Masanori Terashima1, Kazumasa Fujitani2, Masahiko Ando3, Kentaro Sakamaki4, Ryohei Kawabata5, Yuichi Ito6, Takaki Yoshikawa7, Masato Kondo8, Yasuhiro Kodera9, Masahide Kaji10, Yoshio Oka11, Hiroshi Imamura12, Junji Kawada13, Akinori Takagane14, Hideaki Shimada15, Yutaka Tanizawa16, Takeharu Yamanaka17, Satoshi Morita18, Motoki Ninomiya19, Kazuhiro Yoshida20. 1. Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan. m.terashima@scchr.jp. 2. Department of Surgery, Osaka General Medical Center, Osaka, Japan. 3. Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan. 4. Center for Data Science, Yokohama City University, Yokohama, Japan. 5. Department of Surgery, Osaka Rosai Hospital, Sakai, Japan. 6. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. 7. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan. 8. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. 9. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 10. Toyama Prefectural Central Hospital, Toyama, Japan. 11. Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan. 12. Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan. 13. Department of Surgery, Kaizuka City Hospital, Kaizuka, Japan. 14. Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan. 15. Department of Gastrointestinal Surgery, Toho University School of Medicine, Ota-Ku, Tokyo, Japan. 16. Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan. 17. Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan. 18. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 19. Tomishiro Central Hospital, Tomishiro, Japan. 20. Department of Surgical Oncology, School of Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan.
Abstract
BACKGROUND: We had previously reported that surgical palliation could maintain quality of life (QOL) while improving solid food intake among patients with malignant gastric outlet obstruction (GOO) caused by advanced gastric cancer. The present study aimed to perform a survival analysis according to the patients' QOL to elucidate its impact on survival. METHODS: Patients with GOO who underwent either palliative gastrectomy or gastrojejunostomy were included in this study. A validated QOL instrument (EQ-5D) was used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the GOO scoring system (GOOSS). Thereafter, univariate and multivariate survival analyses were performed to determine independent prognostic factors. RESULTS: The median survival time of the 104 patients included herein was 11.30 months. Patients who received postoperative chemotherapy, PS 0/1, baseline EQ-5D ≥ 0.75, improved or stable EQ-5D, and improved oral intake expressed as GOOSS = 3 had significantly better survival. Multivariate analysis identified postoperative chemotherapy, a better baseline PS, a better baseline EQ5D, improved or stable EQ5D scores, and improved oral intake 3 months after surgical palliation as independent prognostic factors. CONCLUSION: Apart from preoperative PS and postoperative chemotherapy, the present study identified better baseline QOL, improvement in postoperative QOL, and improvement in oral intake as prognostic factors among patients who underwent palliative surgery for advanced gastric cancer with GOO.
BACKGROUND: We had previously reported that surgical palliation could maintain quality of life (QOL) while improving solid food intake among patients with malignant gastric outlet obstruction (GOO) caused by advanced gastric cancer. The present study aimed to perform a survival analysis according to the patients' QOL to elucidate its impact on survival. METHODS:Patients with GOO who underwent either palliative gastrectomy or gastrojejunostomy were included in this study. A validated QOL instrument (EQ-5D) was used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the GOO scoring system (GOOSS). Thereafter, univariate and multivariate survival analyses were performed to determine independent prognostic factors. RESULTS: The median survival time of the 104 patients included herein was 11.30 months. Patients who received postoperative chemotherapy, PS 0/1, baseline EQ-5D ≥ 0.75, improved or stable EQ-5D, and improved oral intake expressed as GOOSS = 3 had significantly better survival. Multivariate analysis identified postoperative chemotherapy, a better baseline PS, a better baseline EQ5D, improved or stable EQ5D scores, and improved oral intake 3 months after surgical palliation as independent prognostic factors. CONCLUSION: Apart from preoperative PS and postoperative chemotherapy, the present study identified better baseline QOL, improvement in postoperative QOL, and improvement in oral intake as prognostic factors among patients who underwent palliative surgery for advanced gastric cancer with GOO.
Entities:
Keywords:
EQ-5D; GOOSS; Gastric outlet obstruction; Palliative surgery; Quality of life
Authors: Konstantinos Lasithiotakis; Stavros A Antoniou; George A Antoniou; Ioannis Kaklamanos; Odysseas Zoras Journal: Anticancer Res Date: 2014-05 Impact factor: 2.480