title: Significant prognostic factors in patients with Stage IV gastric cancer with special reference to the curability of surgery.
abstract: OBJECTIVE
  The purpose of this study was to determine an effective treatment strategy for patients with Stage IV gastric cancer.
  
  
  METHODS
  We analyzed the significant prognostic factors in 74 patients who underwent surgery between 1989 and 2005, and were finally determined to have Stage IV gastric cancer. These patients were classified as curability A (n = 0), B (n = 29) and C (n = 45) according to the criteria outlined by Japanese Gastric cancer society. Anti-tumor drugs were used after surgery in some cases. There were 32 patients who received either no treatment or an oral anti-tumor drug, and 42 patients who received new chemotherapeutic regimens.
  
  
  RESULTS
  According to a univariate analysis, the postoperative mean survival times were significantly different; tumor size ≤ 12 cm, a tumor without lymphatic involvement, more than D2 lymphadenectomy, and classification as curability B were favorable prognostic factors. The multivariate analysis revealed that tumor size, lymphadenectomy and curability were independent prognostic factors. In curability B patients, venous involvement was an independent prognostic factor. In curability C patients, both the tumor size and postoperative chemotherapy affected their prognosis.
  
  
  CONCLUSIONS
  In patients with curable Stage IV gastric cancer, at least a D2 gastrectomy to reduce the absolute volume of tumor cells, followed by adjuvant chemotherapy, may be essential to improve their prognosis. In incurable cases, aggressive new chemotherapeutic regimens should be the treatment of choice for the prolongation of survival.
authors: Department of Surgery, Fukuoka City Hospital, 13-1 Yoshizuka-honmachi, Hakata-ku, Fukuoka 812-0046, Japan. shinji5996@yahoo.co.jp
authors: Shinji
authors: S
authors: Shinohara
authors: Daisuke
authors: D
authors: Korenaga
authors: Ai
authors: A
authors: Edagawa
authors: Kenichi
authors: K
authors: Koushi
authors: Shinji
authors: S
authors: Itoh
authors: Hirofumi
authors: H
authors: Kawanaka
authors: Daihiko
authors: D
authors: Eguchi
authors: Katsumi
authors: K
authors: Kawasaki
authors: Toshiro
authors: T
authors: Okuyama
authors: Yasuharu
authors: Y
authors: Ikeda
authors: Kenji
authors: K
authors: Takenaka
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004338:Drug Combinations; D005743:Gastrectomy; D006801:Humans; D000077146:Irinotecan; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010094:Oxonic Acid / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000077146:Irinotecan; D017239:Paclitaxel; D002945:Cisplatin; D002166:Camptothecin