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Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis

  • Original Article – Clinical Oncology
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Abstract

Purpose

The clinical benefit of conversion surgery (CS) for unresectable gastric cancer (GC), whereby unresectable GC responds to chemotherapy and subsequently receives curative-intent surgery, remains unclear. Here, we aimed to clarify the clinical value of CS.

Methods

In this retrospective cohort study, we analyzed 175 unresectable GC, who received triple combined chemotherapy between 2004 and 2019. We divided patients into two groups: those who underwent CS and those receiving chemotherapy only (CS and C groups, respectively). Propensity score matching was used to minimize confounding bias.

Results

Of 175 cases, 61 (34.9%) underwent CS. R0 resection was obtained in 85.2%. After matching, 44 pairs were selected; there were no significant differences in baseline covariants. Group CS had a significantly better median overall survival (OS) (18.8 vs. 46.0 months, p < 0.001), and prolonged progression-free survival (7.4 vs. 25.8 months, p < 0.001). Subgroup analysis of OS showed a favorable trend for CS for almost all subgroups. Multivariate analysis revealed that good ECOG performance status and CS were associated with a longer OS.

Conclusion

The survival benefit of CS was consistently demonstrated in the univariate and multivariate analysis, even in the matched cohort. Additional large-scale trials are needed for further validation.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-0061, Japan

    Hiroyuki Ohnuma, Naoki Onoyama, Kota Hamaguchi, Naotaka Hayasaka, Masanori Sato, Kazuyuki Murase, Kohichi Takada, Koji Miyanishi & Junji Kato

  2. Department of Community Medicine for Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Yasushi Sato

  3. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan

    Takeshi Murakami, Tatsuya Ito, Takayuki Nobuoka & Ichiro Takemasa

Authors
  1. Hiroyuki Ohnuma
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  2. Yasushi Sato
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  3. Naoki Onoyama
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  4. Kota Hamaguchi
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  8. Kohichi Takada
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  11. Tatsuya Ito
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  12. Takayuki Nobuoka
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  14. Junji Kato
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Contributions

Conceptualization and design, HO and YS; data acquisition, HO, YS, NO, KH, NH, MS, TM, TI, and TN; investigation, KM, KT, and KM; interpretation of data and results, HO and YS; writing and editing, HO; supervision, IT and JK. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Junji Kato.

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Conflict of interests

J. Kato received research funding from SymBio Pharmaceuticals, Alexion Pharmaceuticals, Ono Pharmaceutical, Asahi Kasei Pharma, Astellas Pharma, Eisai, Otsuka Pharmaceutical, Kyowa Hakko Kirin, Shionogi, Daiichi Sankyo, Taiho Pharmaceutical, Chugai Pharmaceutical, Toyama Chemical, and Pfizer Japan, outside the submitted work. The other authors have no conflict of interest.

Ethics approval and consent to participate

The ethical committee of Sapporo Medical University Hospital approved this study. In this retrospective study, patients’ consent was obtained by opt-out manner. Participating patients were excluded when they specified that they were unwilling to participate.

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Ohnuma, H., Sato, Y., Onoyama, N. et al. Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis. J Cancer Res Clin Oncol 147, 2385–2396 (2021). https://doi.org/10.1007/s00432-021-03516-7

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  • DOI: https://doi.org/10.1007/s00432-021-03516-7

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