Leonardo Solaini1, Silvia Ministrini2, Maria Bencivenga3, Alessia D'Ignazio4, Elisabetta Marino5, Chiara Cipollari3, Beatrice Molteni2, Gianni Mura6, Daniele Marrelli4, Luigina Graziosi5, Franco Roviello4, Giovanni De Manzoni3, Guido A M Tiberio2, Paolo Morgagni7. 1. General and Oncologic Surgery, Department of Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, Italy. 2. Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy. 3. General and Upper GI Surgery Division, University of Verona, Verona, Italy. 4. Department of Surgery, Policlinico le Scotte- University of Siena, Siena, Italy. 5. Department of Surgery, Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy. 6. Department of Surgery, Azienda USl Toscana SudEst- Arezzo, Arezzo, Italy. 7. General and Oncologic Surgery, Department of Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, Italy. morgagni2002@libero.it.
Abstract
BACKGROUND: The aim of this study is to report the experience with conversion surgery from six Gruppo Italiano Ricerca Cancro Gastrico (GIRCG) centers, focusing our analysis on factors affecting survival and the risk of recurrence. METHODS: A retrospective, multicenter cohort study was performed in patients who had undergone conversion gastrectomy between 2005 and 2017. Data were extracted from a GIRCG database including all metastatic gastric cancer patients submitted to surgery. Only stage IV unresectable tumors/metastases which became resectable after chemotherapy were included in this analysis. RESULTS: Forty-five resected M1 patients were included in the analysis. Reasons for being deemed unresectable at diagnosis were peritoneal involvement (PCI > 6) (n = 38, 84.4%), distant metastatic nodes (n = 3, 6.6%) and extensive liver involvement (n = 4, 8.8%). Median follow-up was 25 months (IQR 9-50). Median overall survival from surgery was 15 months and 1-, 3- and 5-year survivals were 57.2, 36.1 and 24%, respectively. Median progression-free survival was 12 months with 1- and 3-year survival of 46.4 and 33.9%, respectively. At cox regression analysis the only independent prognostic factor for OS was the presence of more than one type of metastasis (HR 4.41, 95% CI 1.72-11.3, p = 0.002). A positive microscopic resection margin was the only risk factor for recurrence (HR 5.72, 95% CI 1.04-31.4, p = 0.045). CONCLUSIONS: Unresectable stage IV GC patients could benefit from radical surgery after chemotherapy and achieve long survivals. The main prognostic factor for these patients was the presence of more than one type of extra-gastric metastatic involvement.
BACKGROUND: The aim of this study is to report the experience with conversion surgery from six Gruppo Italiano Ricerca Cancro Gastrico (GIRCG) centers, focusing our analysis on factors affecting survival and the risk of recurrence. METHODS: A retrospective, multicenter cohort study was performed in patients who had undergone conversion gastrectomy between 2005 and 2017. Data were extracted from a GIRCG database including all metastatic gastric cancerpatients submitted to surgery. Only stage IV unresectable tumors/metastases which became resectable after chemotherapy were included in this analysis. RESULTS: Forty-five resected M1 patients were included in the analysis. Reasons for being deemed unresectable at diagnosis were peritoneal involvement (PCI > 6) (n = 38, 84.4%), distant metastatic nodes (n = 3, 6.6%) and extensive liver involvement (n = 4, 8.8%). Median follow-up was 25 months (IQR 9-50). Median overall survival from surgery was 15 months and 1-, 3- and 5-year survivals were 57.2, 36.1 and 24%, respectively. Median progression-free survival was 12 months with 1- and 3-year survival of 46.4 and 33.9%, respectively. At cox regression analysis the only independent prognostic factor for OS was the presence of more than one type of metastasis (HR 4.41, 95% CI 1.72-11.3, p = 0.002). A positive microscopic resection margin was the only risk factor for recurrence (HR 5.72, 95% CI 1.04-31.4, p = 0.045). CONCLUSIONS: Unresectable stage IV GC patients could benefit from radical surgery after chemotherapy and achieve long survivals. The main prognostic factor for these patients was the presence of more than one type of extra-gastric metastatic involvement.
Authors: Maria Antonietta Mazzei; Giulio Bagnacci; Francesco Gentili; Iacopo Capitoni; Gianni Mura; Daniele Marrelli; Roberto Petrioli; Luca Brunese; Salvatore Cappabianca; Marco Catarci; Maurizio Degiuli; Giovanni De Manzoni; Marco De Prizio; Annibale Donini; Uberto Fumagalli Romario; Luigi Funicelli; Andrea Laghi; Giuseppe Minetti; Paolo Morgagni; Enrico Petrella; Frida Pittiani; Stefano Rausei; Laura Romanini; Riccardo Rosati; Amato Antonio Stabile Ianora; Guido A M Tiberio; Luca Volterrani; Franco Roviello; Roberto Grassi Journal: Eur Radiol Date: 2021-08-12 Impact factor: 5.315