Preliminary trial of adjuvant surgery for advanced gastric cancer

Abstract

In patients with stage IV gastric cancer, systemic chemotherapy is the key treatment. Combination chemotherapy (cis-diamminedichloride platinum plus S-1 and docetaxel plus S-1) results in long-term survival in clinical practice. In selected cases, additional (adjuvant) surgery may result in further long-term survival. This study aimed to evaluate the efficacy of adjuvant surgery following the response to chemotherapy for advanced gastric cancer. Based on response to chemotherapy, the indications for adjuvant surgery (surgery after the response to chemotherapy) are that resection is expected to be curative rather than palliative, provided that no other distant metastases occur. The study included 20 advanced gastric cancer patients who had undergone gastrectomies after the response to the combination chemotherapy of docetaxel and S-1, between September 2003 and December 2008 at Hiroshima University Hospital. At a median follow-up of 980 days, the median overall survival was 855 days. A 2- and 3-year survival was observed in 80 and 54.9% of patients, respectively, following macroscopic curative surgery. In the palliative group, the median overall survival was 510 days, but a 3-year survival was not observed. In the partial response group, the median overall survival was 865 days and a 3-year survival was observed in 37% of patients. One-year survival was not observed in the stable disease group. The patient survival in the partial response group was statistically more prolonged than in the stable disease group. The median overall survival in patients with liver metastasis was 865 days, while that in patients with peritoneal dissemination was 510 days. In conclusion, adjuvant surgery may be effective in gastric cancer patients diagnosed as stage IV by means of liver or distant lymph node metastasis, except in cases of peritoneal dissemination.

Figure 1

Overall survival. At a median follow-up of 980 days, OS was 855 days.

Figure 2

Comparison of OS in patients between the curative resection and palliative groups. A 2- and 3-year survival was observed in 80 and 54.9% of patients, respectively, following macroscopic curative surgery. In the palliative group, the median OS was 510 days, but a 3-year survival was not observed.

Figure 3

Comparison of OS in patients between the partial response and stable disease groups. In the partial response group, the median OS was 865 days and a 3-year survival was observed in 37% of patients. One-year survival was not observed in the stable disease group.

Figure 4

Comparison of OS among the various unresectable factors (liver metastasis, H factor; peritoneal dissemination, P factor; lymph node metastasis, N factor). The median OS in patients with the H factor was 865 days, while that in patients with the P factor was 510 days.