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QUESTIONING THE BENEFIT OF SURGICAL RESECTION IN SMALL CELL GASTRIC CANCER: AN ANALYSIS OF THE U.S. NCDB
Katelin Mirkin*2, Christopher Hollenbeak2, Joyce Wong1
1Lenox Hill Hospital/ Northwell Health, New York, NY; 2Penn State Medical Center, Hershey, PA
Introduction: Small cell cancer most commonly occurs in the lung although has been rarely reported in extrapulmonary locations, such as the stomach. They are considered to be aggressive and often present with metastatic disease. Surgery is of unknown benefit given the rarity of the diagnosis.
Methods: The United States National Cancer Data Base (NCDB) from 1998-2012 was utilized; patients with the diagnosis code of small cell carcinoma were included. Patients were stratified according to receipt of surgery. The primary endpoint was survival. Demographic and pathologic information was compared using student's t-test and chi-square test. Kaplan-Meier and Cox Proportional Hazards models were used to evaluate survival.
Results: 354 patients were included; the majority (257, 73%) were male. The median age was in the 7th[Office1] decade of life. The vast majority of patients presented with metastatic disease, stage IV (187, 53%). Proximal location was commonly seen, with 168 ( 48%) having gastric cardia or fundic (28, 8%) tumors. Only 53 (15%) underwent surgery; resection of other organs occurred in 20%. Lymphadenectomy was not frequently performed, with an average number of 2 regional examined lymph nodes. Surgical margins were positive in 32%.
When evaluating overall survival, surgery offered improved survival vs. no surgery, p<0.0001. This benefit was also observed in 98 patients with unknown clinical stage and 181 patients with stage IV disease. However, in 20 patients with clinical stage I disease, only 3 underwent resection and did not demonstrate improved survival, p=0.854. Similarly, in 26 patients with stage III disease, surgery did not offer improved survival, p=0.202. Of 9 patients with stage II disease, those who underwent surgery had worse survival, p=0.022. After controlling for patient and disease characteristics, surgery was associated with improved risk of mortality, HR 0.37, p<0.001.
Conclusions: Small cell carcinoma of the stomach is a rare entity, with the majority presenting with advanced disease in the proximal stomach. Although few patients undergo surgery, it seems to be associated with a modest survival benefit in some patients.
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