PM10 - Cytoreductive Surgery in Selected Patients with Metastatic Gastric Cancer Treated with Systemic Chemotherapy
Saturday, February 15, 2020
2:15 PM – 2:30 PM
Location: Sebastian I 1/2
Background: We hypothesized that cytoreductive surgery (CRS – gastrectomy combined with metastasectomy) in addition to systemic chemotherapy is associated with an improved survival when compared to chemotherapy alone in patients with metastatic gastric adenocarcinoma (MGA).
Methods: Patients with MGA who received systemic chemotherapy between 2004-2016 were identified using the National Cancer Database (NCDB). Nearest neighbor 1:1 propensity score matching was used to create comparable groups. Overall survival (OS) was compared between subgroups using Kaplan-Meier analyses. Immortal bias analysis was performed among those that survived at least 90 days.
Results: We identified 29,728 chemotherapy-treated patients who were divided into 4 subgroups: No surgery (NS, n=25,690), metastasectomy alone (n=1170), gastrectomy alone (n=2248) and CRS (n=620) with a median OS of 8.6, 10.9, 14.8 and 16.3 months, respectively (p<0.001). Compared to patients who underwent no surgery, patients who underwent CRS were younger (58.9±13.4 vs. 62.0±13.1 years), had lower proportion of disease involving multiple sites (5.0% vs. 26.2%), and were more likely to be clinically occult (cM0 58.9% vs. 7.3%) - all p<0.001. OS for propensity matched patients who underwent CRS (n=490) was longer than NS (16.3 vs. 8.8 months, p<0.001), including in those with clinical M1 stage (n=203). On Cox regression model using the matched data, the hazard ratio for CRS vs. NS was 0.80 (95%CI 0.76-0.84). In the immortal matched cohort, the corresponding median OS was 16.7 vs. 9.7 months, p<0.001.
Conclusions: CRS in addition to systemic chemotherapy may be associated with an OS benefit in a selected group of patients with MGA.
Learning Objectives:
Results:
We identified 29,728 chemotherapy-treated patients who were divided into 4 subgroups: No surgery (NS, n=25,690), metastasectomy alone (n=1170), gastrectomy alone (n=2248) and CRS (n=620) with a median OS of 8.6, 10.9, 14.8 and 16.3 months, respectively (p<0.001). Compared to patients who underwent no surgery, patients who underwent CRS were younger (58.9±13.4 vs. 62.0±13.1 years), had lower proportion of disease involving multiple sites (5.0% vs. 26.2%), and were more likely to be clinically occult (cM0 58.9% vs. 7.3%) - all p<0.001. OS for propensity matched patients who underwent CRS (n=490) was longer than NS (16.3 vs. 8.8 months, p<0.001), including in those with clinical M1 stage (n=203). On Cox regression model using the matched data, the hazard ratio for CRS vs. NS was 0.80 (95%CI 0.76-0.84). In the immortal matched cohort, the corresponding median OS was 16.7 vs. 9.7 months, p<0.001. Conclusions:
CRS in addition to systemic chemotherapy may be associated with an OS benefit in a selected group of patients with MGA.
CRS in addition to systemic chemotherapy may be associated with an OS benefit in a selected group of patients with MGA.
