The role of surgical resection for stage IV gastric cancer with synchronous hepatic metastasis

Omar Picado, Levi Dygert, Francisco Igor Macedo, Dido Franceschi, Danny Sleeman, Alan S. Livingstone, Nipun Merchant, Danny Yakoub

Research output: Contribution to journalArticle

Abstract

Background: With improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. Methods: The National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. Results: We identified 3175 patients with MGC to the liver. Most patients (94%, n = 2979) were treated with PCT, whereas 6% (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95% CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95% CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95% CI: 1.17-2.03, P < 0.001). Conclusions: G-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.

Original languageEnglish (US)
Pages (from-to)422-429
Number of pages8
JournalJournal of Surgical Research
Volume232
DOIs
StatePublished - Dec 1 2018

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Stomach Neoplasms
Liver Neoplasms
Neoplasm Metastasis
Drug Therapy
Liver
Confidence Intervals
Survival
Gastrectomy
Adjuvant Chemotherapy
Survival Analysis
Databases
Therapeutics
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery

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The role of surgical resection for stage IV gastric cancer with synchronous hepatic metastasis. / Picado, Omar; Dygert, Levi; Macedo, Francisco Igor; Franceschi, Dido; Sleeman, Danny; Livingstone, Alan S.; Merchant, Nipun; Yakoub, Danny.

In: Journal of Surgical Research, Vol. 232, 01.12.2018, p. 422-429.

Research output: Contribution to journalArticle

Picado, O, Dygert, L, Macedo, FI, Franceschi, D, Sleeman, D, Livingstone, AS, Merchant, N & Yakoub, D 2018, 'The role of surgical resection for stage IV gastric cancer with synchronous hepatic metastasis', Journal of Surgical Research, vol. 232, pp. 422-429. https://doi.org/10.1016/j.jss.2018.06.067
Picado, Omar ; Dygert, Levi ; Macedo, Francisco Igor ; Franceschi, Dido ; Sleeman, Danny ; Livingstone, Alan S. ; Merchant, Nipun ; Yakoub, Danny. / The role of surgical resection for stage IV gastric cancer with synchronous hepatic metastasis. In: Journal of Surgical Research. 2018 ; Vol. 232. pp. 422-429.
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abstract = "Background: With improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. Methods: The National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. Results: We identified 3175 patients with MGC to the liver. Most patients (94{\%}, n = 2979) were treated with PCT, whereas 6{\%} (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95{\%} confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95{\%} CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95{\%} CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95{\%} CI: 1.17-2.03, P < 0.001). Conclusions: G-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.",
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AU - Picado, Omar

AU - Dygert, Levi

AU - Macedo, Francisco Igor

AU - Franceschi, Dido

AU - Sleeman, Danny

AU - Livingstone, Alan S.

AU - Merchant, Nipun

AU - Yakoub, Danny

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: With improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. Methods: The National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. Results: We identified 3175 patients with MGC to the liver. Most patients (94%, n = 2979) were treated with PCT, whereas 6% (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95% CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95% CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95% CI: 1.17-2.03, P < 0.001). Conclusions: G-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.

AB - Background: With improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. Methods: The National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. Results: We identified 3175 patients with MGC to the liver. Most patients (94%, n = 2979) were treated with PCT, whereas 6% (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95% CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95% CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95% CI: 1.17-2.03, P < 0.001). Conclusions: G-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.

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