Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea;
Jun Ho Ji , Danbi Lee , Yong-Pyo Lee , Seok Jae Huh , Se-Il Go , Jung Hoon Kim , Sung Yong Oh , Jung Hun Kang , Kwang Min Kim
Background: The characteristics and prognosis of de novo metastatic gastric cancer and recurrent metastatic gastric cancer have not yet been elucidated. Here, we compare prognosis and characteristics of patients with de novo versus recurrent gastric cancer. Methods: This retrospective study included 301 advanced pathologically confirmed gastric cancer patients who received palliative chemotherapy between 2012 and 2022. The de novo cohort was included of patients who presented with distant metastasis at diagnosis and recurrent metastatic cohort was composed of patients with metastasis after curative gastrectomy. We analyzed prognostic association by Cox regression and compared survival time of both cohorts using the Kaplan-meire method. Results: A total of 167 de novo and 112 recurrent patients were included. There were no differences noted among the patients with de novo disease and recurrent metastatic disease with respect to age, sex, ECOG, primary cancer location and pathologic features. Patients in the recurrent group versus de novo group were longer duration of chemotherapy (1.16 ± 1.18 years versus 0.85 ± 0.84, P = 0.01) and lower mean body mass index. (20.22 ± 2.78 versus 21.93 ± 3.38, p < 0.001) The median overall survival in the de novo group was 11.6 versus s 14.4 months in the recurrent group. (P = 0.02) In a multivariate analysis, the age of 70 years or older at the time of stage 4 diagnosis was independently associated with shorter survival. Conclusions: De novo and recurrent metastatic gastric cancer characterize distinguished subpopulations. And advanced gastric cancer with distant recurrence has significantly better survival versus those with de novo cohort. This differences between de novo and recurrent gastric cancer could facilitate discussions about patient selection of clinical trial and help with advanced personalized treatment.
Baseline Characteristics | De novo (n=167) | Recurrent (n=112) | P-value |
---|---|---|---|
> 70 years | 79 (47.31) | 47 (41.96) | |
Gender | 0.173 | ||
Female | 44 (26.35) | 38 (33.93) | |
Male | 123 (73.65) | 74 (66.07) | |
ECOG (n=278) | 0.382 | ||
0-2 | 161 (96.41) | 109 (98.20) | |
Others | 6 (3.59) | 2 (1.80) | |
Duration for chemotherapy | 0.85 ± 0.84 | 1.16 ± 1.18 | 0.010 |
BMI (n=276) | 21.93 ± 3.38 | 20.22 ± 2.78 | <0.001 |
< 18.5 | 22 (13.17) | 29 (26.61) | <0.001 |
18.5-25.0 | 109 (65.27) | 75 (68.81) | |
≥ 25.0 | 36 (21.56) | 5 (4.59) | |
Smoking (n=244) | 0.029 | ||
Never | 61 (41.78) | 51 (52.04) | |
Ex | 41 (28.08) | 32 (32.65) | |
Current | 44 (30.14) | 15 (15.31) | |
Primary site (n=277) | 0.282 | ||
Antrum | 69 (41.57) | 39 (35.14) | |
Others | 97 (58.43) | 72 (64.86) | |
Operation (n=98) | - | ||
Subtotal | - | 55 (56.12) | |
Total | - | 43 (43.88) | |
HER2 status (n=278) | 0.396 | ||
Positive | 24 (14.46) | 13 (11.61) | |
Negative | 135 (81.33) | 97 (86.61) | |
Unknown | 7 (4.22) | 2 (1.79) | |
Degree of differentiation | 0.327 | ||
Well | 9 (5.39) | 9 (8.04) | |
Moderate | 51 (30.54) | 31 (27.68) | |
Poor | 88 (52.69) | 52 (46.43) | |
Others | 19 (11.38) | 20 (17.86) | |
Tissue organization (n=278) | 0.155 | ||
Adenoca | 140 (84.34) | 84 (75.00) | |
PCC | 16 (9.64) | 17 (15.18) | |
Others | 10 (6.02) | 11 (9.82) |
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