番茄社区

SAN FRANCISCO -- A decline in survival rates in stage IV gastric cancer coincides with the increased use of chemotherapy rather than radiation and surgery, researchers found.

One-year survival after diagnosis of stage IV gastric cancer declined from 23.8% to 22.6%, according to an analysis of data from the National Cancer Data Base comparing the periods 1994 to 1997 and 1998 to 2002. Five-year survival went from 6% to 2.9%.

The use of surgical resection to treat the condition declined from 31.2% in 2000 to 22% in 2008 (P<0.0001) and the use of radiation therapy dropped from 20% to 18.5% (P=0.0009), Anna Mary Leung, MD, of the John Wayne Cancer Institute in Santa Monica, Calif., and colleagues reported here at the Multidisciplinary Gastrointestinal Cancers Symposium.

During that time, there was an increase in chemotherapy from 45.5% in 2000 to 55.1% in 2008 (P<0.001).

"In recent years, there has been an increase in the use of systemic chemotherapy and a reduction in palliative gastrectomy for [stage IV] gastric cancer," Leung told 番茄社区. "Overall survival of [these patients] has trended down over the years."

Leung noted that current guidelines from the National Comprehensive Cancer Network recommend chemotherapy as first-line treatment for stage IV gastric cancer so the the role for palliative gastrectomy in these patients has been called into question. Their data, however, suggest "that treatment pathways be re-evaluated," the researchers wrote.

Her group identified 29,655 patients in the database who were diagnosed with stage IV gastric cancer and observed the following survival rates between the two time periods:

• From 1994 to 1997 in 12,132 patients: 23.8% for year one, 12.1% for year two, 9.1% for year three, 7.8% for year four, and 6% for year five (95% CI 5.6 to 6.4, P<0.05)
• From 1998 to 2002 in 17,543 patients: 22.6% for year one, 8.4% for year two, 5% for year three, 3.6% for year four, and 2.9 for year five (95% CI 2.7 to 3.2, P<0.05)

She noted that palliative resection is possible with low operative mortality and acceptable mortality and that "resection should be offered to stage 4 gastric cancer patients who are reasonable operative candidates."

But Richard Goldberg, MD, from the James Cancer Hospital and Solove Research Institute at Ohio State University in Columbus, told 番茄社区 that the data did not seem compelling enough to him to routinely offer surgery to these patients.

"You might use surgery in patients who had their stomach obstructed or were bleeding," he said. "I would reserve surgery or radiation therapy for those patients who had a local complication that I couldn't control with chemotherapy and were still in good enough shape to potentially benefit from the surgery."

Goldberg noted that "life after a total gastrectomy is way different than life with a stomach. You can't sit down and eat a big meal; you lose the opportunity of fellowship with people that eating brings to you. It's a six-week recovery where you are in pretty desperate shape for a lot of that time. You are looking at very little gain for a lot of discomfort and cost."

The symposium is jointly sponsored by the American Gastroenterology Association, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology.

Comment