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

• Published in: Annals of surgical oncology 2010-12, Vol.17 (12), p.3163-3172
• Main Authors: Kang, Myoung Hee, Kim, Shi Nae, Kim, Noe Kyeong, Park, Young-Iee, Kim, Young-Woo, Ryu, Keun Won, Lee, Jun Ho, Lee, Jong Seok, Park, Sook Ryun
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - secondary; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carcinoma, Signet Ring Cell - drug therapy; Carcinoma, Signet Ring Cell - secondary; Clinical outcomes; Female; Gastrointestinal Oncology; Humans; Intestinal Perforation - chemically induced; Intestinal Perforation - drug therapy; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Male; Medical Records; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Palliative Care; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - secondary; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1164-3

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.