title: Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study.
abstract: Background.Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure.Methods.The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors.Results.Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n= 137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months,P= 0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P= 0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9.Conclusions.Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan; Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan; College of Medicine, School of Medicine, China Medical University, Taichung 40402, Taiwan.
authors.forename: Chang-Fang
authors.initials: CF
authors.lastname: Chiu
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Horng-Ren
authors.initials: HR
authors.lastname: Yang
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Mei-Due
authors.initials: MD
authors.lastname: Yang
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.affiliation: Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan.
authors.forename: Tse-Yen
authors.initials: TY
authors.lastname: Yang
authors.affiliation: Charles River Laboratories, Preclinical Services, Spencerville, OH 45887, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Sargeant
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan; College of Medicine, School of Medicine, China Medical University, Taichung 40402, Taiwan.
authors.forename: Li-Yuan
authors.identifier: 0000-0001-7739-4077
authors.initials: LY
authors.lastname: Bai