Dat Tran Quang, Thong Dang Quang, Nguyen Doan Thuy, Hai Nguyen Viet, Thang Nguyen Nam, Bac Nguyen Hoang, Long Vo Duy
Gastro-intestinal Surgery Department, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
Department of General Surgery, Tay Nguyen Regional General Hospital, Daklak Province, Viet Nam.
Eur J Surg Oncol. 2025 Feb;51(2):109485. doi: 10.1016/j.ejso.2024.109485. Epub 2024 Nov 22.
For patients with stage IV gastric cancer (GC), systemic therapy is often the standard treatment, but the prognosis remains poor. Conversion surgery (CS) has emerged as a potential therapeutic option for selected patients who had certain response to chemotherapy. This study aims to compare the survival outcomes of CS versus continued chemotherapy (CT) in stage IV GC.
We conducted a retrospective cohort study of 52 patients with stage IV gastric adenocarcinoma, from January-2018 to June-2023. Patients were divided into two groups: those who underwent CS (CS group) after a response to chemotherapy and those who continued with systemic chemotherapy (CT group). Baseline characteristics, chemotherapy toxicity, surgical outcomes, and survival data were analyzed and compared.
Among 52 patients, 26 patients underwent CS, while other 26 continued with CT. The CS group showed a significantly higher 3-year overall survival (OS) rate and median survival time (MST) compared to the CT group (36 % vs. 15 %, HR = 0.39, 95%CI: 0.19-0.79, p = 0.009; 23.4 months vs. 14.7 months, p < 0.001, respectively). Subgroup analysis by Yoshida classification revealed superior survival outcomes for CS in category 3 (MST: 26.1 months vs. 12.6 months, p < 0.001). Multivariate analysis indicated that CS were associated with a longer survival. No major postoperative complications were observed in the CS group.
Conversion surgery improved survival outcomes in selected stage IV GC patients compared to systemic chemotherapy alone. CS should be considered as a treatment option for patients who responds to initial chemotherapy, particularly those in Yoshida category 3.
对于IV期胃癌（GC）患者，全身治疗通常是标准治疗方法，但预后仍然很差。转化手术（CS）已成为对化疗有一定反应的特定患者的一种潜在治疗选择。本研究旨在比较IV期GC患者中CS与继续化疗（CT）的生存结果。
我们对2018年1月至2023年6月期间的52例IV期胃腺癌患者进行了一项回顾性队列研究。患者分为两组：化疗有反应后接受CS的患者（CS组）和继续进行全身化疗的患者（CT组）。分析并比较了基线特征、化疗毒性、手术结果和生存数据。
52例患者中，26例接受了CS，另外26例继续进行CT。与CT组相比，CS组的3年总生存率（OS）和中位生存时间（MST）显著更高（分别为36%对15%，HR = 0.39，95%CI：0.19 - 0.79，p = 0.009；23.4个月对14.7个月，p < 0.001）。根据吉田分类进行的亚组分析显示，CS在3类中的生存结果更好（MST：26.1个月对12.6个月，p < 0.001）。多因素分析表明，CS与更长的生存期相关。CS组未观察到重大术后并发症。
与单纯全身化疗相比，转化手术改善了部分IV期GC患者的生存结果。对于对初始化疗有反应的患者，尤其是吉田分类为3类的患者，应考虑将CS作为一种治疗选择。
