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Jiang YK, Li W, Qiu YY, Yue M. Advances in targeted therapy for human epidermal growth factor receptor 2 positive in advanced gastric cancer. World J Gastrointest Oncol 2024; 16:2318-2334. [PMID: 38994153 PMCID: PMC11236256 DOI: 10.4251/wjgo.v16.i6.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024] Open
Abstract
Emerging therapeutic methods represented by targeted therapy are effective supplements to traditional first-line chemoradiotherapy resistance. Human epidermal growth factor receptor 2 (HER2) is one of the most important targets in targeted therapy for gastric cancer. Trastuzumab combined with chemotherapy has been used as the first-line treatment for advanced gastric cancer. The safety and efficacy of pertuzumab and margetuximab in the treatment of gastric cancer have been verified. However, monoclonal antibodies, due to their large molecular weight, inability to penetrate the blood-brain barrier, and drug resistance, lead to decreased therapeutic efficacy, so it is necessary to explore the efficacy of other HER2-targeting therapies in gastric cancer. Small-molecule tyrosine kinase inhibitors, such as lapatinib and pyrrotinib, have the advantages of small molecular weight, penetrating the blood-brain barrier and high oral bioavailability, and are expected to become the drugs of choice for perioperative treatment and neoadjuvant therapy of gastric cancer after validation by large-scale clinical trials in the future. Antibo-drug conjugate, such as T-DM1 and T-DXd, can overcome the resistance of monoclonal antibodies despite their different mechanisms of tumor killing, and are a supplement for the treatment of patients who have failed the treatment of monoclonal antibodies such as trastuzumab. Therefore, after more detailed stratification of gastric cancer patients, various gastric cancer drugs targeting HER2 are expected to play a more significant role.
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Affiliation(s)
- Ya-Kun Jiang
- Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
| | - Wei Li
- Health Management Center, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
| | - Ying-Yang Qiu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Meng Yue
- Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
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Ozmen MM, Zulfikaroglu B, Ozmen F, Moran M, Ozalp N, Seckin S. D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer. Turk J Surg 2021; 37:49-58. [PMID: 34585094 DOI: 10.47717/turkjsurg.2020.4931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
Objectives Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role. Material and Methods In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival. Results Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables. Conclusion This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.
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Affiliation(s)
- Mehmet Mahir Ozmen
- Department of Surgery, Medical School, Istinye University, Istanbul, Turkey.,General Surgery, Liv Hospital, Ankara, Turkey.,General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Baris Zulfikaroglu
- General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Fusun Ozmen
- Department of Basic Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey.,Medical Oncology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Munevver Moran
- General Surgery, Liv Hospital, Ankara, Turkey.,General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Necdet Ozalp
- General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Selda Seckin
- Pathology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
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Zhao X, Ren Y, Hu Y, Cui N, Wang X, Cui Y. Neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the esophagus or the gastroesophageal junction: A meta-analysis based on clinical trials. PLoS One 2018; 13:e0202185. [PMID: 30138325 PMCID: PMC6107145 DOI: 10.1371/journal.pone.0202185] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background The benefit of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy for treating cancer of the esophagus or the gastroesophageal junction remains controversial. In the present study, we conducted a comprehensive meta-analysis to examine the efficacy of these two management strategies. Methods The MEDLINE (PubMed), SinoMed, Embase, and Cochrane Library databases were searched for eligible studies. We searched for the most relevant studies published until the end of September 2017. Data were extracted independently and were analyzed using RevMan statistical software version 5.3 (Cochrane Collaboration, http://tech.cochrane.org/revman/download). Weighted mean differences, risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration’s risk of bias tool was used to assess the risk of bias. In this comprehensive meta-analysis, we examined the efficiency of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy for the treatment of cancer of the esophagus or the gastroesophageal junction as reported in qualified clinical trials. Results Six qualified articles that included a total of 866 patients were identified. The meta-analysis showed that for 3-year and 5-year survival rates in primary outcomes, the results favored neoadjuvant chemoradiotherapy strategies compared with neoadjuvant chemotherapy (RR = 0.78, 95% CI = 0.62–0.98, P = 0.03; RR = 0.69, 95% CI = 0.50–0.96, P = 0.03, respectively). In terms of secondary outcomes, neoadjuvant chemoradiotherapy significantly increased the rate of R0 resection and pathological complete response as well (RR = 0.87, 95% CI = 0.81–0.92, P < 0.0001; RR = 0.16, 95% CI = 0.09–0.28, P < 0.00001, respectively). However, there were no significant differences in postoperative mortality between the two groups (RR = 1.85, 95% CI = 0.93–3.65, P = 0.08). For the results of postoperative complications, revealed that there was a statistically significant difference between the two groups in the incidence of postoperative complications such as pulmonary, anastomotic leak and cardiovascular complications. The subgroup analysis of patients with esophageal adenocarcinoma or squamous cell carcinoma showed that both esophageal adenocarcinoma and squamous cell carcinoma patients achieved a high rate of R0 resection (RR = 0.85, 95% CI = 0.77–0.93, P = 0.0006; RR = 0.88, 95% CI = 0.81–0.96, P = 0.005, respectively) and pathological complete response benefit of neoadjuvant chemoradiotherapy (RR = 0.23, 95% CI = 0.09–0.57, P = 0.001; RR = 0.18, 95% CI = 0.03–0.96, P = 0.05, respectively). Conclusion Our findings suggested that compared with neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy should be recommended with a significant long-term survival benefit in patients with cancer of the esophagus or the gastroesophageal junction. In view of the clinical heterogeneity, whether these conclusions are broadly applicable should be further determined.
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Affiliation(s)
- Xin Zhao
- Tianjin Medical University, Tianjin, China
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School, Tianjin Medical University, Tianjin, China
| | - Yiming Ren
- Department of Bone and Joint, Tianjin Union Medicine Center, Tianjin, PR China
| | - Yong Hu
- Tianjin Medical University, Tianjin, China
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School, Tianjin Medical University, Tianjin, China
| | - Naiqiang Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School, Tianjin Medical University, Tianjin, China
| | - Ximo Wang
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School, Tianjin Medical University, Tianjin, China
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School, Tianjin Medical University, Tianjin, China
- * E-mail:
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Cai Z, Yin Y, Zhao Z, Xin C, Cai Z, Yin Y, Shen C, Yin X, Wang J, Chen Z, Zhou Y, Zhang B. Comparative Effectiveness of Neoadjuvant Treatments for Resectable Gastroesophageal Cancer: A Network Meta-Analysis. Front Pharmacol 2018; 9:872. [PMID: 30127746 PMCID: PMC6087755 DOI: 10.3389/fphar.2018.00872] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/19/2018] [Indexed: 02/05/2023] Open
Abstract
Background: Several neoadjuvant treatments are available for patients with resectable gastroesophageal cancer. We did a Bayesian network meta-analysis (NMA) to compare available treatments, summarizing the direct and indirect evidence. Method: We searched relevant databases for randomized controlled trials of neoadjuvant treatments for resectable gastroesophageal cancer which compared two or more of the following treatments: surgery alone, perioperative docetaxel, oxaliplatin, leucovorin, and fluorouracil (FLOT), and neoadjuvant treatments listed in National Comprehensive Cancer Network guideline. Then we performed a NMA to summarize the direct and indirect evidence to estimate the relative efficacy for outcomes including overall survival (OS), progression-free survival and R0 resection rate. We calculated odds ratio (OR) and hazard ratio (HR) with 95% credible intervals (CrI) for dichotomous data and time-to-event data, respectively. We also calculated the surface under the cumulative ranking curve (SUCRA) value of each intervention to obtain a hierarchy of treatments. Result: Eight eligible trials (2434 patients) were included in our NMA. The treatment with the highest probability of benefit on OS as compared with surgery alone was perioperative FLOT [HR = 0.58 with 95% CrI: (0.43, 0.78), SUCRA = 93%], followed by preoperative radiotherapy, paclitaxel, and carboplatin (RT/PC) [HR = 0.68 with 95% CrI: (0.53, 0.87), SUCRA = 72%], perioperative cisplatin with fluorouracil (CF) [HR = 0.70 with 95% CrI: (0.51, 0.95), SUCRA = 68%], and perioperative epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) [HR = 0.75 with 95% CrI: (0.60, 0.94), SUCRA = 56%]. Conclusion: Compared with surgery alone, perioperative CF, perioperative ECF/ECX, perioperative FLOT, and preoperative RT/PC significantly improved survival. Perioperative FLOT is likely to be the most effective neoadjuvant treatment for the disease. Further clinical studies are needed and justified.
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Affiliation(s)
- Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqiong Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyu Xin
- West China College of Public Health, Sichuan University, Chengdu, China
| | - Zhaohui Cai
- Department of Infectious Disease, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- The First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhixin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhou
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Cai Z, Cai Z, He T, Zhao Z, Yin Y, Shen C, Yin X, Chen Z, Dan C, Zhang B. Comparative effectiveness of hyperthermic intraperitoneal chemotherapy for gastric cancer: A systematic review and network meta-analysis protocol. Medicine (Baltimore) 2018; 97:e11949. [PMID: 30113499 PMCID: PMC6112913 DOI: 10.1097/md.0000000000011949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Comparative efficacy and safety of different hyperthermic intraperitoneal chemotherapies (HIPEC) in patients with advanced gastric cancer who underwent gastrectomy is unclear. To investigate this question, we conduct a systematic review and network meta-analysis. METHODS The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. PubMed, Embase, and the Cochrane Library will be searched systematically for eligible randomized controlled trials without language restriction. The primary outcome is overall survival. The second outcomes are postoperative complications. The surface under the cumulative ranking curve value will be calculated to establish a hierarchy of the treatments. RESULTS The results will provide useful information about the effectiveness and safety of HIPEC regimens in patients with resected gastric cancer. CONCLUSION The findings of the study will be disseminated through peer-reviewed journal.
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Affiliation(s)
- Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Zhaohui Cai
- Department of Infectious Disease, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine
- The First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing
| | - Tao He
- Department of Breast Surgery, West China Hospital
| | - Zhou Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Zhixin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Cao Dan
- Department of Medical Oncology, Cancer Center of West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
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Larsen AC, Holländer C, Duval L, Schønnemann K, Achiam M, Pfeiffer P, Yilmaz MK, Thorlacius-Ussing O, Bæksgaard L, Ladekarl M. A Nationwide Retrospective Study of Perioperative Chemotherapy for Gastroesophageal Adenocarcinoma: Tolerability, Outcome, and Prognostic Factors. Ann Surg Oncol 2014; 22:1540-7. [DOI: 10.1245/s10434-014-4127-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Indexed: 11/18/2022]
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Pathological complete response and long-term survival in a very elderly patient after neoadjuvant chemotherapy for locally advanced, unresectable gastric cancer. Case Rep Oncol Med 2014; 2014:532924. [PMID: 25298899 PMCID: PMC4179970 DOI: 10.1155/2014/532924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/02/2014] [Indexed: 11/17/2022] Open
Abstract
We address the pathological complete response and long-term survival of elderly patients after neoadjuvant chemotherapy in locally advanced, unresectable gastric cancer. An 83-year-old man was hospitalized for upper abdominal pain. Gastrointestinal endoscopy showed a large tumor spanning from the gastric angle to the antrum, and extending to the duodenum. Histological analysis of the biopsy specimen revealed a poorly differentiated adenocarcinoma. Computed tomography images showed thickening of the gastric wall and invasion of the body and head of the pancreas, but did not show distant metastases. The patient was diagnosed with unresectable gastric cancer, and was treated with neoadjuvant chemotherapy using S-1 (80 mg/m(2)) and paclitaxel (60 mg/m(2)). After the third course of chemotherapy, gastrointestinal endoscopy and abdominal computed tomography revealed a remarkable reduction in tumor size. This reduction allowed distal gastrectomy to be conducted. Histological examination of the specimen revealed no cancer cells in the primary lesion or lymph nodes. The patient was treated with adjuvant chemotherapy of oral tegafur-uracil (300 mg/day) for one year after surgery. He lived for five years after surgery without recurrence. Neoadjuvant chemotherapy using S-1 and paclitaxel is a potent strategy for improving survival in very elderly patients with unresectable gastric cancer.
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Lorenzen S, Pauligk C, Homann N, Schmalenberg H, Jäger E, Al-Batran SE. Feasibility of perioperative chemotherapy with infusional 5-FU, leucovorin, and oxaliplatin with (FLOT) or without (FLO) docetaxel in elderly patients with locally advanced esophagogastric cancer. Br J Cancer 2013; 108:519-26. [PMID: 23322206 PMCID: PMC3593547 DOI: 10.1038/bjc.2012.588] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this exploratory subgroup analysis of the fluorouracil, oxaliplatin, docetaxel (FLOT)65+ trial was to determine tolerability and feasibility of perioperative chemotherapy in elderly, potentially operable esophagogastric cancer patients. METHODS Patients aged ≥65 with locally advanced esophagogastric adenocarcinoma were randomized to perioperative chemotherapy consisting of four pre- and four postoperative cycles of infusional 5-FU, leucovorin, and oxaliplatin (FLO) without or with docetaxel 50 mg m(-)(2) (FLOT), every 2 weeks. RESULTS Forty-four patients with a median age of 70 years were randomized and 43 patients started preoperative chemotherapy (FLO, 22; FLOT, 21). Thirty-eight (86.4%) patients completed four cycles of preoperative chemotherapy and 32 (74.4%) proceeded to surgery, with 67.4% R0 resections on intent-to-treat analysis (90.1% of the 32 patients who underwent resection). Median overall survival was not reached and median progression-free survival (PFS) was 17.3 months. Compared with the FLO group, the FLOT group showed a trend towards an improved median PFS (21.1 vs 12.0 months; P=0.09), however, associated with increased chemotherapy related toxicity. No perioperative mortality was observed. Postoperative morbidity was observed in 46.9% of patients (FLO, 35.3%; FLOT, 60%). CONCLUSION Neoadjuvant FLO or FLOT may offer a reasonable chance of curative surgery in elderly patients with locally advanced resectable gastroesophageal cancer. However, the increase in side effects with the FLOT regimen and postoperative morbidity should be carefully considered when an intensive chemotherapy regimen is planned.
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Affiliation(s)
- S Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Ge L, Wang HJ, Yin D, Lei C, Zhu JF, Cai XH, Zhang GQ. Effectiveness of 5-flurouracil-based neoadjuvant chemotherapy in locally-advanced gastric/gastroesophageal cancer: A meta-analysis. World J Gastroenterol 2012; 18:7384-7393. [PMID: 23326149 PMCID: PMC3544046 DOI: 10.3748/wjg.v18.i48.7384] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 10/08/2012] [Accepted: 11/06/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effectiveness of 5-flurouracil-based neoadjuvant chemotherapy (NAC) for gastroesophageal and gastric cancer by meta-analysis.
METHODS: MEDLINE and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the flurouracil-based NAC for gastroesophageal and gastric cancer, and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery. Studies that included patients with metastases at enrollment were excluded. Primary endpoint was the odds ratio (OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer. Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gastroesophageal and gastric cancer. Safety analyses were also performed. The OR was the principal measurement of effect, which was calculated as the treatment group (NAC plus surgery) vs control group (surgery alone) and was presented as a point estimate with 95% confidence intervals (CI). All calculations and statistical tests were performed using RevMan 5.1 software.
RESULTS: Seven RCTs were included for the analysis. A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group (n = 620) and control group (n = 629). The quality scores of the RCTs were assessed according to the method of Jadad. The RCT quality scores ranged from 2 to 7 (5-point scale), with a mean of 3.75. The median follow-up time in these studies was over 3 years. The meta-analysis showed that NAC improved the overall survival rate (OR 1.40, 95%CI 1.11-1.76; P = 0.005), which was statistically significant. The 3-year progression-free survival rate was significantly higher in treatment group than in control group (37.7% vs 27.3%) (OR 1.62, 95%CI 1.21-2.15; P = 0.001). The tumor down-stage rate was higher in treatment group than in control group (55.76% vs 41.38%) (OR 1.77, 95%CI 1.27-2.49; P = 0.0009) and the R0 resection rate of the gastroesophageal and gastric cancer was higher in treatment group than in control group (75.11% vs 68.56%) (OR 1.38, 95%CI 1.03-1.85; P = 0.03), with significant differences. No obvious safety concerns about mortality and complications were raised in these trials. There were no statistically significant differences in perioperative mortality (5.08% vs 4.86%) (OR 1.05, 95%CI 0.57-1.94; P = 0.87 fixed-effect model) and in the complication rate between the two groups (13.25% vs 9.66%) (OR 1.40, 95%CI 0.91-2.14; P = 0.12 fixed-effect model). Trials showed that patients from Western countries favored NAC compared with those from Asian countries (OR 1.40, 95%CI 1.07-1.83). Monotherapy was inferior to multiple chemotherapy (OR 1.40, 95%CI 1.07-1.83). Intravenous administration of NAC was more advantageous than oral route (OR 1.41, 95%CI 1.09-1.81).
CONCLUSION: Flurouracil-based NAC can safely improve overall survival rate of patients with gastroesophageal/gastric cancer. Additionally, NAC can down the tumor stage and improve R0 resection.
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Laparoscopic gastrectomy and impact on recurrence of gastric cancer. Surg Endosc 2011; 26:889-90. [PMID: 22011945 DOI: 10.1007/s00464-011-1965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Wen Y, Wang Q, Zhou C, Yan D, Qiu G, Yang C, Tang H, Peng Z. Decreased expression of RASSF6 is a novel independent prognostic marker of a worse outcome in gastric cancer patients after curative surgery. Ann Surg Oncol 2011; 18:3858-67. [PMID: 21442347 DOI: 10.1245/s10434-011-1668-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Our previous study observed that the expression of RASSF6, a member of the Ras-association domain family, was down-regulated in gastric cancer cells. The present study further investigated the clinical significance of RASSF6 in gastric cancer. METHODS Using real-time PCR, Western blot analysis, tissue microarray (TMA), and immunohistochemical staining, we evaluated RASSF6 mRNA and protein levels in tumor tissues and in the paired adjacent normal mucosa from patients with gastric cancers at different stages. RESULTS RASSF6 mRNA and protein levels were decreased in gastric cancer tissues compared with the adjacent normal mucosa. Immunohistochemical detection of RASSF6 in a TMA that contained 264 paired specimens showed that a decreased cytoplasmic RASSF6 expression was significantly associated with the extent of cancer invasion, lymph node metastasis, distant metastasis, tumor histological grade, advanced clinical stage, and Ki-67 proliferative index. Moreover, RASSF6 expression in metastatic lymph nodes was lower than in the paired primary tumors. Patients with RASSF6-negative tumors had extremely higher disease recurrence rates and poorer survival than patients with RASSF6-positive tumors even after radical surgery. Stratification analysis revealed RASSF6 as an independent predictor for tumor recurrence in patients with gastric cancers irrespective of tumor stage. CONCLUSIONS RASSF6 might contribute to the progression of gastric carcinogenesis and may function as a novel independent prognostic marker for the prediction of the recurrence of cancer in patients after curative operations.
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Affiliation(s)
- Yugang Wen
- Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Laparoscopic sphincter-preserving rectal cancer surgery: a highly demanding procedure. Surg Endosc 2011; 24:3241-3. [PMID: 20372934 DOI: 10.1007/s00464-010-1025-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hanisch E, Ziogas D, Baltogiannis G, Katsios C. Laparoscopic total gastrectomy: further progress in gastric cancer. Surg Endosc 2011; 24:2355-7. [PMID: 20177935 DOI: 10.1007/s00464-010-0920-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Fatourou E, Papaziogas B. Double endoscopic intraluminal surgery: superior to ESD for early gastric cancer? Surg Endosc 2011; 24:2349-50. [PMID: 20177914 DOI: 10.1007/s00464-010-0957-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Open versus laparoscopic versus robotic gastrectomy for cancer: need for comparative-effectiveness quality. Surg Endosc 2010; 24:1510-2. [PMID: 20044770 DOI: 10.1007/s00464-009-0790-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zoras O, Spiliotis J. Monitoring and assessing the intraabdominal therapeutic response for gastric cancer: is second-look laparoscopy the solution? Surg Endosc 2010; 24:2351-3; author reply 2354. [PMID: 20414679 DOI: 10.1007/s00464-010-0958-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baltogiannis G, Katsios C. Endoscopic submucosal dissection for remnant gastric cancer. Surg Endosc 2010; 24:3244-6. [PMID: 20354873 DOI: 10.1007/s00464-010-1023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baltogiannis G, Katsios C. High-quality clinical practice: laparoscopic rectal cancer resection. Surg Endosc 2010; 24:2913-5. [PMID: 20354876 DOI: 10.1007/s00464-010-1019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hanisch E, Ziogas D. Laparoscopic low vs. high anterior resection for rectal cancer. Surg Endosc 2010; 24:2359-60; author reply 2361. [PMID: 20174933 DOI: 10.1007/s00464-010-0932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Biffi R, Fazio N, Luca F, Chiappa A, Andreoni B, Zampino MG, Roth A, Schuller JC, Fiori G, Orsi F, Bonomo G, Crosta C, Huber O. Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer. World J Gastroenterol 2010; 16:868-74. [PMID: 20143466 PMCID: PMC2825334 DOI: 10.3748/wjg.v16.i7.868] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate feasibility, morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.
METHODS: Patients suffering from locally-advanced (T3-4 any N M0 or any T N1-3 M0) gastric carcinoma, staged with endoscopic ultrasound, bone scan, computed tomography, and laparoscopy, were assigned to receive four 21 d/cycles of TCF (docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and fluorouracil 300 mg/m2 per day for days 1-14), either before (Arm A) or after (Arm B) gastrectomy. Operative morbidity, overall mortality, and severe adverse events were compared by intention-to-treat analysis.
RESULTS: From November 1999 to November 2005, 70 patients were treated. After preoperative TCF (Arm A), thirty-two (94%) resections were performed, 85% of which were R0. Pathological response was complete in 4 patients (11.7%), and partial in 18 (55%). No surgical mortality and 28.5% morbidity rate were observed, similar to those of immediate surgery arm (P = 0.86). Serious chemotherapy adverse events tended to be more frequent in arm B (23% vs 11%, P = 0.07), with a single death per arm.
CONCLUSION: Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.
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Outweighing the benefits and weakness of endoscopic submucosal dissection for early gastric cancer in the west. Surg Endosc 2010; 24:1507-9. [DOI: 10.1007/s00464-009-0789-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Hottenrott C. Curability risks by endoscopic submucosal dissection for early gastric cancer. Surg Endosc 2009; 24:1224-5. [PMID: 19915904 DOI: 10.1007/s00464-009-0749-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Is laparoscopic gastrectomy safe for western patients with gastric cancer with high body mass index? Surg Endosc 2009; 24:977-9. [DOI: 10.1007/s00464-009-0696-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 06/12/2009] [Indexed: 12/17/2022]
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Hottenrott C. Totally laparoscopic vs. laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 2009; 24:961-3; author reply 964. [PMID: 19760327 DOI: 10.1007/s00464-009-0697-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 07/04/2009] [Indexed: 12/16/2022]
Affiliation(s)
- Christof Hottenrott
- Department of Surgery, Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Strasse 3, 60487, Frankfurt, Germany.
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Hottenrott C. Laparoscopic low anterior resection for rectal cancer: improving outcomes. Surg Endosc 2009; 23:2871-3. [PMID: 19688396 DOI: 10.1007/s00464-009-0643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/12/2009] [Indexed: 10/20/2022]
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Standardization and time trends in laparoscopic colorectal surgery. Surg Endosc 2009; 24:726-7. [PMID: 19633895 DOI: 10.1007/s00464-009-0612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
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Robotic versus laparoscopic gastrectomy. Surg Endosc 2009; 24:239-41; author reply 242-3. [DOI: 10.1007/s00464-009-0625-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 05/06/2009] [Indexed: 12/17/2022]
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Hanisch E. Preventing and managing complications of laparoscopic gastrectomy. Surg Endosc 2009; 23:2855-7. [PMID: 19551435 DOI: 10.1007/s00464-009-0581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/01/2009] [Indexed: 11/26/2022]
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Body mass index and risks of laparoscopic gastrectomy. Surg Endosc 2009; 23:2864-6. [PMID: 19484307 DOI: 10.1007/s00464-009-0523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 04/11/2009] [Indexed: 10/20/2022]
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Kanellos D, Pramateftakis MG, Kanellos I. Facts and trends in laparoscopic gastrectomy for cancer. Surg Endosc 2009; 23:2867-9; author reply 2870. [PMID: 19466484 DOI: 10.1007/s00464-009-0525-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 04/11/2009] [Indexed: 02/02/2023]
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Beyond quality-of-life improvement: how robotic surgery for low anterior resection with total mesorectal excision also may improve oncologic outcomes. Surg Endosc 2009; 23:2662-4. [DOI: 10.1007/s00464-009-0526-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/12/2009] [Indexed: 10/20/2022]
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Impact of laparoscopic D2 gastrectomy on long-term survival for early gastric cancer. Surg Endosc 2009; 23:1681-3. [DOI: 10.1007/s00464-009-0502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 02/01/2009] [Indexed: 12/18/2022]
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Marakis G, Demetriades H, Ziogas D, Kanellos I. Local Excision for Rectal Cancer—Safety and Efficacy Challenges. Ann Surg Oncol 2009; 16:2369-70; author reply 2371-2. [DOI: 10.1245/s10434-009-0499-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 11/18/2008] [Accepted: 11/18/2008] [Indexed: 11/18/2022]
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Demetetriades H, Marakis GN, Ziogas D, Kanellos I. Robotic D2 surgery for gastric cancer. Surg Endosc 2009; 23:1919-21; author reply 1922-3. [DOI: 10.1007/s00464-009-0496-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 12/08/2008] [Indexed: 01/11/2023]
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Kanellos D, Kanellos I. Assessing Potential Synergistic Effects of S-1 Plus Paclitaxel Chemotherapy in Gastric Cancer. Ann Surg Oncol 2009; 16:1442-3; author reply 1444-5. [DOI: 10.1245/s10434-009-0360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/02/2008] [Indexed: 11/18/2022]
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Liakakos T, Misiakos EP, Macheras A. Advanced gastric cancer: is laparoscopic gastrectomy safe? Surg Endosc 2009; 23:1161-3. [PMID: 19296172 DOI: 10.1007/s00464-009-0427-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 12/04/2008] [Indexed: 02/07/2023]
Affiliation(s)
- T Liakakos
- Third Surgical Department, University of Athens, Athens, Greece.
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Liakakos T, Patapis P, Charalambopoulos A, Macheras A. Laparoscopic D2 gastrectomy: time for a randomized trial. World J Surg 2009; 33:1542-3; author reply 1544. [PMID: 19225833 DOI: 10.1007/s00268-009-9948-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Batsis C, Ziogas D, Fatouros M. Neoadjuvant Chemotherapy for Breast Cancer: Does Pretreatment Axillary Nodal Staging Improve Decision Making? Ann Surg Oncol 2009; 16:1063-4. [DOI: 10.1245/s10434-009-0351-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 12/02/2008] [Indexed: 12/17/2022]
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Ignantiadou E, Ziogas D, Fatouros M. Stage IV breast cancer: is surgical resection of clinical utility? Ann Surg Oncol 2009; 16:1437-8; author reply 1439. [PMID: 19184228 DOI: 10.1245/s10434-008-0312-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/04/2008] [Indexed: 12/11/2022]
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Liakakos T, Karatzas G. Predicting prognosis of gastric cancer: limitations of metastatic lymph nodes number and promise of genomics. Ann Surg Oncol 2009; 16:1432-3; author reply 1434. [PMID: 19184231 DOI: 10.1245/s10434-008-0305-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 11/20/2008] [Indexed: 11/18/2022]
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Liakakos T, Polychronidis A, Bistarakis D, Kopanakis K, Macheras A. Laparoscopic peritoneal cytology: can it affect decision-making for neoadjuvant treatment of gastric cancer? Ann Surg Oncol 2009; 16:1072-3; author reply 1076. [PMID: 19184234 DOI: 10.1245/s10434-008-0301-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 09/27/2008] [Indexed: 01/19/2023]
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Bali C, Ziogas D, Fatouros E, Fatouros M. Is there a role for surgery in recurrent gastric cancer. Ann Surg Oncol 2009; 16:1074-5; author reply 1076. [PMID: 19184233 DOI: 10.1245/s10434-008-0302-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 12/14/2022]
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Ziogas D, Ignatiadou E, Fatouros M. Predicting and preventing positive surgical margins and local failures in breast-conserving surgery. Ann Surg Oncol 2008; 16:544-5. [PMID: 19050960 DOI: 10.1245/s10434-008-0254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 09/18/2008] [Indexed: 11/18/2022]
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Liakakos T, Xeropotamos N, Ziogas D, Roukos D. EGFR as a Prognostic Marker for Gastric Cancer. World J Surg 2008; 32:1225-6; author reply 1227-9. [PMID: 18224475 DOI: 10.1007/s00268-007-9434-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lieto E, Ferraraccio F, Orditura M, Castellano P, La Mura A, Pinto M, Zamboli A, De Vita F, Galizia G. Integrated Therapy in Localized Gastric Cancer: Targeted and Tailored Approach. Ann Surg Oncol 2008. [DOI: 10.1245/s10434-008-0092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Baltogiannis G, Ziogas D, Fatouros M. Exploring clinical implications of mechanisms for breast cancer local recurrence. Ann Surg Oncol 2008; 16:783-4; author reply 785-6. [PMID: 18773243 DOI: 10.1245/s10434-008-0124-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 08/01/2008] [Indexed: 11/18/2022]
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Fatourou E, Macheras A, Misiakos EP, Liakakos T. Perioperative chemotherapy for gastric cancer. Ann Surg Oncol 2008; 16:226-7. [PMID: 18773245 DOI: 10.1245/s10434-008-0117-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 12/14/2022]
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Ignatiadou E, Ziogas D, Lykoudis E, Misiakos EP, Liakakos T. Screening for or prevention of local ipsilateral recurrence and contralateral breast cancer after breast-conserving surgery? Ann Surg Oncol 2008; 15:3617-9. [PMID: 18618184 DOI: 10.1245/s10434-008-0031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 05/29/2008] [Indexed: 11/18/2022]
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