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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Effectiveness and safety of chemotherapy for patients with malignant gastrointestinal obstruction: A Japanese population-based cohort study
Gota Fujisawa, Ryota Niikura, Takuya Kawahara, Tetsuro Honda, Kenkei Hasatani, Naohiro Yoshida, Tsutomu Nishida, Tetsuya Sumiyoshi, Shu Kiyotoki, Takashi Ikeya, Masahiro Arai, Yoku Hayakawa, Takashi Kawai, Mitsuhiro Fujishiro
Gota Fujisawa, Yoku Hayakawa, Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
Ryota Niikura, Takashi Kawai, Gastroenterological Endoscopy, Tokyo Medical University, Tokyo 1600023, Japan
Takuya Kawahara, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo 1138655, Japan
Tetsuro Honda, Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 8508555, Japan
Kenkei Hasatani, Department of Gastroenterology, Fukui Prefectural Hospital, Fukui 9108526, Japan
Naohiro Yoshida, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 9208530, Japan
Tsutomu Nishida, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 5608565, Japan
Tetsuya Sumiyoshi, Department of Gastroenterology, Tonan Hospital, Hokkaido 0600004, Japan
Shu Kiyotoki, Department of Gastroenterology, Shuto General Hospital, Yamaguchi 7420032, Japan
Takashi Ikeya, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 1048560, Japan
Masahiro Arai, Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo 1790072, Japan
Author contributions: All authors contributed to the acquisition of data for this study; Fujisawa G analyzed the data and wrote the draft manuscript; Niikura R designed the research study; Kawahara T contributed data analysis; Honda T, Hasatani K, Yoshida N, Nishida T, Sumiyoshi T, Kiyotoki S, Ikeya T, Arai M, Hayakawa Y, Kawai T, and Fujishiro M performed the research; All authors have read and approved the final manuscript.
Supported by the Tokyo Medical University Cancer Research Foundation, No. 2021; and KAKENHI Grants-in-Aid for Scientific Research, No. 20K08375.
Institutional review board statement: This study was approved by the Institutional Review Board of the University of Tokyo Hospital (No. 2019161NI) and conducted ethically in accordance with the World Medical Association Declaration of Helsinki.
Informed consent statement: Informed consent was obtained in the form of opt-out on the website.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ryota Niikura, MD, PhD, Adjunct Associate Professor, Doctor, Gastroenterological Endoscopy, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 1600023, Japan. rniikura@triton.ocn.ne.jp
Received: December 30, 2021
Peer-review started: December 30, 2021
First decision: March 7, 2022
Revised: March 9, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: June 6, 2022
ARTICLE HIGHLIGHTS
Research background
Malignant gastrointestinal obstruction is an important issue in advanced cancer and occurs in approximately 30% of patients with gastrointestinal cancer. Gastrointestinal obstruction causes oral intake impairment, nausea, vomiting, and abdominal pain and increases the risk of gastrointestinal perforation. Primary therapy involves fasting and decompression, and subsequently complete surgical resection is performed for resectable malignant gastrointestinal obstruction; palliative surgery includes bypass and stoma surgery or self-expandable metal stent (SEMS) placement.
Research motivation
The impacts of chemotherapy on patients with malignant gastrointestinal obstructions remain unclear, and multicenter evidence is lacking.
Research objectives
We performed a large multicenter cohort study to evaluate the effectiveness and safety of chemotherapy after palliative surgery or SEMS placement compared with best supportive care (BSC) in patients with unresectable malignant gastrointestinal obstructions. In addition, we aimed to identify the optimal population for chemotherapy after palliative surgery or SEMS placement.
Research methods
We conducted a multicenter retrospective cohort study that compared the chemotherapy group who received any chemotherapeutics after interventions, including palliative surgery or self-expandable metal stent placement, for unresectable malignant gastrointestinal obstruction vs BSC group between 2014 and 2019 in nine hospitals. The primary outcome was overall survival, and the secondary outcomes were patency duration and adverse events, including gastrointestinal perforation and gastrointestinal bleeding.
Research results
In total, 470 patients in the chemotherapy group and 652 patients in the BSC group were analyzed. During the follow-up period of 54.1 mo, the median overall survival durations were 19.3 mo in the chemotherapy group and 5.4 mo in the BSC group (log-rank test, P < 0.01). The median patency durations were 9.7 mo [95% confidence interval (CI): 7.7-11.5 mo] in the chemotherapy group and 2.5 mo (95%CI: 2.0-2.9 mo) in the BSC group (log-rank test, P < 0.01). The perforation rate was 1.3% (6/470) in the chemotherapy group and 0.9% (6/652) in the BSC group (P = 0.567). The gastrointestinal bleeding rate was 1.5% (7/470) in the chemotherapy group and 0.5% (3/652) in the BSC group (P = 0.105).
Research conclusions
Chemotherapy after interventions for unresectable malignant gastrointestinal obstruction was associated with increased overall survival and patency duration.
Research perspectives
Our results showed that chemotherapy may be more beneficial in cases of pancreatic cancer and gastroduodenal obstruction. These findings will help guide future research on treatment approaches and precision medicine. In the near future, these precision medicine methods are expected to contribute to cancer therapies including molecular targeted anti-cancer drugs, monoclonal antibody therapy, and antibiotic therapies.
