Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | No. of Patients (%) |
---|---|
Age (years) | 60.6 ± 14.1 |
Sex | |
Male | 95 (64.2) |
Female | 53 (35.8) |
Body mass index (kg/m2) | 22.2 ± 3.2 |
ASA-PS score | |
1 | 51 (34.5) |
2 | 85 (57.4) |
3 | 11 (7.4) |
4 | 1 (0.7) |
Histology | |
Differentiated | 39 (26.4) |
Undifferentiated | 106 (71.6) |
Unknown | 3 (2.0) |
Gross type | |
Bormann type I | 1 (0.7) |
Bormann type II | 13 (8.8) |
Bormann type III | 77 (52.0) |
Bormann type IV | 38 (25.7) |
Unspecified | 19 (12.8) |
Metachronous cancer in the remnant stomach | 6 (4.1) |
Outlet obstruction | 14 (9.5) |
Bleeding from cancer | 5 (3.4) |
Preoperative radiologic findings | |
Adjacent organ invasion | 19 (12.8) |
Metastatic disease | 33 (22.3) |
Tumor markers at baseline | |
CEA (ng/mL) | 1.8 (0.4–255.3) |
CA 19-9 (U/mL) | 15.9 (0.2–1822.9) |
CA 125 (U/mL) | 8.8 (0.9–200.8) |
Type of surgery | |
Palliative resection | 55 (37.2) |
Distal gastrectomy | 28 (18.9) |
Total gastrectomy | 25 (16.9) |
Whipple’s operation | 2 (1.4) |
Nonresection | 93 (62.8) |
Bypass surgery (including gastrojejunostomy) | 39 (26.4) |
Opening and closure | 54 (36.5) |
Combined resection | 24 (16.2) |
Extent of lymph-node dissection | |
D0 | 93 (62.8) |
Less than D2 | 4 (2.7) |
D2 or more | 51 (34.5) |
Reason for incurability | |
Advanced primary disease | 65 (43.9) |
Extended nodal disease | 21 (14.2) |
Metastatic disease | 120 (81.1) |
Peritoneal seeding | 100 (67.6) |
Hepatic metastasis | 9 (6.1) |
Metastasis to other organs (except for liver) | 9 (6.1) |
Two or more noncurative factors | 48 (32.4) |
Intraperitoneal chemotherapy † | 14 (9.5) |
Postoperative chemotherapy | 102 (68.9) |
Overall survival (months) | 10.9 (0.2–69.5) |
Variables | Before Matching | After Matching | ||||
---|---|---|---|---|---|---|
PG Group (n = 55) | NR Group (n = 93) | p-Value | PG Group (n = 55) | NR Group (n = 55) | p-Value | |
Age at operation (years) | 54.0 ± 14.1 | 64.5 ± 12.6 | <0.001 | 54.0 ± 14.1 | 59.9 ± 12.1 | 0.020 |
Sex | ||||||
Male | 28 (50.9%) | 67 (72.0%) | 0.013 | 28 (50.9%) | 36 (65.5%) | 0.122 |
Female | 27 (49.1%) | 26 (28.0%) | 27 (49.1%) | 19 (34.5%) | ||
ASA-PS classification | 0.054 | 0.076 | ||||
1 | 21 (38.2%) | 30 (32.3%) | 21 (38.2%) | 16 (29.1%) | ||
2 | 26 (47.3%) | 59 (63.4%) | 26 (47.3%) | 37 (67.3%) | ||
3 | 7 (12.7%) | 4 (4.3%) | 8 (14.5%) | 2 (3.6%) | ||
4 | 1 (1.8%) | 0 (0%) | 1 (1.8%) | 0 (0%) | ||
Clinical stage * | ||||||
T category | 0.109 | 0.495 | ||||
T2 | 3 (5.5%) | 2 (2.2%) | 3 (5.5%) | 1 (1.8%) | ||
T3 | 9 (16.4%) | 18 (19.4%) | 9 (16.4%) | 12 (21.8%) | ||
T4a | 24 (43.6%) | 26 (28.0%) | 24 (43.6%) | 19 (34.5%) | ||
T4b | 19 (34.5%) | 47 (50.5%) | 19 (34.5%) | 23 (41.8%) | ||
N category | 0.311 | |||||
N0 | 5 (9.1%) | 8 (8.6%) | 0.086 | 5 (9.1%) | 4 (7.3%) | |
N1 | 7 (12.7%) | 24 (25.8%) | 7 (12.7%) | 13 (23.6%) | ||
N2 | 24 (43.6%) | 45 (48.4%) | 24 (43.6%) | 27 (49.1%) | ||
N3a | 18 (32.7%) | 15 (16.1%) | 18 (32.7%) | 11 (20.0%) | ||
N3b | 1 (1.8%) | 1 (1.1%) | 1 (1.8%) | 0 (0%) | ||
Reason for incurability | ||||||
Advanced primary disease | 19 (34.5%) | 46 (54.1%) | 0.025 | 19 (34.5%) | 23 (41.8%) | 0.432 |
Extended nodal disease | 7 (12.7%) | 10 (10.8%) | 0.792 | 7 (12.7%) | 7 (12.7%) | >0.999 |
Metastatic disease | ||||||
Peritoneal seeding | 41 (74.5%) | 59 (63.4%) | 0.204 | 41 (74.5%) | 37 (67.3%) | 0.401 |
Hepatic metastasis | 1 (1.8%) | 8 (8.6%) | 0.154 | 1 (1.8%) | 1 (1.8%) | >0.999 |
Metastasis to other organs (except for liver) | 5 (9.1%) | 4 (4.3%) | 0.293 | 5 (9.1%) | 3 (5.5%) | 0.716 |
Two or more noncurative factors | 20 (36.4%) | 28 (30.1%) | 0.470 | 20 (36.4%) | 13 (23.6%) | 0.146 |
Postoperative complications † | <0.001 | 0.003 | ||||
None | 44 (80.0%) | 90 (96.8%) | 44 (80.0%) | 54 (98.2%) | ||
Grade I | 7 (12.7%) | 1 (1.1%) | 7 (12.7%) | 0 (0%) | ||
Grade II | 3 (5.5%) | 2 (2.2%) | 3 (5.5%) | 1 (1.8%) | ||
Grade IV | 1 (1.8%) | 0 | 1 (1.8%) | 0 (0%) | ||
Length of hospital stay (days) | 13.0 ± 11.1 | 9.3 ± 7.3 | 0.017 | 13.0 ± 11.1 | 9.5 ± 8.0 | 0.063 |
Preoperative chemotherapy | 4 (7.3%) | 6 (6.5%) | >0.999 | 4 (7.3%) | 5 (9.1%) | >0.999 |
Intraperitoneal chemotherapy | 14 (25.5%) | 0 | <0.001 | 14 (25.5%) | 0 (0%) | <0.001 |
Postoperative chemotherapy | 47 (85.5%) | 55 (59.1%) | 0.001 | 47 (85.5%) | 31 (56.4%) | 0.001 |
No. of chemotherapy cycles ‡ | 13 (1–104) | 8 (1–44) | 0.004 | 13 (1–104) | 8 (1–39) | 0.027 |
Variables | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | |
Palliative resection (vs. nonresection) | 0.185 (0.106–0.321) | <0.001 | 0.169 (0.089–0.321) | <0.001 |
Age < 70 years (vs. age ≥ 70) | 0.545 (0.307–0.969) | 0.039 | 0.617 (0.322–1.181) | 0.145 |
Male (vs. female) | 1.382 (0.832–2.295) | 0.211 | ||
ASA-PS ≤ 1 | 0.476 (0.270–0.842) | 0.011 | 0.425 (0.215–0.838) | 0.014 |
Outlet obstruction | 1.466 (0.631–3.409) | 0.374 | ||
Differentiated (vs. undifferentiated) | 0.943 (0.527–1.685) | 0.842 | ||
Tumor markers | ||||
CEA > 7 | 1.390 (0.502–3.849) | 0.527 | ||
CA 19-9 > 37 | 0.858 (0.476–1.545) | 0.609 | ||
CA 125 > 30 | 2.020 (0.908–4.494) | 0.085 | 1.373 (0.532–3.543) | 0.512 |
Surgical findings | ||||
Advanced primary disease | 1.127 (0.676–1.880) | 0.646 | ||
Extended nodal disease | 1.435 (0.705–2.921) | 0.319 | ||
Peritoneal seeding | 0.662 (0.389–1.127) | 0.129 | ||
Hepatic metastasis | 0.627 (0.087–4.549) | 0.645 | ||
Neoadjuvant chemotherapy | 1.983 (0.899–4.371) | 0.090 | 0.797 (0.270–2.350) | 0.681 |
Intraperitoneal chemotherapy | 0.561 (0.255–1.234) | 0.151 | ||
Postoperative chemotherapy | 0.326 (0.189–0.563) | <0.001 | 0.665 (0.360–1.231) | 0.194 |
Variables | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | |
Age < 70 years (vs. age ≥ 70) | 0.432 (0.174–1.072) | 0.070 | 1.170 (0.371–3.689) | 0.788 |
Male (vs. female) | 1.246 (0.545–2.848) | 0.601 | ||
ASA-PS ≤ 1 | 0.409 (0.152–1.104) | 0.078 | 0.528 (0.181–1.537) | 0.241 |
Differentiated (vs. undifferentiated) | 0.850 (0.252–2.867) | 0.793 | ||
Extent of surgery | ||||
Distal gastrectomy | Ref. | 0.624 | ||
Total gastrectomy | 0.845 (0.365–1.956) | 0.695 | ||
Whipples’ operation | 2.308 (0.292–18.252) | 0.428 | ||
LND ≥ D2 (vs. LND < D2) | 1.527 (0.204–11.419) | 0.680 | ||
Pathologic findings | ||||
No. of positive nodes < 15 | 0.351 (0.148–0.832) | 0.014 | 0.327 (0.129–0.831) | 0.019 |
Peritoneal seeding | 0.862 (0.339–2.190) | 0.755 | ||
Extended nodal disease | 3.472 (1.237–9.745) | 0.018 | 3.078 (0.931–10.176) | 0.065 |
Advanced primary disease | 1.017 (0.415–2.495) | 0.971 | ||
Intraperitoneal chemotherapy | 1.380 (0.559–3.407) | 0.484 | ||
Postoperative chemotherapy | 0.339 (0.112–1.024) | 0.055 | 0.258 (0.068–0.984) | 0.047 |
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Park, J.Y.; Yu, B.; Park, K.B.; Kwon, O.K.; Lee, S.S.; Chung, H.Y. Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer. Medicina 2021, 57, 198. https://doi.org/10.3390/medicina57030198
Park JY, Yu B, Park KB, Kwon OK, Lee SS, Chung HY. Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer. Medicina. 2021; 57(3):198. https://doi.org/10.3390/medicina57030198
Chicago/Turabian StylePark, Ji Yeon, Byunghyuk Yu, Ki Bum Park, Oh Kyoung Kwon, Seung Soo Lee, and Ho Young Chung. 2021. "Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer" Medicina 57, no. 3: 198. https://doi.org/10.3390/medicina57030198