Prognostic Significance of Conversion Surgery Following First- or Second-line Chemotherapy for Unresectable Gastric Cancer.

Abstract

Advances in chemotherapy for gastric cancer have encouraged surgeons to perform conversion surgery following a response to first-line chemotherapy in patients with initially unresectable gastric cancer. In this study we evaluated the efficacy of conversion surgery following first- or second-line chemotherapy for unresectable gastric cancer. We retrospectively analyzed clinicopathological and survival data of 94 patients with unresectable gastric cancer treated with first- (n=94) or second-line (n=43) chemotherapy. Patients who converted to surgery following first- (n=26) or second-line (n=5) chemotherapy had significantly longer survival times than those treated with chemotherapy alone (n=63) (p<0.01). Survival length did not differ significantly between patients converted to surgery following first- and second-line chemotherapy. Among 31 patients who underwent conversion surgery, one initial non-curative factor (odds ratio(OR)=0.49; 95% confidence interval (95%CI)=0.22-0.95; p=0.03) was the only significant independent predictor of longer survival in multivariate Cox regression analysis. Patients with unresectable gastric cancer initially exhibiting one noncurative factor may obtain survival benefit from conversion surgery after a response to both first- and second-line chemotherapy.