This single-center retrospective study (2013–2023) evaluated outcomes of gastrectomy after systemic cancer therapy in 121 cStage IVB gastric cancer patients (79 oligometastatic, 42 polymetastatic) to identify prognostic factors for postoperative survival.
3-year OS was 65% overall; oligometastatic disease outperformed polymetastatic (76% vs. 43%, p=0.009). Major pathological response (MPR, seen in 32%) strongly predicted survival in both groups (oligometastatic 97%, polymetastatic 89%). Patients without clinical complete response and without MPR had 3-year OS of only 50%.
- Single-center retrospective design limits generalizability and introduces selection bias (only 7.6% of treated patients underwent gastrectomy). - No randomized control group; outcomes for comparable patients who did not undergo surgery are not reported. - The definition of oligometastatic vs. polymetastatic disease was center-specific and not validated externally.
For stage IVB gastric cancer, surgical decision-making should go beyond technical resectability — pretreatment metastatic burden and depth of response (especially major pathological response) are key prognostic filters. Gastrectomy after systemic therapy may be appropriate in oligometastatic responders but offers limited benefit in polymetastatic patients without MPR.
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