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Prognostic Role of Conversion Surgery for Unresectable Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognosis of unresectable gastric cancer is poor. Chemotherapy occasionally converts an initially unresectable gastric cancer to a resectable cancer.

Methods

The responses of noncurative factors to initial chemotherapy and the outcomes of additional (conversion) surgery were retrospectively evaluated in 151 patients with unresectable gastric cancer receiving combination chemotherapy with S-1 plus cisplatin or paclitaxel from February 2003 to December 2013.

Results

Forty (26 %) of 151 patients underwent conversion surgery. After chemotherapy, R0 resection was accomplished in 32 patients (80 %). The 5-year overall survival (OS) rate among the 40 patients who underwent conversion surgery was 43 % (median survival time, 53 months). The 5-year OS rate in the 111 patients treated with chemotherapy alone was 1 % (median survival time, 14 months). Patients who underwent conversion surgery had significantly longer OS times than patients who underwent chemotherapy alone (P < 0.01). The 5-year OS rate among patients who underwent R0 resection was 49 % (median survival time, 62 months). Patients who underwent R0 resection had significantly longer OS times than those who underwent R1 and R2 resection (P = 0.03). Among patients who underwent conversion surgery, multivariate Cox regression analysis showed that one noncurative factor (odds ratio 0.49; 95 % confidence interval 0.28–0.88; P = 0.02) and R0 resection (odds ratio 0.52; 95 % confidence interval 0.28–0.95; P = 0.03) were significant independent predictors for favorable OS.

Conclusions

Patients with unresectable gastric cancer initially exhibiting one noncurative factor may obtain a survival benefit from chemotherapy and subsequent curative surgery.

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References

  1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.

    PubMed Central  PubMed  Google Scholar 

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  3. MacDonald JS, Schein PS, Woolley PV, et al. 5-Fluorouracil, doxorubicin, and mitomycin (FAM) combination chemotherapy for advanced gastric cancer. Ann Intern Med. 1980;93:533–6.

    Article  CAS  PubMed  Google Scholar 

  4. Findlay M, Cunningham D, Norman A, et al. A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF). Ann Oncol. 1994;5:609–16.

    CAS  PubMed  Google Scholar 

  5. Ohtsu A, Shimada Y, Shirao K, et al. Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: the Japan Clinical Oncology Group Study (JCOG9205). J Clin Oncol. 2003;21:54–9.

    Article  CAS  PubMed  Google Scholar 

  6. Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215–21.

    Article  CAS  PubMed  Google Scholar 

  7. Mochiki E, Ogata K, Ohno T, et al. Phase II multi-institutional prospective randomised trial comparing S-1 + paclitaxel with S-1 + cisplatin in patients with unresectable and/or recurrent advanced gastric cancer. Br J Cancer. 2012;107:31–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Okabe H, Ueda S, Obama K, Hosogi H, Sakai Y. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol. 2009;16:3227–36.

    Article  PubMed  Google Scholar 

  9. Wang Y, Yu YY, Li W, et al. A phase II trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis. Cancer Chemother Pharmacol. 2014;73:1155–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Kodera Y, Ito S, Mochizuki Y, et al. Long-term follow up of patients who were positive for peritoneal lavage cytology: final report from the CCOG0301 study. Gastric Cancer. 2012;15:335–7.

    Article  PubMed  Google Scholar 

  11. Nakajima T, Ota K, Ishihara S, et al. Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol. 1997;4:203–8.

    Article  CAS  PubMed  Google Scholar 

  12. Suzuki T, Tanabe K, Taomoto J, et al. Preliminary trial of adjuvant surgery for advanced gastric cancer. Oncol Lett. 2010;1:743–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  13. Sobin LH, Gospodarowicz MK, Wittekind CW. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2009.

    Google Scholar 

  14. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: third English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines, 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Article  Google Scholar 

  16. Koizumi W, Tanabe S, Saigenji K, et al. Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer. Br J Cancer. 2003;89:2207–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Chua YJ, Cunningham D. The UK NCRI MAGIC trial of perioperative chemotherapy in resectable gastric cancer: implications for clinical practice. Ann Surg Oncol. 2007;14:2687–90.

    Article  PubMed  Google Scholar 

  18. Iwasaki Y, Sasako M, Yamamoto S, et al. Phase II study of preoperative chemotherapy with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). J Surg Oncol. 2013;107:741–5.

    Article  CAS  PubMed  Google Scholar 

  19. Yoshida K, Yamaguchi K, Okumura N, et al. The roles of surgical oncologists in the new era: minimally invasive surgery for early gastric cancer and adjuvant surgery for metastatic gastric cancer. Pathobiology. 2011;78:343–52.

    Article  CAS  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

    Minoru Fukuchi MD, PhD, Toru Ishiguro MD, Okihide Suzuki MD, Youichi Kumagai MD, PhD, Keiichiro Ishibashi MD, PhD, Hideyuki Ishida MD, PhD & Erito Mochiki MD, PhD

  2. Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan

    Kyoichi Ogata MD, PhD & Hiroyuki Kuwano MD, PhD

Authors
  1. Minoru Fukuchi MD, PhD
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  2. Toru Ishiguro MD
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  3. Kyoichi Ogata MD, PhD
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  4. Okihide Suzuki MD
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  5. Youichi Kumagai MD, PhD
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  6. Keiichiro Ishibashi MD, PhD
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  7. Hideyuki Ishida MD, PhD
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  8. Hiroyuki Kuwano MD, PhD
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  9. Erito Mochiki MD, PhD
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Corresponding author

Correspondence to Minoru Fukuchi MD, PhD.

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Fukuchi, M., Ishiguro, T., Ogata, K. et al. Prognostic Role of Conversion Surgery for Unresectable Gastric Cancer. Ann Surg Oncol 22, 3618–3624 (2015). https://doi.org/10.1245/s10434-015-4422-6

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  • DOI: https://doi.org/10.1245/s10434-015-4422-6

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