title: Identification of prognostic factors and surgical indications for metastatic gastric cancer.
abstract: BACKGROUND
  The treatment of metastatic gastric cancer is not uniform, and the prognostic factors and indications for surgery are currently unclear. This retrospective study aimed to identify the prognostic factors and clinical indications for surgery in patients with metastatic gastric cancer.
  
  
  METHODS
  A total of 123 consecutive patients with gastric cancer and synchronous distant metastasis treated between January 1999 and December 2011 were reviewed. Patient, tumor, laboratory, surgical, and chemotherapy factors were analyzed, with overall survival as the endpoint. Univariate analyses were performed using the log-rank test, multivariate analyses were performed using the Cox proportional hazards model, and Kaplan-Meier curves were used to estimate survival. Significance was set at p<0.05.
  
  
  RESULTS
  The median overall survival time was 13.1 months. Ninety-eight patients received chemotherapy. Twenty-eight patients underwent gastrectomy with metastasectomy and 55 underwent gastrectomy without metastasectomy. The median overall survival time for patients who underwent gastrectomy with metastasectomy, gastrectomy without metastasectomy, and no surgical intervention was 21.9 months, 12.5 months, and 7.2 months, respectively (p<0.001). Multivariate analysis identified gastrectomy with or without metastasectomy, performance status (PS) ≥ 3, neutrophil-to-lymphocyte ratio (NLR) >3.1, and carbohydrate antigen 19-9 (CA19-9) level >37 U/mL as predictors of poor survival. NLR and CA19-9 level were also independent prognostic factors in the group of patients who underwent surgery.
  
  
  CONCLUSIONS
  High pretreatment NLR, CA19-9 level, and PS are predictors of poor prognosis in patients with metastatic gastric cancer. In selected patients, gastrectomy can be performed safely, and may be associated with longer survival.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. ya-mohri@clin.medic.mie-u.ac.jp.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Mohri
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohi
authors.forename: Susumu
authors.initials: S
authors.lastname: Saigusa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yasuda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Toiyama
authors.forename: Toshimitu
authors.initials: T
authors.lastname: Araki
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy* / Q000473:pathology*; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology; D011379:Prognosis; D013274:Stomach Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; C578959:carbohydrate antigen 199, human