Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry

• Published in: European journal of surgical oncology Vol. 44; no. 8; pp. 1191 - 1198
• Main Authors: Carmona-Bayonas, Alberto, Jiménez-Fonseca, Paula, Echavarria, Isabel, Sánchez Cánovas, Manuel, Aguado, Gema, Gallego, Javier, Custodio, Ana, Hernández, Raquel, Viudez, Antonio, Cano, Juana María, Martínez de Castro, Eva, Macías, Ismael, Martín Carnicero, Alfonso, Garrido, Marcelo, Mangas, Monserrat, Álvarez Manceñido, Felipe, Visa, Laura, Azkarate, Aitor, Ramchandani, Avinash, Fernández Montes, Ana, Longo, Federico, Sánchez, Ana, Pimentel, Paola, Limón, María Luisa, Arias, David, Cacho Lavin, Diego, Sánchez Bayona, Rodrigo, Cerdá, Paula, García Alfonso, Pilar
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2018
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; AGAMENON; Aged; Aged, 80 and over; Combined Modality Therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagogastric Junction; Female; Gastric cancer; HER2; Humans; Incidence; Male; Metastasectomy; Metastases; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Prospective Studies; Registries; Spain - epidemiology; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Survival Rate - trends; Young Adult; Metastasectomy; HER2; AGAMENON; Gastric cancer; Surgery; Metastases
• ISSN: 0748-7983; 1532-2157; 1532-2157
• DOI: 10.1016/j.ejso.2018.03.019

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. 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. 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 0.34 (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 R0 resection were 58% and 65%, respectively. Median time since R0 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. 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.