Clinical impact of gastrectomy in surgically proven stage IV gastric cancers: retrospective analysis from Korean multicenter dataset (PASS-META).

IF 5.1 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastric Cancer Pub Date : 2025-10-19 DOI:10.1007/s10120-025-01676-w

Ho-Jung Shin, Jeong Ho Song, Sung Eun Kim, In-Seob Lee, Hyoung-Il Kim, Han Hong Lee, Oh Jeong, Mi Ran Jung, Hoon Hur

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引用次数: 0

Abstract

Background: Palliative resection for metastatic gastric cancer is not recommended in current practice guidelines; however, it is frequently performed based on clinical considerations. Prospective trials face challenges, necessitating large-scale retrospective analyses to provide clinical evidence.

Methods: The PASS-META study group established a cohort of 983 patients with gastric cancer with surgically confirmed metastatic lesions treated at five major Korean institutions from 2014 to 2021, collecting 126 variables from preoperative, operative, and postoperative data through hospital records. The correlation between gastrectomy and survival outcomes was investigated using inverse probability of treatment weighting (IPTW) and standardization to estimate counterfactual outcomes.

Results: Machine learning-based imputation and statistical causal survival analysis revealed that gastrectomy was found to significantly improve survival in patients with limited peritoneal metastasis (P1 or P2; RR: 0.90, 95% CI 0.85-0.94), as well as in those with distant lymph node metastasis (dLN1; RR: 0.92, 95% CI 0.91-0.94) and hepatic metastasis (H1; RR: 0.92, 95% CI 0.82-1.00), suggesting a potential survival advantage across these subgroups. No survival benefit was observed in patients with severe peritoneal metastasis (P3). Among patients with P1-P2 metastasis, extensive lymph node dissection improved the 5-year survival rates compared with limited dissection, whereas minimally invasive surgery did not affect the survival outcome. Although gastrectomy increased the postoperative hospital stay and delayed the initiation of the first postoperative chemotherapy compared to patients without gastrectomy, it did not affect the total number of chemotherapy cycles.

Conclusion: This study suggests that gastrectomy offers a significant survival benefit to patients with surgically proven stage IV gastric cancer and limited peritoneal metastasis (P1/P2), distant lymph node (dLN1), or hepatic metastases (H1). Furthermore, specific surgical procedures such as extended lymph node dissection or minimally invasive surgery may be considered for patients undergoing gastrectomy.

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胃切除术对经手术证实的IV期胃癌的临床影响：来自韩国多中心数据集（PASS-META）的回顾性分析

背景：目前的实践指南不推荐姑息性切除转移性胃癌；然而，它经常是基于临床考虑进行的。前瞻性试验面临挑战，需要大规模的回顾性分析来提供临床证据。方法：PASS-META研究组通过医院记录收集术前、术中、术后126个变量，建立了2014 - 2021年在韩国5家主要机构治疗的983例手术证实转移性胃癌患者的队列。使用治疗加权逆概率（IPTW）和标准化来估计反事实结果，研究胃切除术与生存结果之间的相关性。结果：基于机器学习的归算和统计因果生存分析显示，胃切除术可显著提高有限腹膜转移（P1或P2； RR: 0.90, 95% CI 0.85-0.94）以及远处淋巴结转移（dLN1; RR: 0.92, 95% CI 0.91-0.94）和肝转移（H1; RR: 0.92, 95% CI 0.82-1.00）患者的生存率，表明这些亚组存在潜在的生存优势。严重腹膜转移（P3）患者未观察到生存获益。在P1-P2转移患者中，与有限清扫相比，广泛淋巴结清扫可提高5年生存率，而微创手术不影响生存结果。虽然与未行胃切除术的患者相比，胃切除术增加了术后住院时间，延迟了术后首次化疗的开始时间，但不影响化疗总周期数。结论：本研究表明，对于手术证实的IV期胃癌和有限腹膜转移（P1/P2）、远处淋巴结（dLN1）或肝转移（H1）的患者，胃切除术可显著提高生存期。此外，可以考虑对胃切除术患者进行特定的外科手术，如扩大淋巴结清扫或微创手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastric Cancer 医学-胃肠肝病学

CiteScore

14.70

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide. The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics. Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field. With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.