An Observational Retrospective Analysis of the Main Metastatic Site and Corresponding Locoregional Treatment As a Prognostic Factor in Metastatic Gastric Cancer

Overview

Journal Oncol Lett

Specialty Oncology

Date 2021 Mar 15

PMID 33717264

Citations 1

Authors

Riccardo Giampieri

Luca Cantini

Michela Del Prete

Alessandro Bittoni

Enrica Giglio

Alessandra Mandolesi

Elena Maccaroni

Andrea Lanese

Tania Meletani

Maria Giuditta Baleani

Renato Bisonni

Marina Scarpelli

Rossana Berardi

Affiliations

Soon will be listed here.

Abstract

Despite novel drugs, the prognosis for patients with metastatic gastric cancer remains poor. In rare instances, locoregional therapies are used in addition to standard chemotherapy in patients with oligometastatic involvement. This type of approach has not been supported by solid published evidence. The aim of the present retrospective study was to assess the prognostic impact of factors such as metastatic site, tumour histology and locoregional treatment in patients with metastatic gastric cancer. A total of 184 patients with metastatic gastric or gastroesophageal junction adenocarcinoma who received at least one line of palliative therapy with doublet or triplet chemotherapy were enrolled in the current analysis. Median overall survival (OS) was 8.32 months (95% CI, 7.02-9.41) and median progression-free survival (PFS) was 4.16 months (95% CI, 3.24-5.08). Lung metastases vs. other sites of metastatic involvement [hazard ratio (HR), 0.27; P=0.0133] and intestinal histology (HR, 0.48; P=0.08) were significantly associated with an improved OS. Improved PFS was also observed (HR, 0.49; P=0.10 and HR, 0.72; P=0.08 for lung metastases and intestinal histology, respectively). Second line chemotherapy and locoregional treatment of metastases (surgery or radiotherapy) were associated with improved OS (HR, 0.52; P<0.0001 and HR, 0.35; P<0.0001, respectively). Multivariate analysis confirmed an independent prognostic role for OS only for locoregional treatment, second line treatment and intestinal histology. The present results suggested that the presence of lung metastases alone was not a relevant prognostic factor and was influenced by the availability of further lines of treatment or by locoregional treatments. Locoregional treatments in patients with oligometastatic disease should be offered as they allow prolonged survival in patients with otherwise relatively short life expectancy.

Citing Articles

Impact of Signet-Ring Cell Histology in the Management of Patients with Non-Metastatic Gastric Cancer: Results from a Retrospective Multicenter Analysis Comparing FLOT Perioperative Chemotherapy vs. Surgery Followed by Adjuvant Chemotherapy.

Giampieri R, Baleani M, Bittoni A, Rastelli F, Catalano V, Del Prete M Cancers (Basel). 2023; 15(13).

PMID: 37444451 PMC: 10340225. DOI: 10.3390/cancers15133342.

References

Bang Y, Van Cutsem E, Feyereislova A, Chung H, Shen L, Sawaki A . Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010; 376(9742):687-97. DOI: 10.1016/S0140-6736(10)61121-X. View

Fujitani K, Yang H, Mizusawa J, Kim Y, Terashima M, Han S . Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016; 17(3):309-318. DOI: 10.1016/S1470-2045(15)00553-7. View

Bittoni A, Del Prete M, Scartozzi M, Pistelli M, Giampieri R, Faloppi L . Three drugs vs two drugs first-line chemotherapy regimen in advanced gastric cancer patients: a retrospective analysis. Springerplus. 2015; 4:743. PMC: 4666886. DOI: 10.1186/s40064-015-1545-y. View

Gonzalez M, Gervaz P . Risk factors for survival after lung metastasectomy in colorectal cancer patients: systematic review and meta-analysis. Future Oncol. 2015; 11(2 Suppl):31-3. DOI: 10.2217/fon.14.259. View

Aurello P, Petrucciani N, Giulitti D, Campanella L, DAngelo F, Ramacciato G . Pulmonary metastases from gastric cancer: Is there any indication for lung metastasectomy? A systematic review. Med Oncol. 2015; 33(1):9. DOI: 10.1007/s12032-015-0718-4. View

Rudloff U, Langan R, Mullinax J, Beane J, Steinberg S, Beresnev T . Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol. 2014; 110(3):275-84. PMC: 6301031. DOI: 10.1002/jso.23633. View

. Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 2014; 513(7517):202-9. PMC: 4170219. DOI: 10.1038/nature13480. View

Riihimaki M, Hemminki A, Sundquist K, Sundquist J, Hemminki K . Metastatic spread in patients with gastric cancer. Oncotarget. 2016; 7(32):52307-52316. PMC: 5239553. DOI: 10.18632/oncotarget.10740. View

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

10.

Medina-Franco H, Contreras-Saldivar A, Ramos-De la Medina A, Palacios-Sanchez P, Cortes-Gonzalez R, Ugarte J . Surgery for stage IV gastric cancer. Am J Surg. 2004; 187(4):543-6. DOI: 10.1016/j.amjsurg.2003.12.045. View

11.

Hartgrink H, Putter H, Kranenbarg E, Bonenkamp J, van de Velde C . Value of palliative resection in gastric cancer. Br J Surg. 2002; 89(11):1438-43. DOI: 10.1046/j.1365-2168.2002.02220.x. View

12.

Scartozzi M, Giampieri R, Loretelli C, Bittoni A, Mandolesi A, Faloppi L . Tumor angiogenesis genotyping and efficacy of first-line chemotherapy in metastatic gastric cancer patients. Pharmacogenomics. 2013; 14(16):1991-8. DOI: 10.2217/pgs.13.185. View

13.

Sun J, Song Y, Wang Z, Chen X, Gao P, Xu Y . Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis. BMC Cancer. 2013; 13:577. PMC: 4235220. DOI: 10.1186/1471-2407-13-577. View

14.

Li J, Qin S, Xu J, Xiong J, Wu C, Bai Y . Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Apatinib in Patients With Chemotherapy-Refractory Advanced or Metastatic Adenocarcinoma of the Stomach or Gastroesophageal Junction. J Clin Oncol. 2016; 34(13):1448-54. DOI: 10.1200/JCO.2015.63.5995. View

15.

Fuchs C, Tomasek J, Yong C, Dumitru F, Passalacqua R, Goswami C . Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2013; 383(9911):31-39. DOI: 10.1016/S0140-6736(13)61719-5. View

16.

Wagner A, Grothe W, Haerting J, Kleber G, Grothey A, Fleig W . Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol. 2006; 24(18):2903-9. DOI: 10.1200/JCO.2005.05.0245. View

17.

LAUREN P . THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION. Acta Pathol Microbiol Scand. 1965; 64:31-49. DOI: 10.1111/apm.1965.64.1.31. View

18.

Mohri Y, Tanaka K, Ohi M, Saigusa S, Yasuda H, Toiyama Y . Identification of prognostic factors and surgical indications for metastatic gastric cancer. BMC Cancer. 2014; 14:409. PMC: 4057566. DOI: 10.1186/1471-2407-14-409. View

19.

Yoshida Y, Imakiire T, Yoneda S, Obuchi T, Inada K, Iwasaki A . Ten cases of resected solitary pulmonary metastases arising from gastric cancer. Asian Cardiovasc Thorac Ann. 2014; 22(5):578-82. DOI: 10.1177/0218492313513777. View

20.

Fornaro L, Fanotto V, Musettini G, Uccello M, Rimassa L, Vivaldi C . Selecting patients for gastrectomy in metastatic esophago-gastric cancer: clinics and pathology are not enough. Future Oncol. 2017; 13(25):2265-2275. DOI: 10.2217/fon-2017-0246. View