A statistical analysis of 741 cases of stage IV gastric cancer patients diagnosed between 1987 and 1991 at Seoul National University Hospital was done to evaluate the clinicopathological features and to find a proper management of stage IV gastric cancer. Peritoneal metastais (PM) was present in 227 patients (31%), liver metastasis (LM) in 198 patients (29%), direct invasion to adjacent organ (DI) in 148 patients (20%), and synchronous peritoneal and liver metast sis in 62 patients (8%). Patients with peritoneal metastasis were younger, and have Borrmann type IV and signet rinacell type lesion more frequently. Patients with liver metastasis were loder, and have Borrman type I and II and moderately-differentiated, highly-located lesion more frequently. Two-year survival rate for patients with direct invasion (DI) group was 20.4%, 17.7% for patients with liver metastasis (LM), 6.9% for patients with pritoneal meatstasis (PM), and 4.2% for patients with synchronous liver and peritoneal metastasis. In the group of patients with direct invasion (DI), patients who received gastric resection have better survival time than the patients who recieved bypass procedure (450 days vs 202 days in median survival, P<0.05), althrough resected group shows less invasive than bypass group. There was significant survival gain in resected group when comparision was done in T4NZMO homogenized group. But there was no significant survival gain by resection in liver or peritoneal metastasis (P > 0.05). Two year survival rate of the patients who recieved gastrectomy was 34.0% in immunochemotherapy group (n=23), 23.4% in chemotheraPy group (n=33), and 13.5% in operation ony group (n=22)(P<0.05), where prognostic parameters of these aroups were relatively comparable. We conclude that in stage IV gastric cancer there were different clinicopathologic features according to the metastatic patterns and gastric resection has significant survival gain than bypass procedure in direct invasion group, although not in liver or peritoneal metastasis. This retrospective analysis suggested the possibility that postoperative immunochemotherapy or chemotherapy may have some role in treatment of stage IV gastric cancer.
PDF Links
Full text via DOI 
Download Citation 
