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SURGICAL MANAGEMENT OF METASTATIC GASTRIC CANCER: A NATIONAL CANCER DATABASE ANALYSIS
Omar Picado*, Levi Dygert, Basem Azab, Dido Franceschi, Danny Sleeman, Alan S. Livingstone, Nipun Merchant, Danny Yakoub
Surgery, University of Miami, Miami, FL
BACKGROUND: Surgical management of gastric cancer patients with synchronous liver metastasis is debated. The role of metastasectomy is not well defined. We seek to describe survival of surgically managed metastatic gastric cancer (MGC) patients.
METHODS: Data from the National Cancer Database (2010-2014), on patients with MGC were analyzed. Survival in patients who had palliative chemotherapy was compared to those who had gastrectomy and metastasectomy or gastrectomy and adjuvant chemotherapy. The association between treatment and hazard of death was assessed using Kaplan-Meier and Cox proportional hazards modeling.
RESULTS: We identified 3573 patients with MGC. Mean age was 64 years. M/F ratio was 3 to 1. White non-Hispanic race constituted 73.9% of patients. Over 93% of patients were insured and 33.9% were treated at an academic facility. Tumors were most commonly in the cardia (55.6%), were poorly differentiated (46%). All included patients had liver metastasis. There was no significant difference between the groups in terms of distribution of bone, brain metastases. Most patients (n=3461, 96.9%) were treated with palliative chemotherapy (PCT) while 46 patients had gastrectomy and metastasectomy and 66 patients had gastrectomy and adjuvant chemotherapy. Marginally more patients with lung metastasis were referred to PCT compared to surgical management. There was a significantly increased median overall survival (OS) in patients treated with surgery, those who had gastrectomy and metastasectomy (18.4 months), gastrectomy with adjuvant chemotherapy (14.8 months) compared to patients with PCT (9.2 months, p<0.001). Multivariate analysis showed decreased hazard of death in patients managed surgically: gastrectomy and metastasectomy (HR: 0.61, 95%CI: 0.44 - 0.87, p<0.01) and gastrectomy with adjuvant chemotherapy (HR: 0.52, 95%CI: 0.40 - 0.71, p<0.01). There was increased hazard of death with age (HR: 1.07, 95%CI: 1.03 - 1.11, p<0.01), non-academic facility (HR: 1.22, 95%CI: 1.08-1.38, p=0.01), Charlson-Deyo score of 2 (HR: 1.34, 95%CI: 1.15-1.56, p<0.01), and poorly differentiated grade (HR: 1.49, 95%CI: 1.14 - 1.95, p<0.01). There was no difference in survival based on gender, insurance status, T stage (short of vs invading serosa) or N stage.
CONCLUSION: Gastrectomy with metastasectomy in select patients or with adjuvant chemotherapy is associated with improved survival in metastatic gastric cancer patients.
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