Survival benefit of palliative gastrectomy followed by chemotherapy in stage IV gastric signet ring cell carcinoma patients: A large population-based study.

Abstract

BACKGROUND:

Stage IV gastric signet ring cell carcinoma (SRCC) is a type of malignant gastric cancer (GC) with poorer survival compared to metastatic non-SRCC gastric cancer (NOS). However, chemotherapy alone was unable to maintain long-term survival. This study aimed to evaluate survival benefit of palliative gastrectomy plus chemotherapy (PG+C) for metastatic gastric SRCC.

METHODS:

We obtained data on gastric cancer patients between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Statistical methods included χ2 tests, Kaplan-Meier curves, COX models, propensity score matching (PSM) and subgroup analysis.

RESULTS:

Among 27 240 gastric cancer patients included, 4638 (17.03%) were SRCC patients. The proportion of patients with younger age, female gender, poorly differentiated grade and M1 stage was higher in SRCC than in NOS (P < .001). Multivariate analysis revealed that multiple metastatic sites (HR = 1.39, 95% CI: 1.14-1.69, P = .001) was associated with increased mortality risk in metastatic SRCC. Median survival time was improved in metastatic SRCC receiving PG+C compared to PG/C alone (13 vs 7 months, P < .001). Notably, in subgroup analysis, 13 of 17 groups of metastatic SRCC patients with PG+C had prolonged overall survival compared to chemotherapy alone, especially for those with only one metastatic site (HR = 0.61, 95% CI: 0.51-0.73, P < .001).

CONCLUSIONS:

Our results suggested that there exists at least a selective group of stage IV gastric SRCC patients, who could benefit from palliative gastrectomy followed by chemotherapy compared to chemotherapy alone. Further prospective trials are needed to support our conclusion.

• Authors: Tao Shi, Xueru Song, Qin Liu, Yang Yang, Lixia Yu, Baorui Liu, Jia Wei
• Journal: Cancer medicine (Cancer Med) Vol. 8 Issue 13 Pg. 6010-6020 (10 2019) ISSN: 2045-7634 [Electronic] United States
• PMID: 31448584 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Topics

• Adenocarcinoma (drug therapy, mortality, pathology, surgery)
• Aged
• Carcinoma, Signet Ring Cell
• Combined Modality Therapy
• Female
• Gastrectomy
• Humans
• Male
• Neoplasm Staging
• Palliative Care
• Stomach Neoplasms (drug therapy, mortality, pathology, surgery)