Survival benefits of gastrectomy in gastric cancer patients with stage IV: a population-based study
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Xingkang He1,2, Sanchuan Lai1,2, Tingting Su1,2, Yangyang Liu2,3, Yue Ding1,2, Sheng Quan2,3, Jianmin Si1,2 and Leimin Sun1,2
1Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
2Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
3Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, China
4Department of Clinical Medicine, Zhejiang University City College, Hangzhou, China
Leimin Sun, email: [email protected]
Keywords: metastatic gastric cancer; gastrectomy; SEER; survival analysis
Received: June 21, 2017 Accepted: October 28, 2017 Published: November 20, 2017
Objective: The aim of the current study is to investigate the role of gastrectomy for survival among metastatic gastric cancer patients.
Results: We finally identified 12,986 eligible patients with stage IV GC between 2004 and 2012, including 1,981 (15.3%) patients with gastrectomy and 11,005 (84.7%) without surgery. The median overall survival time for patients with and without surgery were 9.0 (95%, 8.3–9.7) and 4.0 (95%, 3.9–4.1) months respectively. Patients who received gastrectomy had a significantly better survival outcome compared with those without surgery (P < 0.05). In the multivariate Cox analysis, gastrectomy was associated with decreased overall mortality (HR, 0.47, 95% CI 0.44–0.49, P < 0.001) and cancer-specific mortality (HR, 0.46, 95% CI 0.44–0.50, P < 0.001). The survival benefits associated with surgery persisted even after performing the propensity score matching analysis (overall survival, HR, 0.47, 95% CI 0.43–0.50, cancer-specific survival, HR, 0.47, 95% CI 0.44–0.50).
Conclusions: Based on population-based study, we demonstrated that there was a survival advantage of gastrectomy in stage IV GC patients. Further prospective trials need to verify our findings.
Materials and Methods: We included an eligible cohort of stage IV gastric cancer (GC) patients in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2012. The survival difference of patients with and without gastrectomy were assessed by Kaplan–Meier analysis and log-rank test. Multivariate Cox analyses were performed to analyze the effect of gastrectomy on overall and cancer-specific mortality. Furthermore, we performed propensity score matching (PSM) to reduce the potential selection bias.
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