title: Significance of surgical treatment in multimodal therapy for stage IV highly advanced gastric cancer.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of surgical treatment following a response to chemotherapy to improve stage IV gastric cancer and to identify the factors contributing to survival benefit.
  
  
  METHODS
  In total, 148 patients with cStage IV gastric cancer were treated with S-1 and CDDP. We retrospectively evaluated the factors contributing to a survival benefit and the significance of surgical treatment.
  
  
  RESULTS
  The 148 cStage IV patients included 107 males with a median age of 61 years. The overall response rate was 54.7%. After chemotherapy, 97 patients underwent surgery. R0 resection was successfully performed in 51 (52.6%) patients. The overall median survival time (MST) of the patients was 16.8 months, with a 5YSR of 16.4%. The MST of patients who went on to receive surgery was 22.5 months, and the 5YSR was 19.6%. In the multivariate analysis of 97 patients who underwent surgery, R0 resection, lymph node dissection of D2/D3 and obtaining a CR/PR from chemotherapy were the only independently prognostic factors.
  
  
  CONCLUSIONS
  The use of multi-modal treatment, including surgical treatment, at an appropriate time was well tolerated and effective for patients with stage IV gastric cancer.
authors.affiliation: Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan. yabu@niigata-cc.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yabusaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nashimoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Matsuki
authors.forename: Masaki
authors.initials: M
authors.lastname: Aizawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*