Survival benefits of gastrectomy in gastric cancer patients with stage IV: a population-based study

Objective The aim of the current study is to investigate the role of gastrectomy for survival among metastatic gastric cancer patients. Results We finally identified 12,986 eligible patients with stage IV GC between 2004 and 2012, including 1,981 (15.3%) patients with gastrectomy and 11,005 (84.7%) without surgery. The median overall survival time for patients with and without surgery were 9.0 (95%, 8.3-9.7) and 4.0 (95%, 3.9-4.1) months respectively. Patients who received gastrectomy had a significantly better survival outcome compared with those without surgery (P < 0.05). In the multivariate Cox analysis, gastrectomy was associated with decreased overall mortality (HR, 0.47, 95% CI 0.44-0.49, P < 0.001) and cancer-specific mortality (HR, 0.46, 95% CI 0.44-0.50, P < 0.001). The survival benefits associated with surgery persisted even after performing the propensity score matching analysis (overall survival, HR, 0.47, 95% CI 0.43-0.50, cancer-specific survival, HR, 0.47, 95% CI 0.44-0.50). Conclusions Based on population-based study, we demonstrated that there was a survival advantage of gastrectomy in stage IV GC patients. Further prospective trials need to verify our findings. Materials and Methods We included an eligible cohort of stage IV gastric cancer (GC) patients in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2012. The survival difference of patients with and without gastrectomy were assessed by Kaplan-Meier analysis and log-rank test. Multivariate Cox analyses were performed to analyze the effect of gastrectomy on overall and cancer-specific mortality. Furthermore, we performed propensity score matching (PSM) to reduce the potential selection bias.