33–0.65, P<0.001) all indicated the superiority of palliative gastrectomy plus chemotherapy. However, the pooled HR for PFS (HR=0.61, 95% CI=0.33–1.13, P=0.110) got separate outcome.ConclusionThe results of this meta-analysis indicated that palliative gastrectomy plus chemotherapy can improve OS for incurable advanced gastric cancer. In addition, analyses based on liver metastasis and peritoneal dissemination demonstrated the advantages of palliative gastrectomy plus chemotherapy. However, the PFS of incurable advanced gastric cancer with palliative gastrectomy plus chemotherapy was no better than that under chemotherapy alone.

HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study

“…More importantly, survival analysis showed that patients treated with HIFU had the best OS and PFS, followed by PC, while the BSC group had the worst survival rate. The median survival time in the BSC group was about half a year, which is in line with previous studies [ 42 , 43 ]. The median survival time of the patients who underwent PC was about twice as long as that of the BSC group, up to approximately 1 year.…”

HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study Running title: HIFU treatment for gastric cancer with liver metastases

“…More importantly, survival analysis showed that patients treated with HIFU had the best OS and PFS, followed by PC, while the BSC group had the worst survival rate. The median survival time in the BSC group was about half a year, which is in line with previous studies [42,43]. The median survival time of the patients who underwent PC was about twice as long as that of the BSC group, up to approximately 1 year.…”

The Impact of Intervention on Survival of Elderly Patients with Gastric Cancer at IV Stage: A SEER Population-Based Study.

“…Although Katai et al [10] reported nonideal short-term survival after surgery in elderly patients ten years ago, some recent studies have demonstrated that the postoperative morbidity and mortality in elderly patients are comparable with those in younger patients [19,22], which may be attributable to advances in nutritional support, anesthesia, surgical instruments and skills. The benefits of surgery plus CT for the survival of GC patients with stage IV disease were also clearly identified [12,26,27,32]. The postoperative complication rate was not different between elderly populations of different ages, which suggested that the benefits of surgical intervention would not decrease with age.…”