Abstract
The role of conversion surgery in metastatic gastric cancer remains unclear. Cancer dormancy markers might have a role in predicting the survival in patients with conversion surgery. We identified 26 patients who went through conversion surgery, i.e., a curative-intent gastrectomy with metastasectomy after chemotherapy in initially metastatic gastric cancer. As controls, 114 potential candidates for conversion surgery who only received chemotherapy were included for the propensity score matching. Conversion surgery showed a significantly longer overall survival (OS) compared with only palliative chemotherapy (median—43.6 vs. 14.0 months, respectively, p < 0.001). This better survival in the conversion surgery group persisted even after propensity matching (p < 0.001), and also when compared to patients with tumor response over 5.1 months in the chemotherapy only group (p = 0.005). In the conversion surgery group, OS was longer in patients with R0 resection (22/26, 84.6%) than without R0 resection (4/26, 15.4%) (median—not reached vs 22.1 months, respectively, p = 0.005). Although it should be interpreted with caution due to the primitive analysis in a small population, the positive expression of NR2F1 showed a longer duration of disease-free survival (DFS) after conversion surgery (p = 0.016). In conclusion, conversion surgery showed a durable OS even in patients with initially metastatic gastric cancer when R0 resection was achieved after chemotherapy.
Highlights
The incidence of gastric cancer is widely varied geographically
We investigated whether the expression of cancer dormancy markers might play a role in predicting survival in patients receiving conversion surgery as a pilot study
The favorable response of complete response (CR) or partial response (PR) to palliative chemotherapy was seen in 17 patients (65.4%)
Summary
The incidence of gastric cancer is widely varied geographically. Despite the trend of steady decline and country-specific disparity, it remains to be the fifth most prevalent cancer and the third causeCancers 2020, 12, 86; doi:10.3390/cancers12010086 www.mdpi.com/journal/cancersCancers 2020, 12, 86 of death worldwide [1,2]. Conversion surgery is a term for operative resection of primary or metastatic lesions with a curative intent, after confirming either a complete response (CR) or partial response (PR), following several cycles of palliative chemotherapy. Addition of gastrectomy (without metastasectomy) to palliative chemotherapy in metastatic gastric cancer did not show survival benefit when compared with chemotherapy only in the previous REGATTA trial [4], there have been recent attempts to conduct surgery in selected patients with a good initial response to palliative chemotherapy [5,6,7,8,9,10,11,12]. It has been shown to improve the prognosis in a few retrospective studies Whether this improvement of survival is attributed to conversion surgery or good tumor biology in patients undergoing conversion surgery remains unclear. The characteristics of patients that might benefit from conversion surgery remain unknown
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