Selective survival advantage associated with primary tumor resection for metastatic gastric cancer in a Western population
Background The prognosis of metastatic gastric cancer (GC) remains dismal, with a median survival of 10 months. Historically, primary tumor resection was not thought to confer any survival benefit. Although high-level data exist guiding treatment of metastatic GC for patients in the East, no such da...
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| Veröffentlicht in: | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2018-03, Vol.21 (2), p.324-337 |
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| container_title | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association |
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| creator | Warschkow, René Baechtold, Matthias Leung, Kenneth Schmied, Bruno M. Nussbaum, Daniel P. Gloor, Beat Blazer III, Dan G. Worni, Mathias |
| description | Background
The prognosis of metastatic gastric cancer (GC) remains dismal, with a median survival of 10 months. Historically, primary tumor resection was not thought to confer any survival benefit. Although high-level data exist guiding treatment of metastatic GC for patients in the East, no such data exist for Western patients despite inherent ethnic differences in GC biology.
Methods
The 2006–2012 National Cancer Database was queried for adult patients with metastatic gastric adenocarcinoma. Patients were classified into those who underwent primary tumor resection and chemotherapy (PTRaC) and those who received chemotherapy only. Groups were propensity score matched, and survival was compared using advanced statistical modeling.
Results
A total of 7026 patients met the inclusion criteria: 6129 (87%) patients were treated with chemotherapy alone and 897 (13%) patients were treated with PTRaC. After multivariable adjustment, patients who underwent PTRaC had a significantly better overall survival (OS) than patients who received systemic therapy only (HR, 0.60; 95% CI, 0.56–0.64;
p
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| doi_str_mv | 10.1007/s10120-017-0742-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1913395485</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2009484499</sourcerecordid><originalsourceid>FETCH-LOGICAL-c439t-a457ca32fe947748bedcd724123af9c6a8d2424ca019bf7ec80341c7511e0c893</originalsourceid><addsrcrecordid>eNp1kU-LFDEQxYMozuzqB_AiAS9eWlNJutM5yqDuwoAHFY-hJl099tB_xiQ9op_eNDPjguCpqsh7L0X9GHsB4g0IYd5GECBFIcAUwmhZlI_YGrSqCqVE-fjaSwsrdhPjQQgoLVRP2UrWla5kWa_Z78_Uk0_diXicw6k7Yc-xOeGYcE8cY5x8h4ka_rNL3_kxdAOGXzzNwxR4oLhYp5G3eRooYUyYOs_3uQm5ehw9Bd6NHPk3ionCyI_Tce5xcT1jT1rsIz2_1Fv29cP7L5u7Yvvp4_3m3bbwWtlUoC6NRyVbstoYXe-o8Y2RGqTC1voK60ZqqT0KsLvWkK-F0uBNCUDC11bdstfn3GOYfsx5DTd00VPf40jTHB1YUMqWui6z9NU_0sM0hzFv56QQVtda2yUQziofphgDte5yFwfCLWDcGYzLYNwCxi3JLy_J826g5q_jSiIL5FkQ89O4p_Dw9f9T_wDZQ5p3</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2009484499</pqid></control><display><type>article</type><title>Selective survival advantage associated with primary tumor resection for metastatic gastric cancer in a Western population</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Warschkow, René ; Baechtold, Matthias ; Leung, Kenneth ; Schmied, Bruno M. ; Nussbaum, Daniel P. ; Gloor, Beat ; Blazer III, Dan G. ; Worni, Mathias</creator><creatorcontrib>Warschkow, René ; Baechtold, Matthias ; Leung, Kenneth ; Schmied, Bruno M. ; Nussbaum, Daniel P. ; Gloor, Beat ; Blazer III, Dan G. ; Worni, Mathias</creatorcontrib><description>Background
The prognosis of metastatic gastric cancer (GC) remains dismal, with a median survival of 10 months. Historically, primary tumor resection was not thought to confer any survival benefit. Although high-level data exist guiding treatment of metastatic GC for patients in the East, no such data exist for Western patients despite inherent ethnic differences in GC biology.
Methods
The 2006–2012 National Cancer Database was queried for adult patients with metastatic gastric adenocarcinoma. Patients were classified into those who underwent primary tumor resection and chemotherapy (PTRaC) and those who received chemotherapy only. Groups were propensity score matched, and survival was compared using advanced statistical modeling.
Results
A total of 7026 patients met the inclusion criteria: 6129 (87%) patients were treated with chemotherapy alone and 897 (13%) patients were treated with PTRaC. After multivariable adjustment, patients who underwent PTRaC had a significantly better overall survival (OS) than patients who received systemic therapy only (HR, 0.60; 95% CI, 0.56–0.64;
p
< 0.001). Following full bipartite propensity score-adjusted analysis, 2-year OS for patients who received chemotherapy only was 12.6% (95% CI, 11.7–13.5%), whereas it was 34.2% (95% CI, 31.3–37.5%) for patients who underwent PTRaC (HR for resection: 0.52; 95% CI, 0.47–0.57;
p
< 0.001).
Conclusion
Our data suggest that there exists a subset of patients with metastatic GC for which PTRaC may improve OS. As significant uncertainty still remains, our results support the need for further prospective trials investigating the influence of palliative gastrectomy on survival among Western patients.</description><identifier>ISSN: 1436-3291</identifier><identifier>EISSN: 1436-3305</identifier><identifier>DOI: 10.1007/s10120-017-0742-5</identifier><identifier>PMID: 28646258</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Abdominal Surgery ; Adenocarcinoma ; Adenocarcinoma - drug therapy ; Adenocarcinoma - mortality ; Adenocarcinoma - surgery ; Adult ; Aged ; Antineoplastic Agents - therapeutic use ; Cancer Research ; Cancer therapies ; Chemotherapy ; Clinical trials ; Combined Modality Therapy - methods ; Female ; Gastrectomy ; Gastrectomy - methods ; Gastrectomy - mortality ; Gastric cancer ; Gastroenterology ; Humans ; Male ; Mathematical models ; Medical prognosis ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Middle Aged ; Oncology ; Original Article ; Palliative Care - methods ; Prognosis ; Propensity Score ; Retrospective Studies ; Stomach Neoplasms - drug therapy ; Stomach Neoplasms - mortality ; Stomach Neoplasms - surgery ; Surgical Oncology ; Survival ; Survival Analysis ; United States ; Young Adult</subject><ispartof>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2018-03, Vol.21 (2), p.324-337</ispartof><rights>The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2017</rights><rights>Gastric Cancer is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-a457ca32fe947748bedcd724123af9c6a8d2424ca019bf7ec80341c7511e0c893</citedby><cites>FETCH-LOGICAL-c439t-a457ca32fe947748bedcd724123af9c6a8d2424ca019bf7ec80341c7511e0c893</cites><orcidid>0000-0001-9422-431X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10120-017-0742-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10120-017-0742-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28646258$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Warschkow, René</creatorcontrib><creatorcontrib>Baechtold, Matthias</creatorcontrib><creatorcontrib>Leung, Kenneth</creatorcontrib><creatorcontrib>Schmied, Bruno M.</creatorcontrib><creatorcontrib>Nussbaum, Daniel P.</creatorcontrib><creatorcontrib>Gloor, Beat</creatorcontrib><creatorcontrib>Blazer III, Dan G.</creatorcontrib><creatorcontrib>Worni, Mathias</creatorcontrib><title>Selective survival advantage associated with primary tumor resection for metastatic gastric cancer in a Western population</title><title>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</title><addtitle>Gastric Cancer</addtitle><addtitle>Gastric Cancer</addtitle><description>Background
The prognosis of metastatic gastric cancer (GC) remains dismal, with a median survival of 10 months. Historically, primary tumor resection was not thought to confer any survival benefit. Although high-level data exist guiding treatment of metastatic GC for patients in the East, no such data exist for Western patients despite inherent ethnic differences in GC biology.
Methods
The 2006–2012 National Cancer Database was queried for adult patients with metastatic gastric adenocarcinoma. Patients were classified into those who underwent primary tumor resection and chemotherapy (PTRaC) and those who received chemotherapy only. Groups were propensity score matched, and survival was compared using advanced statistical modeling.
Results
A total of 7026 patients met the inclusion criteria: 6129 (87%) patients were treated with chemotherapy alone and 897 (13%) patients were treated with PTRaC. After multivariable adjustment, patients who underwent PTRaC had a significantly better overall survival (OS) than patients who received systemic therapy only (HR, 0.60; 95% CI, 0.56–0.64;
p
< 0.001). Following full bipartite propensity score-adjusted analysis, 2-year OS for patients who received chemotherapy only was 12.6% (95% CI, 11.7–13.5%), whereas it was 34.2% (95% CI, 31.3–37.5%) for patients who underwent PTRaC (HR for resection: 0.52; 95% CI, 0.47–0.57;
p
< 0.001).
Conclusion
Our data suggest that there exists a subset of patients with metastatic GC for which PTRaC may improve OS. As significant uncertainty still remains, our results support the need for further prospective trials investigating the influence of palliative gastrectomy on survival among Western patients.</description><subject>Abdominal Surgery</subject><subject>Adenocarcinoma</subject><subject>Adenocarcinoma - drug therapy</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Cancer Research</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>Combined Modality Therapy - methods</subject><subject>Female</subject><subject>Gastrectomy</subject><subject>Gastrectomy - methods</subject><subject>Gastrectomy - mortality</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Palliative Care - methods</subject><subject>Prognosis</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - drug therapy</subject><subject>Stomach Neoplasms - mortality</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>United States</subject><subject>Young Adult</subject><issn>1436-3291</issn><issn>1436-3305</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU-LFDEQxYMozuzqB_AiAS9eWlNJutM5yqDuwoAHFY-hJl099tB_xiQ9op_eNDPjguCpqsh7L0X9GHsB4g0IYd5GECBFIcAUwmhZlI_YGrSqCqVE-fjaSwsrdhPjQQgoLVRP2UrWla5kWa_Z78_Uk0_diXicw6k7Yc-xOeGYcE8cY5x8h4ka_rNL3_kxdAOGXzzNwxR4oLhYp5G3eRooYUyYOs_3uQm5ehw9Bd6NHPk3ionCyI_Tce5xcT1jT1rsIz2_1Fv29cP7L5u7Yvvp4_3m3bbwWtlUoC6NRyVbstoYXe-o8Y2RGqTC1voK60ZqqT0KsLvWkK-F0uBNCUDC11bdstfn3GOYfsx5DTd00VPf40jTHB1YUMqWui6z9NU_0sM0hzFv56QQVtda2yUQziofphgDte5yFwfCLWDcGYzLYNwCxi3JLy_J826g5q_jSiIL5FkQ89O4p_Dw9f9T_wDZQ5p3</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Warschkow, René</creator><creator>Baechtold, Matthias</creator><creator>Leung, Kenneth</creator><creator>Schmied, Bruno M.</creator><creator>Nussbaum, Daniel P.</creator><creator>Gloor, Beat</creator><creator>Blazer III, Dan G.</creator><creator>Worni, Mathias</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9422-431X</orcidid></search><sort><creationdate>20180301</creationdate><title>Selective survival advantage associated with primary tumor resection for metastatic gastric cancer in a Western population</title><author>Warschkow, René ; 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The prognosis of metastatic gastric cancer (GC) remains dismal, with a median survival of 10 months. Historically, primary tumor resection was not thought to confer any survival benefit. Although high-level data exist guiding treatment of metastatic GC for patients in the East, no such data exist for Western patients despite inherent ethnic differences in GC biology.
Methods
The 2006–2012 National Cancer Database was queried for adult patients with metastatic gastric adenocarcinoma. Patients were classified into those who underwent primary tumor resection and chemotherapy (PTRaC) and those who received chemotherapy only. Groups were propensity score matched, and survival was compared using advanced statistical modeling.
Results
A total of 7026 patients met the inclusion criteria: 6129 (87%) patients were treated with chemotherapy alone and 897 (13%) patients were treated with PTRaC. After multivariable adjustment, patients who underwent PTRaC had a significantly better overall survival (OS) than patients who received systemic therapy only (HR, 0.60; 95% CI, 0.56–0.64;
p
< 0.001). Following full bipartite propensity score-adjusted analysis, 2-year OS for patients who received chemotherapy only was 12.6% (95% CI, 11.7–13.5%), whereas it was 34.2% (95% CI, 31.3–37.5%) for patients who underwent PTRaC (HR for resection: 0.52; 95% CI, 0.47–0.57;
p
< 0.001).
Conclusion
Our data suggest that there exists a subset of patients with metastatic GC for which PTRaC may improve OS. As significant uncertainty still remains, our results support the need for further prospective trials investigating the influence of palliative gastrectomy on survival among Western patients.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>28646258</pmid><doi>10.1007/s10120-017-0742-5</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0001-9422-431X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal Surgery Adenocarcinoma Adenocarcinoma - drug therapy Adenocarcinoma - mortality Adenocarcinoma - surgery Adult Aged Antineoplastic Agents - therapeutic use Cancer Research Cancer therapies Chemotherapy Clinical trials Combined Modality Therapy - methods Female Gastrectomy Gastrectomy - methods Gastrectomy - mortality Gastric cancer Gastroenterology Humans Male Mathematical models Medical prognosis Medicine Medicine & Public Health Metastases Metastasis Middle Aged Oncology Original Article Palliative Care - methods Prognosis Propensity Score Retrospective Studies Stomach Neoplasms - drug therapy Stomach Neoplasms - mortality Stomach Neoplasms - surgery Surgical Oncology Survival Survival Analysis United States Young Adult |
| title | Selective survival advantage associated with primary tumor resection for metastatic gastric cancer in a Western population |
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