title: The role of non-curative surgery in incurable, asymptomatic advanced gastric cancer.
abstract: BACKGROUND
  Although general agreement exists on palliative surgery with intent of symptom palliation in advanced gastric cancer (AGC), the role of non-curative surgery for incurable, asymptomatic AGC is hotly debated. We aim to clarify the role of non-curative surgery in patients with incurable, asymptomatic AGC under the first-line chemotherapy.
  
  
  METHODS
  A total of 737 patients with incurable, asymptomatic advanced gastric adenocarcinoma between January 2008 and May 2012 at the Sun Yat-sen University Cancer Center were retrospectively analyzed, comprising 414 patients with non-curative surgery plus first-line chemotherapy, and 323 patients with first-line chemotherapy only. The clinicopathologic data, survival, and prognosis were evaluated, with propensity score adjustment for selection bias.
  
  
  RESULTS
  The median overall survival (OS) outcomes significantly favored non-curative surgery group over first-line chemotherapy only group in entire population (28.00 versus 10.37 months, P = 0.000), stage 4 patients (23.87 versus 10.37 months, P = 0.000), young patients (28.70 versus 10.37 months, P = 0.000) and elderly patients (23.07 versus 10.27 months, P = 0.031). The median OS advantages of non-curative surgery over first-line chemotherapy only were also maintained when the analyses were restricted to single organ metastasis (P = 0.001), distant lymph node metastasis (P = 0.002), peritoneal metastasis (P = 0.000), and multi-organ metastasis (P = 0.010). Significant OS advantages of non-curative surgery over chemotherapy only were confirmed solid by multivariate analyses before and after adjustment on propensity score (P = 0.000). Small subsets of patients with surgery of single metastatic lesion after previous curative gastrectomy, and with surgery of both primary and single metastatic sites showed sound median OS.
  
  
  CONCLUSIONS
  There is a role for non-curative surgery plus first-line chemotherapy for incurable, asymptomatic AGC, in terms of survival. Randomized controlled trials are warranted to fill a gap in knowledge about the value of metastectomy and patient selection strategies.
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Ming-ming
authors.initials: MM
authors.lastname: He
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Dong-sheng
authors.initials: DS
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Zhi-qiang
authors.initials: ZQ
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Hui-yan
authors.initials: HY
authors.lastname: Luo
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jin
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Xiao-li
authors.initials: XL
authors.lastname: Wei
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Rui-hua
authors.initials: RH
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden