title: Is noncurative gastrectomy always a beneficial strategy for stage IV gastric cancer?
abstract: OBJECTIVE
  The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease.
  
  
  METHODS
  We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated.
  
  
  RESULTS
  A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group.
  
  
  CONCLUSIONS
  Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.
authors.affiliation: Department of Surgery, Korea University Medical Center, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Chang Min
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Department of Oncology, Korea University Medical Center, Seoul, Korea.; Department of Oncology, Korea University College of Medicine, Seoul, Korea.
authors.forename: In Keun
authors.initials: IK
authors.lastname: Choi
authors.affiliation: Department of Surgery, Korea University Medical Center, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jong-Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Korea University Medical Center, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Da Won
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Oncology, Korea University Medical Center, Seoul, Korea.; Department of Oncology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jun Suk
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Korea University Medical Center, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Seong-Heum
authors.initials: SH
authors.lastname: Park
keywords: Gastrectomy; Metastasis; Prognosis; Stomach neoplasms