Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Abstract

Background/Aim: This work explored the prognostic role of curative versus non-curative surgery, the prognostic value of the various localizations of metastatic disease, and the possibility of identifying patients to be submitted to aggressive therapies. Patients and Methods: Retrospective chart review of stage IV patients operated on in our institutions. Results: Two hundred and eighty-two patients were considered; 73.4% had a single metastatic presentation. In 117 cases, a curative (R0) resection of primary and metastases was possible; 75 received a R1 resection and 90 a palliative R2 gastrectomy. Surgery was integrated with chemotherapy in multiple forms: conversion therapy, HIPEC, neo-adjuvant and adjuvant treatment. Median overall survival (OS) of the entire cohort was 10.9 months, with 14 months for the R0 subgroup. There was no correlation between metastasis site and survival. At multivariate analysis, several variables associated with the lymphatic sphere showed prognostic value, as well as tumor histology and the curativity of the surgical procedure, with a worse prognosis associated with a low number of resected nodes, D1 lymphectomy, pN3, non-intestinal histology, and R+ surgery. Considering the subgroup of R0 patients, the variables pT, pN and D displayed an independent prognostic role with a cumulative effect, showing that patients with no more than 1 risk factor can reach a median survival of 33 months. Conclusions: Our data show that the possibility of effective care also exists for Western patients with stage IV gastric cancer.

Surgical resection of synchronous liver metastases in gastric cancer patients. A propensity score-matched study

“…reported 5-year survival of 11.8%. 22 Although our results compare favourably to results of Ministrini et al ., some studies reported better long-term survival of up to 32% to 59%. 12 , 20 An important reason for better survival after liver resection in these repots might be that patients with metachronous liver resections were included.…”

Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer

“…In this study, the median participant age was 69 years, the median BMI was 20.3, and the median NLR was 3.15. These data are similar to those in previous studies for patients with stage IV gastric cancer [ 7 , 48 , 49 ]. In addition, the median survival time was 261 days in this study, comparable to the median survival time of less than 1 year that has been reported in patients with stage IV gastric cancer treated with chemotherapy [ 7 , 49 , 50 ].…”

“…These data are similar to those in previous studies for patients with stage IV gastric cancer [7,48,49]. In addition, the median survival time was 261 days in this study, comparable to the median survival time of less than 1 year that has been reported in patients with stage IV gastric cancer treated with chemotherapy [7,49,50]. Thus, the characteristics of patients enrolled in our study were similar to those in previous studies.…”

Conversion surgery for stage IV gastric cancer with a complete pathological response to nivolumab: a case report

“…According to the Japanese classification of gastric carcinoma, the presence or absence of residual tumor after surgery is defined as an R status [ 20 ]. Several studies have demonstrated that an R status is one of the most important prognostic factors in patients with advanced gastric cancer undergoing conversion surgery [ 21 – 24 ]. Yamaguchi et al had reported that the MST was 41.3 months and 21.2 months in patients with R0 and R1-2 resection undergoing conversion surgery after chemotherapy, respectively [ 21 ].…”