Abstract
Chemotherapy is generally considered as the main treatment for metastatic gastric adenocarcinoma. The role of gastrectomy for metastatic gastric cancer without obvious symptoms is controversial. The objective of this study is to investigate survival outcomes of treatment modalities using a real-world data setting. A retrospective cohort study was designed using the Taiwan Cancer Registry database. We identified the treatment modalities and used Kaplan–Meier estimates and Cox regressions to compare patient survival outcomes. From 2008 to 2015, 5599 gastric adenocarcinoma patients were diagnosed with metastatic disease (M1). The median overall survival (OS) of patients with surgery plus chemotherapy had the longest survival of 14.2 months. The median OS of the patients who received chemotherapy alone or surgery alone was 7.0 and 3.9, respectively. Age at diagnosis, year of diagnosis, tumor grade, and treatment modalities are prognostic factors for survival. The hazard ratios for patients who received surgery plus chemotherapy, surgery alone, and supportive care were 0.47 (95% CI 0.44–0.51), 1.22 (95% CI 1.1–1.36), and 3.23 (95% CI 3.01–3.46), respectively, by multivariable Cox regression analysis when using chemotherapy alone as a referent. Chemotherapy plus surgery may have a survival benefit for some selected gastric adenocarcinoma patients with metastatic disease.
Highlights
Only 3 to 5 months without treatment
We evaluated the treatment modalities and survival outcome of metastatic gastric adenocarcinoma patients and analyzed the prognostic factors associated with their survival status through the nationwide cancer registry database
There were 3429 male patients (61.2%), 54.6% of the cases were diagnosed at ≥ 65 years old, and 62.5% of cases treated in medical centers
Summary
Palliative chemotherapy is suggested to the patients with unresectable or recurrent disease to delay the development of disease-related symptoms and prolong the survival. The perioperative morbidity and mortality rates for gastrectomy have decreased substantially over the last few decades, the latter ranging from 1 to 12%15–17, and elective palliative gastrectomy is associated with a lower complication rate compared to its use is an emergency situation[18]. Many factors may affect the selection of treatment modality and the treatment outcome for metastatic gastric adenocarcinoma, such as age, performance status, or the presence of tumor-related symptoms or complications. We evaluated the treatment modalities and survival outcome of metastatic gastric adenocarcinoma patients and analyzed the prognostic factors associated with their survival status through the nationwide cancer registry database. We analyzed the effect of gastrectomy on the survival of metastatic gastric adenocarcinoma patients
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