title: Modest overall survival improvements from 1998 to 2009 in metastatic gastric cancer patients: a population-based SEER analysis.
abstract: BACKGROUND
  An increasing fraction of gastric cancer patients present with distant metastases at diagnosis. The objective of the present 11-year population-based trend analysis was to assess the survival rates in patients who underwent and in patients who did not undergo palliative gastrectomy.
  
  
  METHODS
  Patients with metastatic gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2009. Time trend and impact of palliative gastrectomy on survival were assessed by both a multivariate Cox proportional hazards model and propensity score matching.
  
  
  RESULTS
  We identified 8249 patients with stage IV gastric cancer. The rate of metastatic disease increased from 31.0 % in 1998 to 37.5 % in 2009 (P < 0.001). The palliative gastrectomy rate dropped from 18.8 to 10.2 % (P = 0.004). The median survival for patients who underwent palliative gastrectomy (N = 1445, 17.4 %) and for patients who did not undergo palliative gastrectomy (N = 6804, 82.4 %) was 7 and 3 months, respectively. There was an increase in median overall survival from 2 months (1998) to 3 months (2009) in the no-gastrectomy group, and from 6.5 to 8 months in the gastrectomy group. The 3-year cancer-specific survival rates were 2.1 % (95 % confidence interval 1.7-2.5 %) for patients who did not undergo palliative gastrectomy and 9.4 % (95 % confidence interval 7.8-11.2 %) for patients who underwent palliative gastrectomy (P < 0.001). Palliative gastrectomy was associated with an increased cancer-specific survival in propensity-score-adjusted Cox regression analyses (hazard ratio 0.50, 95 % confidence interval 0.46-0.55, P < 0.001).
  
  
  CONCLUSIONS
  On a population-based level, only modest improvements in prognosis for metastatic gastric cancer were observed in patients who underwent and in patients who did not undergo palliative gastrectomy. Considering the low rate of midterm survivors in both groups, only a small subgroup of patients benefits from palliative gastrectomy.
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St Gallen, Switzerland.
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Ebinger
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St Gallen, Switzerland.|Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Warschkow
authors.affiliation: Department of Surgery, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St Gallen, Switzerland.
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.affiliation: Department of Medical Oncology and Haematology, Cantonal Hospital of St Gallen, 9007, St Gallen, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Güller
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St Gallen, Switzerland. marc.schiesser@kssg.ch.
authors.forename: Marc
authors.initials: M
authors.lastname: Schiesser
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors
keywords: Cancer specific survival; Metastatic gastric cancer; Palliative gastrectomy; Relative survival; Surveillance, Epidemiology, and End Results Program