Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
Gastric Cancer. 2011 Jun;14(2):130-8. doi: 10.1007/s10120-011-0015-7. Epub 2011 Mar 4.
This study was performed to investigate the role of surgery in patients with gastric cancer and distant metastases who had received systemic chemotherapy.
Patients with newly diagnosed gastric cancer and synchronous distant metastases who had received chemotherapy (n = 274) were categorized into 3 groups according to the surgical treatment rendered: complete gross resection of both primary and metastatic sites (group A; n = 42); debulking gastrectomy (group B; n = 47); and chemotherapy without debulking (group C; n = 185).
The median overall survival of all patients was 11.8 months. The median overall survival and 3-year survival rates were 28.0, 15.5, and 9.0 months and 42.8, 8.1, and 3.5% in groups A, B, and C, respectively. In group A, patients with peritoneal seeding, intra-abdominal distant lymph nodes, or ovarian or hepatic metastases underwent complete gross resection, and 12 (29%) were disease-free at the time of the last analysis (median follow-up duration, 29.1 months). On multivariate analysis, the adjusted hazard ratios for death were 0.27 (P < 0.001) and 0.64 (P = 0.024) for groups A and B, respectively, as compared to group C.
Our study suggests survival benefits of debulking gastrectomy or gastrectomy plus metastasectomy in gastric cancer patients with distant metastases receiving systemic chemotherapy. Prolonged disease-free survival was observed after complete resection (gastrectomy plus metastasectomy) that may lead to cure in some patients. Well-designed prospective trials of the role of multidisciplinary approaches combining chemotherapy and surgery are needed to confirm the observations of our study.
本研究旨在探讨接受全身化疗的胃癌伴远处转移患者手术的作用。
根据手术治疗方法，将 274 例新诊断为胃癌伴同步远处转移且接受化疗的患者分为 3 组：原发和转移灶完全肉眼切除（A 组，n = 42）；胃大部切除术（B 组，n = 47）；化疗不进行肿瘤减灭术（C 组，n = 185）。
所有患者的中位总生存期为 11.8 个月。A、B 和 C 组的中位总生存期和 3 年生存率分别为 28.0、15.5 和 9.0 个月和 42.8、8.1 和 3.5%。在 A 组中，腹膜种植、腹腔内远处淋巴结或卵巢或肝转移患者行完全肉眼切除术，12 例（29%）在最后一次分析时无疾病（中位随访时间为 29.1 个月）。多变量分析显示，与 C 组相比，A 组和 B 组死亡的调整后危险比分别为 0.27（P < 0.001）和 0.64（P = 0.024）。
本研究表明，对于接受全身化疗的胃癌伴远处转移患者，肿瘤减灭术或胃大部切除术加转移灶切除术可提高生存率。完全切除（胃大部切除术加转移灶切除术）后观察到无疾病生存期延长，这可能使部分患者获得治愈。需要设计良好的前瞻性试验，以确定化疗和手术相结合的多学科方法的作用。
