Surgical Management of Metastatic Gastric Cancer: A National Cancer Database Analysis

BACKGROUND: Surgical management of gastric cancer patients with synchronous liver metastasis is debated. We seek to describe survival of surgically managed metastatic gastric cancer (MGC) patients.METHODS: The National Cancer... [ view full abstract ]

BACKGROUND: Surgical management of gastric cancer patients with synchronous liver metastasis is debated. We seek to describe survival of surgically managed metastatic gastric cancer (MGC) patients.

METHODS: The National Cancer Database (2010-2014) was queried for MGC patients. Survival analysis of patients undergoing surgical resection and adjuvant chemotherapy (ACT) was compared to those treated with palliative chemotherapy (PCT).

RESULTS: We identified 3573 patients with MGC. All included patients had liver metastasis. Tumors were poorly differentiated (46%), mostly in the cardia (56%). Most patients (97%) were treated with PCT while 3% (n=112 patients) underwent surgery and ACT. There was a significantly increased median overall survival in patients treated with surgery and ACT (15.3 months) compared to PCT alone (9.2 months, p<0.001). On multivariate analysis hazards of death increased with increasing age (HR:1.07, 95%CI:1.03–1.11, p<0.01), non-academic institution (HR:1.20, 95%CI:1.11–1.30, p<0.01), and poorly differentiated grade (HR:1.18, 95%CI:1.07–1.30, p<0.01); and decreased in patients treated with gastrectomy with ACT (HR:0.53, 95%CI:0.40–0.71, p<0.01) and also gastrectomy with resection of distant site and ACT (HR:0.49, 95%CI:0.32–0.76, p<0.01).

CONCLUSION: Surgical resection with adjuvant chemotherapy is associated with improved survival, suggesting that surgery may be considered in the management of select metastatic gastric cancer patients.