Prognostic effect of gastrectomy in metastatic gastric cancer: Matching study and creation of a prognostic predictive nomogram
DOI:
https://doi.org/10.26876/osagaiz.1.2024.558Keywords:
2metastasikoa, 3gastrektomia, 4pronostikoa, 5biziraupena, urdaileko minbiziaAbstract
Introduction. The objective of this work is to assess the impact of gastrectomy on the prognosis of metastatic stomach cancer. In fact, metastatic gastric cancer has a poor prognosis and it is not managed uniformly. Although there is increasing evidence that chemotherapy prolongs survival in this disease, it is not clear whether removal of the primary tumour can benefit prognosis. On the other hand, given that the rest of the palliative treatments lose efficacy during the prolongation of life, gastrectomy may be an adequate palliative measure, since in addition to prolonging survival, it would improve the quality of life in well-selected patients.
Methodology. The data of patients diagnosed with metastatic stage of stomach cancer in the years 2005-2014 (N = 348) are collected from the Hospital de Cruces Euskadi tumour registry. At the same time, during this period, the prospective database completed in the General Surgery Service of the Cruces Hospital was used to obtain the data of these patients operated on there. To ensure balanced characteristics of patients who had gastrectomy and those who did not have gastrectomy, 1:1 matching analysis was used. Data to analyse survival have been analysed using Kaplan-Meier and the Cox proportional hazard model. Cox analysis has been used to select independent prognostic factors on the nomogram.
Results. Median survival in gastrectomized patients was 8 months longer. The survival percentages for 6 months, 1 year and 2 years have been respectively 35,7%, 16,3%, 7,4% (not gastrectotomized) and 76,9%, 47,7%, 21,5% (gastrectotomized). In multivariable analyses, gastrectomy has been associated with better overall survival (HR= 0,17, CI95%= 0,11-0,29, p<0,001).
Conclusion. In well-selected patients, gastrectomy has been shown to improve survival in metastatic gastric cancer. However, a randomized prospective study would be needed to address the limits of this study.
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