Significance of surgical treatment in multimodal therapy for stage IV highly advanced gastric cancer

Abstract

Background/aims: The purpose of this study was to evaluate the efficacy of surgical treatment following a response to chemotherapy to improve stage IV gastric cancer and to identify the factors contributing to survival benefit.

Methodology: In total, 148 patients with cStage IV gastric cancer were treated with S-1 and CDDP. We retrospectively evaluated the factors contributing to a survival benefit and the significance of surgical treatment.

Results: The 148 cStage IV patients included 107 males with a median age of 61 years. The overall response rate was 54.7%. After chemotherapy, 97 patients underwent surgery. R0 resection was successfully performed in 51 (52.6%) patients. The overall median survival time (MST) of the patients was 16.8 months, with a 5YSR of 16.4%. The MST of patients who went on to receive surgery was 22.5 months, and the 5YSR was 19.6%. In the multivariate analysis of 97 patients who underwent surgery, R0 resection, lymph node dissection of D2/D3 and obtaining a CR/PR from chemotherapy were the only independently prognostic factors.

Conclusions: The use of multi-modal treatment, including surgical treatment, at an appropriate time was well tolerated and effective for patients with stage IV gastric cancer.