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Open Access Highly Accessed Research article

Identification of prognostic factors and surgical indications for metastatic gastric cancer

Yasuhiko Mohri1*, Koji Tanaka1, Masaki Ohi2, Susumu Saigusa1, Hiromi Yasuda1, Yuji Toiyama1, Toshimitu Araki1, Yasuhiro Inoue1 and Masato Kusunoki12

Author Affiliations

1 Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan

2 Department of Innovative Surgery, Mie University Graduate School of Medicine, Tsu, Japan

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BMC Cancer 2014, 14:409  doi:10.1186/1471-2407-14-409

Published: 6 June 2014



The treatment of metastatic gastric cancer is not uniform, and the prognostic factors and indications for surgery are currently unclear. This retrospective study aimed to identify the prognostic factors and clinical indications for surgery in patients with metastatic gastric cancer.


A total of 123 consecutive patients with gastric cancer and synchronous distant metastasis treated between January 1999 and December 2011 were reviewed. Patient, tumor, laboratory, surgical, and chemotherapy factors were analyzed, with overall survival as the endpoint. Univariate analyses were performed using the log-rank test, multivariate analyses were performed using the Cox proportional hazards model, and Kaplan-Meier curves were used to estimate survival. Significance was set at p < 0.05.


The median overall survival time was 13.1 months. Ninety-eight patients received chemotherapy. Twenty-eight patients underwent gastrectomy with metastasectomy and 55 underwent gastrectomy without metastasectomy. The median overall survival time for patients who underwent gastrectomy with metastasectomy, gastrectomy without metastasectomy, and no surgical intervention was 21.9 months, 12.5 months, and 7.2 months, respectively (p < 0.001). Multivariate analysis identified gastrectomy with or without metastasectomy, performance status (PS) ≥3, neutrophil-to-lymphocyte ratio (NLR) >3.1, and carbohydrate antigen 19–9 (CA19-9) level >37 U/mL as predictors of poor survival. NLR and CA19-9 level were also independent prognostic factors in the group of patients who underwent surgery.


High pretreatment NLR, CA19-9 level, and PS are predictors of poor prognosis in patients with metastatic gastric cancer. In selected patients, gastrectomy can be performed safely, and may be associated with longer survival.