title: Palliative gastrectomy and other factors affecting overall survival in stage IV gastric adenocarcinoma patients receiving chemotherapy: a retrospective analysis.
abstract: OBJECTIVE
  Most patients with gastric cancer present with locally advanced or metastatic disease and usually receive palliative therapy. We sought to identify factors influencing overall survival in patients with stage IV gastric cancer receiving palliative chemotherapy.
  
  
  METHODS
  The records of 311 patients with histological diagnosis of gastric adenocarcinoma were retrospectively reviewed and 17 clinicopathological and therapeutic parameters were evaluated for their influence on overall survival.
  
  
  RESULTS
  In multivariate analysis nine factors were found to independently influence survival: no previous palliative gastrectomy [Hazard ratio (HR, 12; CI 7.969-18.099)], single agent chemotherapy instead of combination chemotherapy (HR, 1.35; CI 1.068-1.721), histological grade III (HR, 1.39; 95% CI 1.098-1.782), the presence of hepatic (HR, 1.6; 95% CI 1.246-2.073) and abdominal metastasis (HR, 1.33; 95% CI 1.039-1.715), CA 72-4 > 7 U/L (HR, 1.39; 95% CI 1.026-1.887), LDH > 225 U/L (HR, 1.72; 95% CI 1.336-2.236], need for blood transfusions (HR, 1.58; 95% CI 1.213-2.082), and weight loss > 5% (HR, 1.96; 95% CI 1.352-2.853) at the time of initial diagnosis. Patients were stratified as low (0-2 factors), intermediate (3-6 factors) and high (7-9 factors) risk and the median survival was 76, 40 and 11 weeks, respectively.
  
  
  CONCLUSIONS
  Nine clinical and laboratory factors that adversely affect survival in patients with stage IV gastric cancer who receive chemotherapy were identified. Their concurrent presence seems to have an additive effect as patients with seven to nine factors have the worse prognosis. Palliative gastrectomy and combination chemotherapy appear to be associated with improved survival.
authors.affiliation: Gastrenterology Unit, "Laikon" University General Hospital, University of Athens, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Sougioultzis
authors.forename: J
authors.initials: J
authors.lastname: Syrios
authors.forename: I D
authors.initials: ID
authors.lastname: Xynos
authors.forename: N
authors.initials: N
authors.lastname: Bovaretos
authors.forename: C
authors.initials: C
authors.lastname: Kosmas
authors.forename: J
authors.initials: J
authors.lastname: Sarantonis
authors.forename: A
authors.initials: A
authors.lastname: Dokou
authors.forename: D
authors.initials: D
authors.lastname: Tzivras
authors.forename: G
authors.initials: G
authors.lastname: Zografos
authors.forename: E
authors.initials: E
authors.lastname: Felekouras
authors.forename: E
authors.initials: E
authors.lastname: Papalambros
authors.forename: N
authors.initials: N
authors.lastname: Tsavaris
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
chemical_list: D014408:Biomarkers, Tumor