Conversion Surgery for Advanced Gastric Cancer According to First-Line Treatment Strategy: A Single-Center Experience with a Focused Review of the Literature.
Simple Summary: For patients with advanced gastric cancer that cannot be removed by surgery at diagnosis, drug therapy can sometimes shrink the disease enough to make an operation called conversion surgery possible. First-line treatments have expanded from conventional chemotherapy to HER2-targeted...
| Publicado en: | Cancers Vol. 18; no. 15; pp. 2483 - 2504 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
MDPI
Aug2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196245232&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196245232 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20726694 B74B jtl: Cancers issn: 20726694 maglogo: N pubinfo: dt: Aug2026 vid: 18 iid: 15 pid: 97109 pub: MDPI artinfo: ui: 196245232 196245232 196245232 10.3390/cancers18152483 196245232 ppf: 2483 ppct: 21 formats: tig: atl: Conversion Surgery for Advanced Gastric Cancer According to First-Line Treatment Strategy: A Single-Center Experience with a Focused Review of the Literature. aug: au: Kinoshita, Jun Doden, Kenta Hayashi, Kengo Matsui, Ryota Saito, Hiroto Watanabe, Megumi Tsuji, Toshikatsu Yamamoto, Daisuke Inaki, Noriyuki affil: Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-Machi, Kanazawa 920-8641, Ishikawa, Japan sug: subj: Stomach Neoplasms Surgery Stomach Neoplasms Prognosis Chemotherapy, Cancer Immune Checkpoint Inhibitors Therapeutic Use Treatment Outcomes Human Male Female Cancer Patients Retrospective Design Medical Records Record Review Prospective Studies Survival Analysis Kaplan-Meier Estimator Comparative Studies Chi Square Test Cox Proportional Hazards Model Multivariate Analysis Sensitivity and Specificity Male Female ab: Simple Summary: For patients with advanced gastric cancer that cannot be removed by surgery at diagnosis, drug therapy can sometimes shrink the disease enough to make an operation called conversion surgery possible. First-line treatments have expanded from conventional chemotherapy to HER2-targeted drugs and immunotherapy, but the outcomes of conversion surgery across these different strategies are not well described. We reviewed 187 patients treated at a single center, grouped according to their first-line treatment, and examined how often they underwent conversion surgery, their surgical and pathological outcomes, and the factors linked to survival. We also summarized previously published reports to place our findings in context. Complete tumor removal and the type of drug therapy were associated with longer survival, while the patients' general nutritional and inflammatory conditions reflected their overall outlook. These descriptive, single-center findings may help identify patients who are most likely to benefit from conversion surgery. Background/Objectives: First-line therapy for advanced gastric cancer (AGC) has evolved from cytotoxic chemotherapy to HER2-targeted and immune checkpoint inhibitor (ICI)-based regimens, yet conversion surgery (CS) outcomes across these strategies remain poorly characterized. We describe CS outcomes and prognostic factors by first-line strategy at a single center. Methods: We retrospectively reviewed 187 patients with AGC who began first-line therapy from 2011, grouped as cytotoxic (CTX, n = 127), HER2-targeted (trastuzumab, n = 21), or ICI (n = 39). CS was defined as resection after response, including an extended oligometastatic definition (n = 74). Overall survival (OS) was measured from chemotherapy initiation, and prognostic factors were assessed by Cox regression. Results: Median OS was 14.8, 18.9, and 20.9 months for CTX, trastuzumab, and ICI, respectively (p = 0.048). CS rates were comparable (41%, 33%, and 38%; p = 0.794). Pathological response was more pronounced after trastuzumab/ICI (grade 3 and ypStage 0/1; both p < 0.001). Among CS cases, R0 resection (hazard ratio [HR] 0.31) and trastuzumab/ICI therapy (HR 0.37) were independent favorable factors, whereas high inflammatory–nutritional indices (NLR, CAR) were independent poor prognostic factors. OS was comparable between oligometastatic and conventional CS (p = 0.324). Conclusions: In this hypothesis-generating study, response depth tracked tumor biology, whereas survival was determined by R0 resection, targeted/ICI therapy, and host inflammatory–nutritional status—two largely dissociable axes informing biology- and host-based selection of CS candidates for prospective testing. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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