C. U. Ihemelandu1, C. U. Ihemelandu1 1MedStar Washington Hospital Center,Surgical Oncology,Washington, DC, USA
Introduction: Most stage IV gastric cancer patients present with non-operable disease, and even in those with operable disease, rates of relapse are high and prognosis is poor. Our aim was to analyze the clinicopathologic characteristics, prognostic factors, and overall survival associated with stage IV gastric cancer
Methods: A retrospective analysis of a tumor registry for all patients treated for stage IV gastric cancer between 1991-2016 at a tertiary institution.
Results:Of 231 patients there were 127(55.0%) males vs. 104(45.0%) females. The mean age at diagnosis was 66 years. Seventy-eight (33.8%) patients presented with a signet ring vs. 153(66.2%) with an intestinal histology. Twenty-six (11.3%) patients were treated with CS and HIPEC vs. 64(27.7%) and 141(61%) respectively who were treated with surgery and systemic chemotherapy, and no surgical intervention. In univarate analysis signet ring tumors had a better overall median survival 5 vs. 3 months (p= 0.04). Amongst the cohort of patients treated with CS and HIPEC the median survival was 40 months for the signet ring histology vs. 8 months for the intestinal. Median survival time was 14 months for patients treated with CS and HIPEC vs. 6 and 2 months respectively for those treated with surgery and systemic chemotherapy or no surgery. One, 3 and 5 year survival was 51%, 38% and 29% respectively for patients treated with CS and HIPEC vs.39%, 16% and 9%, and 14%, 2% and 0% for surgery and no surgery. Significant predictors of an improved survival in multivariate analysis were a young age at diagnosis (p<0.000), treatment with CS and HIPEC (p<0.000). Gender, race, tumor pathology, use of radiation therapy and systemic chemotherapy did not achieve significant status.
Conclusion:Young age at diagnosis and use of CS and HIPEC are independent predictors for an improved overall survival in patients diagnosed with stage IV gastric cancer. Paradoxically signet ring pathology demonstrated an improved survival over an intestinal pathology when treated with CS and HIPEC.