Surgical treatment of gastric cancer liver metastases: Systematic review and meta-analysis of long-term outcomes and prognostic factors

Granieri, Stefano; Altomare, Michele; Bruno, Federica; Paleino, Sissi; Bonomi, Alessandro; Germini, Alessandro; Facciorusso, Antonio; Fagnani, Daniele; Bovo, Giorgio; Cotsoglou, Christian

doi:10.1016/j.critrevonc.2021.103313

Cited by 18 publications

(25 citation statements)

References 47 publications

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“…Carefully selected patients could benefit from surgery, which may significantly improve their overall survival. 11 Our prognostic analysis also demonstrated that palliative surgery is an independent protective factor for the survival of metastatic GC patients. Chemotherapy is now widely used as the standard treatment for stage IV GC patients.…”

Section: Discussionsupporting

confidence: 52%

Effect of Fuzheng Qingdu Therapy for Metastatic Gastric Cancer is Associated With Improved Survival: A Multicenter Propensity-Matched Study

et al. 2021

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Objective To evaluate the therapeutic effect of Traditional Chinese Medicine (TCM), specifically Fuzheng Qingdu (FZQD) therapy, on the survival time of metastatic GC patients. Patients and Methods Databases of medical records of 6 hospitals showed that 432 patients with stage IV GC were enrolled from March 1, 2012 to October 31, 2020. Propensity score matching (PSM) was used to reduce the bias caused by confounding factors in the comparison between the TCM and the non-TCM users. We used a Cox multivariate regression model to compare the hazard ratio (HR) value for mortality risk, and Kaplan-Meier survival curve for the survival time of GC patients Results The same number of subjects from the non-TCM group were matched with 122 TCM-treated patients after PSM to evaluate their overall survival (OS) and progression-free survival (PFS). Median time of OS of TCM and non-TCM users were 16.53 and 9.10 months, respectively. TCM and non-TCM groups demonstrated a 1-year survival rate of 68.5% and 34.5%, 2-year survival rate of 28.6% and 3.5%, and 3-year survival rate of 17.8% and 0.0%, respectively. A statistical difference exists in OS between the 2 groups (χ2 = 33.39 and P < .0001). The PFS of TCM users was also longer than that of non-TCM users (χ2 = 4.95 and P = 0.026). Notably, Chinese herbal decoction, Shenmai and compound Kushen injections were commonly used for FZQD therapy. Conclusion This propensity-matched study showed that FZQD therapy could improve the survival of metastatic GC patients.

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Section: Discussionsupporting

confidence: 52%

Effect of Fuzheng Qingdu Therapy for Metastatic Gastric Cancer is Associated With Improved Survival: A Multicenter Propensity-Matched Study

et al. 2021

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“…However, more and more surgeons investigated the role of surgery resection in patients with liver metastases inspired by survival benefits of surgery of colorectal cancer patients with liver metastases ( 13 , 19 , 20 ). Some retrospective studies showed that surgery, including liver resection or primary tumor resection in GCLM, significantly improved survival ( 11 , 21 – 23 ). But owing to the single center and small case data, the benefit of primary tumor resection for gastric patients with liver metastases needs to be further confirmed.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit of primary tumor resection for gastric cancer with liver metastasis: A propensity score-matched, population-based study

Chen

et al. 2022

Front. Oncol.

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ObjectivesGastric cancer with liver metastasis (GCLM) is highly aggressive and has a poor prognosis. This study aims to evaluate the survival benefit of primary tumor resection (PTR) for gastric cancer with liver metastasis.MethodsData on patients with GCLM was extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. A 1:1 propensity score matching (PSM) analysis was performed to minimize the heterogeneity between the PTR and no-PTR groups. The Kaplan–Meier method and Cox regression analysis were used to assess the impact of primary tumor resection (PTR) on overall survival (OS) and cause-specific survival (CSS).ResultsA total of 3,001 patients with GCLM were included, with 328 patients treated with primary tumor resection (PTR), whereas the other 2,673 patients were not. Patients with PTR had a significantly higher OS and CSS rate than those without PTR in unmatched and PSM cohorts. In an unmatched cohort, the median OS was 12.0 months (95% CI, 10 months to 14 months) for those who underwent PTR and 4 months (95% CI, 4 months to 5 months) for those without PTR; the median CSS for those who underwent PTR was 12.0 months (95% CI, 10 months to14 months) and 4 months (95% CI, 4 months to 5 months) for those without PTR, respectively. After PMS, the median OS was 12.0 months (95% CI, 10 months to 17 months) for those who underwent PTR and 7 months (95% CI, 5 months to 10 months) for those without PTR, respectively; the median CSS for those who underwent PTR was 12.0 months (95% CI, 11 months to 17 months) and 7 months (95% CI, 5 months to 8 months) for those without PTR, respectively. In addition, multivariate Cox analysis in the PSM cohort showed that PTR, age, degree of tumor differentiation, and chemotherapy were independent prognostic factors for OS and CSS in GCLM. Specifically, PTR was a significant protective factor for OS (HR: 0.427; 95% CI, 0.325 to 0.561, P <0.001) and CSS (HR: 0.419; 95% CI, 0.313 to 0.561, P <0.001).ConclusionPrimary tumor resection improves the survival of gastric cancer patients with liver metastasis.

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“…Subgroup analysis found that patients who underwent liver resection had improved survival and a 20% lower risk of overtime death. To some extent, this also clarifies the potential beneficial role of surgery in the treatment of patients with metastatic gastric cancer ( 16 ). In the case of liver metastases from gastric cancer, C-GCLM staging type I and some type II are feasible for comprehensive surgery-centered treatment, and it is noted that resection of the primary site and metastases can increase the overall 5-year survival rate of patients with liver metastases from gastric cancer to more than 20% under strict screening of the patient population ( 17 ).…”

Section: Introductionmentioning

confidence: 71%

Survival benefit of surgical resection for stage IV gastric cancer: A SEER-based propensity score-matched analysis

Sun

Nan

2022

Front. Surg.

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BackgroundGastric cancer (GC) is a major malignancy worldwide, and its incidence and mortality rate are increasing year by year. Clinical guidelines mainly use palliative drug combination therapy for stage IV gastric cancer. In accordance with some small sample studies, surgery can prolong survival. There is no uniform treatment plan for stage IV gastric cancer. This study focused on collecting evidence of the survival benefit of cancer-directed surgery (CDS) for patients with stage IV gastric cancer by analyzing data from a large sample.MethodsData on patients with stage IV gastric cancer diagnosed between 2010 and 2015 was extracted and divided into CDS and no-CDS groups using the large dataset in the Surveillance, Epidemiology, and End Results (SEER) database. With bias between the two groups minimized by propensity score matching (PSM), the prognostic role of CDS was studied by the Cox proportional risk model and Kaplan-Meier.ResultsA total of 6,284 patients with stage IV gastric cancer were included, including 514 patients with CDS who were matched with no-CDS patients according to propensity score (1:1), resulting in the inclusion of 432 patients each in the CDS and no-CDS groups. The results showed that CDS appeared to prolong the median survival time for stage IV gastric cancer (from 6 months to 10 months). Multifactorial analysis showed that poorly differentiated tumors (grades III-IV) significantly affected patient survival, and chemotherapy was a protective prognostic factor.ConclusionThe findings support that CDS can provide a survival benefit for stage IV gastric cancer. However, a combination of age, underlying physical status, tumor histology, and metastatic status should be considered when making decisions about CDS, which will aid in clinical decision-making.

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Surgical treatment of gastric cancer liver metastases: Systematic review and meta-analysis of long-term outcomes and prognostic factors

Cited by 18 publications

References 47 publications

Effect of Fuzheng Qingdu Therapy for Metastatic Gastric Cancer is Associated With Improved Survival: A Multicenter Propensity-Matched Study

Effect of Fuzheng Qingdu Therapy for Metastatic Gastric Cancer is Associated With Improved Survival: A Multicenter Propensity-Matched Study

Survival benefit of primary tumor resection for gastric cancer with liver metastasis: A propensity score-matched, population-based study

Survival benefit of surgical resection for stage IV gastric cancer: A SEER-based propensity score-matched analysis

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