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Annals of Surgical Oncology

, Volume 17, Issue 12, pp 3163–3172 | Cite as

Clinical Outcomes and Prognostic Factors of Metastatic Gastric Carcinoma Patients Who Experience Gastrointestinal Perforation During Palliative Chemotherapy

  • Myoung Hee Kang
  • Shi Nae Kim
  • Noe Kyeong Kim
  • Young-Iee Park
  • Young-Woo Kim
  • Keun Won Ryu
  • Jun Ho Lee
  • Jong Seok Lee
  • Sook Ryun Park
Gastrointestinal Oncology

Abstract

Background

We conducted the current study to investigate the clinical outcomes of metastatic gastric carcinoma (MGC) patients who experienced gastrointestinal (GI) perforation during palliative chemotherapy and to examine the prognostic factors associated with survival after perforation.

Methods

We reviewed the medical records of patients at the Center for Gastric Cancer of the National Cancer Center, Korea who developed GI perforation during palliative chemotherapy between January 2001 and December 2008.

Results

Of the 1,856 patients who received palliative chemotherapy for MGC, 32 patients (1.7%) developed GI perforation during chemotherapy. Patients with perforation at the primary gastric site were more likely to have ulcerative gastric cancer lesion (90.5 vs. 40.0%, P = 0.034) or gastric tumor bleeding (28.6 vs. 0%, P = 0.298), and less likely to have Bormann type IV (14.3 vs. 60.0%, P = 0.062), than patients with perforation at nongastric sites. In 14 patients (43.8%) who resumed chemotherapy after perforation, the disease control rate was 57.1%, and median overall survival (OS) after perforation was 7.5 months [95% confidence interval (CI), 6.0–9.0 months]. In all patients, median OS following perforation was 4.0 months (95% CI, 1.5–6.6 months), and multivariate analysis revealed that differentiated tumor histology, response to chemotherapy before perforation, and absence of septic shock at time of perforation were significantly associated with favorable OS after perforation.

Conclusions

As patients experiencing GI perforation during palliative chemotherapy have heterogeneous clinical presentation, we need to adopt different approaches in the management of the patients that are compatible with the favorable prognostic factors.

Keywords

Gastric Cancer Overall Survival Bevacizumab Perforation Palliative Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This study was supported by grants 0710650 and 1010180 from Research Institute and Hospital, National Cancer Center, Republic of Korea.

References

  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Shin HR, Jung KW, Won YJ, Kong HJ, Yim SH, Sung J, et al. National cancer incidence for the year 2002 in Korea. Cancer Res Treat. 2007;39:139–49.CrossRefPubMedGoogle Scholar
  3. 3.
    D'Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004;240:808–16.CrossRefPubMedGoogle Scholar
  4. 4.
    Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg. 2000;87:236–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Glimelius B, Ekstrom K, Hoffman K, Graf W, Sjoden PO, Haglund U, et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 1997;8:163–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Casaretto L, Sousa PL, Mari JJ. Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis. Braz J Med Biol Res. 2006;39:431–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Asmis TR, Capanu M, Kelsen DP, Shah MA. Systemic chemotherapy does not increase the risk of gastrointestinal perforation. Ann Oncol. 2007;18:2006–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Sandler A, Gray R, Perry MC, Brahmer J, Schiller JH, Dowlati A, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355:2542–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med. 2007;357:2666–76.CrossRefPubMedGoogle Scholar
  11. 11.
    Hapani S, Chu D, Wu S. Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis. Lancet Oncol. 2009;10:559–68.CrossRefPubMedGoogle Scholar
  12. 12.
    Han ES, Monk BJ. What is the risk of bowel perforation associated with bevacizumab therapy in ovarian cancer? Gynecol Oncol. 2007;105:3–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Roviello F, Rossi S, Marrelli D, De Manzoni G, Pedrazzani C, Morgagni P, et al. Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol. 2006;4:19.Google Scholar
  15. 15.
    Adachi Y, Mori M, Maehara Y, Matsumata T, Okudaira Y, Sugimachi K. Surgical results of perforated gastric carcinoma: an analysis of 155 Japanese patients. Am J Gastroenterol. 1997;92:516–8.PubMedGoogle Scholar
  16. 16.
    Kasakura Y, Ajani JA, Fujii M, Mochizuki F, Takayama T. Management of perforated gastric carcinoma: a report of 16 cases and review of world literature. Am Surg. 2002;68:434–40.PubMedGoogle Scholar
  17. 17.
    Lehnert T, Buhl K, Dueck M, Hinz U, Herfarth C. Two-stage radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol. 2000;26:780–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Gertsch P, Yip SK, Chow LW, Lauder IJ. Free perforation of gastric carcinoma. Results of surgical treatment. Arch Surg. 1995;130:177–81.PubMedGoogle Scholar
  19. 19.
    Shah MA, Ramanathan RK, Ilson DH, Levnor A, D'Adamo D, O'Reilly E, et al. Multicenter phase II study of irinotecan, cisplatin, and bevacizumab in patients with metastatic gastric or gastroesophageal junction adenocarcinoma. J Clin Oncol. 2006;24:5201–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Sugrue M, Kozloff M, Hainsworth J, Badarinath S, Cohn A, Flynn P, et al. Risk factors for gastrointestinal perforations in patients with metastatic colorectal cancer receiving bevacizumab plus chemotherapy. J Clin Oncol. 2006;24(suppl 18):abstr 3535.Google Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Myoung Hee Kang
    • 1
  • Shi Nae Kim
    • 1
  • Noe Kyeong Kim
    • 1
  • Young-Iee Park
    • 1
  • Young-Woo Kim
    • 1
  • Keun Won Ryu
    • 1
  • Jun Ho Lee
    • 1
  • Jong Seok Lee
    • 1
  • Sook Ryun Park
    • 1
  1. 1.Center for Gastric CancerResearch Institute and Hospital, National Cancer CenterGoyangRepublic of Korea

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