Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry
Por:
Carmona-Bayonas A, Jiménez-Fonseca P, Echavarria I, Sánchez Cánovas M, Aguado G, Gallego J, Custodio A, Hernández R, Viudez A, Cano JM, Martínez de Castro E, Macías I, Martín Carnicero A, Garrido M, Mangas M, Álvarez Manceñido F, Visa L, Azkarate A, Ramchandani A, Fernández Montes A, Longo F, Sánchez A, Pimentel P, Limón ML, Arias D, Cacho Lavin D, Sánchez Bayona R, Cerdá P, García Alfonso P and AGAMENON Study Group
Publicada:
1 ago 2018
Resumen:
Introduction: The effect of surgery for metastases in patients with esophagogastric cancer is unknown, given the lack of randomized clinical trials; likewise, the criteria for selecting eligible patients remain to be determined.
Methods: This registry evaluates the results of patients with advanced adenocarcinoma of the stomach, distal esophagus, or gastro-esophageal junction from 32 centers. To assess selection criteria and prognostic factors, a state arrival extended Markov proportional hazards (PH) model was used.
Results: 1792 subjects were analyzed, 5% of whom (n = 92) underwent surgery for metastasis. The most common surgeries were peritoneal (29%), hepatic (24%), and distant lymph nodes (11%). Subjects chosen for metastasectomy had higher survival rates, HR 034 (95% CI, 0.06-0.80, p = 0.021). Patients who underwent surgery had a mOS since metastasectomy of 16.7 months (95% CI, 12.5-22.4). The 1- and 3-year relapse rates following RO resection were 58% and 65%, respectively. Median time since RO metastasectomy until relapse was 8.4 months (95% CI, 7.6-23.7). The 3-year OS after surgery was 30.6% (95% CI, 19.3-40.4). Duration of chemotherapy prior to surgery (months) increased mortality (HR 1.04 [95% CI, 1.01-1.07]), p = 0.009. The only significant interaction involved the use of anti-HER2 therapy.
Conclusion: The AGAMENON registry suggests that subjects with limited metastatic disease, selected on a clinical basis, can benefit from early surgeries. Prospective trials are needed to confirm these data. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Filiaciones:
Carmona-Bayonas A:
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
Jiménez-Fonseca P:
Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Echavarria I:
Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
Sánchez Cánovas M:
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
Aguado G:
Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
:
Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
Custodio A:
Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
Hernández R:
Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
Viudez A:
Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
Cano JM:
Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
Martínez de Castro E:
Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Macías I:
Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
Martín Carnicero A:
Medical Oncology Department, Complejo Hospitalario San Millán, Logroño, Spain
Garrido M:
Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile
Mangas M:
Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
Álvarez Manceñido F:
Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Visa L:
Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
Azkarate A:
Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
Ramchandani A:
Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
Fernández Montes A:
Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
Longo F:
Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
Sánchez A:
Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
Pimentel P:
Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
Limón ML:
Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Arias D:
Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
Cacho Lavin D:
Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Sánchez Bayona R:
Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
Cerdá P:
Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain
García Alfonso P:
Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
|