Analysis Of The Effect Of Surgical Intervention On Survival Of Patients With Stage Ⅳ Gastric Cancer Based On SEER Database

Background:The prognosis of stage IV gastric cancer is poor,and there is still a lack of effective treatment.Some patients with advanced gastric cancer with localized metastasis have received radical resection of the primary tumor and metastatic focus through comprehensive treatment such as radiotherapy and chemotherapy,which can improve the survival time of the patients to a certain extent.At present,there is no unified conclusion on the treatment of stage IV gastric cancer.The purpose of this study is to explore the prognostic value of primary tumor and specific metastatic resection in monitoring,epidemiology and final results in(SEER)database of patients with stage IV gastric cancer in(GC).Methods:Patients with stage IVGC were selected using the SEER database between 2010 and 2015.The survival rate was calculated according to the KAPLAN-MEIER method,and the difference between the curves was tested by LOG-RANGE.COX proportional hazard model is used in multivariate analysis.Results:4178 patients with distal metastatic GC were included in this study.Among the single organ sites of metastatic GC,patients with solitary liver metastasis showed the highest total survival(OS)and the highest average survival time(5.9 months).Surgical resection of primary and metastatic sites in patients with liver,bone and simultaneous liver and bone metastasis has a better median OS.For patients with brain or lung metastasis,regardless of surgical resection of the metastatic or primary focus,there is no benefit to the survival time of the patients.Age ≤ 49 years old and palliative primary tumor were associated with better OS.Compared with the non-operative intervention group,patients with stage IV GC who received primary tumor resection had a 20.5% lower risk of death in terms of OS compared with those without surgery.Conclusion:These findings support the survival benefits of palliative gastrectomy for patients with stage IV gastric cancer.However,age,basic physical condition,tumor grade,tumor histology and metastatic status should be taken into account when making decisions about gastrectomy.Chemotherapy should also be recommended for these patients.