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Li Z, Wang Y, Shan F, Ying X, Wu Z, Xue K, Miao R, Zhang Y, Ji J. ypTNM staging after neoadjuvant chemotherapy in the Chinese gastric cancer population: an evaluation on the prognostic value of the AJCC eighth edition cancer staging system. Gastric Cancer 2018; 21:977-987. [PMID: 29748876 DOI: 10.1007/s10120-018-0830-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aims to evaluate the new ypTNM staging system in Chinese gastric cancer patients. METHODS We conducted retrospective survival and regression analyses using a database of gastric cancer patients who underwent neoadjuvant chemotherapy at the Peking University Cancer Hospital and Institute from January 2007 to January 2015. RESULTS A total of 473 patients were included in the study with 28 pathological complete response (pCR) cases, 3 ypT0N1 cases, 65 stage I cases, 126 stage II cases, and 251 stage III cases. The pCR cases had similar survival to stage I patients (p > 0.05). The 3-year disease-free survival (DFS) and 5-year overall survival (OS) rates of stage I, II and III patients were significantly different (3-year DFS: 89.0, 75.5, and 39.6%, p < 0.001; 5-year OS: 89.6, 65.5, and 36.5%, p = 0.001). Both ypT and ypN are independent predictors of patient survival, while further log-rank tests showed that the ypN stage is of better prognostic value than ypT. Subgrouping analysis revealed that stage III patients of ypT4b and ypN3 had worse survival compared to the rest of stage III cases (p < 0.001). The c-index values of the ypTNM stage and modified ypTNM stage (stage III divided into IIIa and IIIb) were 0.657 and 0.708, respectively (p < 0.001). CONCLUSIONS Our data showed significant differences in survival among gastric cancer patients at different ypTNM stages, indicating its prognostic value in the Chinese population. Further detailed analyses may facilitate the subgrouping of each stage to allow for a more accurate evaluation of disease prognosis in gastric cancer patients.
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Affiliation(s)
- Ziyu Li
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Yinkui Wang
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Fei Shan
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Xiangji Ying
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Zhouqiao Wu
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Kan Xue
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Rulin Miao
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Yan Zhang
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China
| | - Jiafu Ji
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, People's Republic of China.
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Biondi A, Agnes A, Del Coco F, Pozzo C, Strippoli A, D'Ugo D, Persiani R. Preoperative therapy and long-term survival in gastric cancer: One size does not fit all. Surg Oncol 2018; 27:575-583. [PMID: 30217321 DOI: 10.1016/j.suronc.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The administration of perioperative chemotherapy represents the Western standard of care for patients with locally advanced gastric cancer. The aim of this study is to determine if the administration of the preoperative component of the perioperative regimen is beneficial in the entire population of patients with locally advanced gastric cancer. METHODS Seventy patients undergoing preoperative therapy were compared with 347 patients undergoing upfront gastrectomy. Survival analyses were conducted with Kaplan-Meier curves and Cox regression. Patients undergoing preoperative therapy or undergoing upfront gastrectomy were matched 1:1 using the propensity score matching (PSM) method, and a survival analysis was conducted on matched patients. A subgroup analysis was conducted by tumor location and Lauren histotype. RESULTS In patients undergoing preoperative therapy, factors significantly associated with survival were T and N downstaging, type of gastrectomy, resection status and Lauren histotype. Preoperative therapy was not significantly associated with survival (p = 0,761 before PSM and p = 0,519 after PSM). After PSM, the independent variables significantly associated with survival were type of gastrectomy, type of lymphadenectomy, R status and postoperative therapy. In the subgroup analysis, preoperative therapy demonstrated a selective association with the location of the tumor (p = 0,055) and with Lauren intestinal histotype (p = 0,002). CONCLUSIONS Preoperative therapy had a non-significant impact on survival in the entire population of gastric cancer patients. The advantage of preoperative therapy seems to be limited to patients with proximal tumors and an intestinal histology. Future studies should better evaluate the diverse response of the different phenotypes of gastric cancer to preoperative therapy.
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Affiliation(s)
- Alberto Biondi
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Annamaria Agnes
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy.
| | - Federica Del Coco
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Carmelo Pozzo
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Antonia Strippoli
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Domenico D'Ugo
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Roberto Persiani
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
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Shu Y, Zhang W, Hou Q, Zhao L, Zhang S, Zhou J, Song X, Zhang Y, Jiang D, Chen X, Wang P, Xia X, Liao F, Yin D, Chen X, Zhou X, Zhang D, Yin S, Yang K, Liu J, Fu L, Zhang L, Wang Y, Zhang J, An Y, Cheng H, Zheng B, Sun H, Zhao Y, Wang Y, Xie D, Ouyang L, Wang P, Zhang W, Qiu M, Fu X, Dai L, He G, Yang H, Cheng W, Yang L, Liu B, Li W, Dong B, Zhou Z, Wei Y, Peng Y, Xu H, Hu J. Prognostic significance of frequent CLDN18-ARHGAP26/6 fusion in gastric signet-ring cell cancer. Nat Commun 2018; 9:2447. [PMID: 29961079 PMCID: PMC6026495 DOI: 10.1038/s41467-018-04907-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/31/2018] [Indexed: 02/05/2023] Open
Abstract
Signet-ring cell carcinoma (SRCC) has specific epidemiology and oncogenesis in gastric cancer, however, with no systematical investigation for prognostic genomic features. Here we report a systematic investigation conducted in 1868 Chinese gastric cancer patients indicating that signet-ring cells content was related to multiple clinical characteristics and treatment outcomes. We thus perform whole-genome sequencing on 32 pairs of SRC samples, and identify frequent CLDN18-ARHGAP26/6 fusion (25%). With 797 additional patients for validation, prevalence of CLDN18-ARHGAP26/6 fusion is noticed to be associated with signet-ring cell content, age at diagnosis, female/male ratio, and TNM stage. Importantly, patients with CLDN18-ARHGAP26/6 fusion have worse survival outcomes, and get no benefit from oxaliplatin/fluoropyrimidines-based chemotherapy, which is consistent with the fact of chemo-drug resistance acquired in CLDN18-ARHGAP26 introduced cell lines. Overall, this study provides insights into the clinical and genomic features of SRCC, and highlights the importance of frequent CLDN18-ARHGAP26/6 fusions in chemotherapy response for SRCC.
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Affiliation(s)
- Yang Shu
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Weihan Zhang
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Qianqian Hou
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Linyong Zhao
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Shouyue Zhang
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Jiankang Zhou
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Xiaohai Song
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Yan Zhang
- Department of Thoracic Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Dan Jiang
- Department of Pathology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Xinzu Chen
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Peiqi Wang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Xuyang Xia
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Fei Liao
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Dandan Yin
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Xiaolong Chen
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Xueyan Zhou
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Duyu Zhang
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Senlin Yin
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Jianping Liu
- Department of Pathology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Leilei Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Lan Zhang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Yuelan Wang
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Junlong Zhang
- Department of Laboratory Medicine/Research Center of Clinical Laboratory Medicine, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Yunfei An
- Department of Laboratory Medicine/Research Center of Clinical Laboratory Medicine, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Hua Cheng
- WuxiNextCODE, 200131, Shanghai, China
| | - Bin Zheng
- WuxiNextCODE, 200131, Shanghai, China
| | | | - Yinglan Zhao
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Yongsheng Wang
- Department of Thoracic Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Dan Xie
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Liang Ouyang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Ping Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Wei Zhang
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, 410008, Changsha, China
| | - Meng Qiu
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Xianghui Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Lunzhi Dai
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Gu He
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Hanshuo Yang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Wei Cheng
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Li Yang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Bo Liu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Biao Dong
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Yuquan Wei
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China
| | - Yong Peng
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China.
| | - Heng Xu
- Precision Medicine Center, State Key Laboratory of Biotherapy and Precision Medicine, Key Laboratory of Sichuan Province, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China.
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China.
- Department of Laboratory Medicine/Research Center of Clinical Laboratory Medicine, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China.
| | - Jiankun Hu
- Department of Gastrointestinal Surgery, Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, 610041, Chengdu, Sichuan, China.
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Tailored treatment for signet ring cell gastric cancer. Updates Surg 2018; 70:167-171. [PMID: 29948660 DOI: 10.1007/s13304-018-0550-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/13/2018] [Indexed: 02/08/2023]
Abstract
Gastric cancer with Laurèn diffuse types is increasing in the West. The raising trend is more evident when considering signet ring cells (SRC) histology. However, to control the biologic potential of this GC subtype, some hypotheses of tailored therapeutic strategies for SRC cancers have been made. A review of the literature was performed using the key words "signet ring cells" AND "gastric cancer". Results of literature review were descriptively reported. Endoscopic submucosal dissection (ESD), according to the Japanese extended criteria, could be a therapeutic option for early SRC tumours. However, according to the evidences from more recent studies, indications for ESD to these tumours types should be carefully considered. Concerning the optimal surgical treatment, considering the high lymphotropism and infiltrating behaviour of SRC histotype, the extension of gastric resection should be wider than for intestinal type cancer and laparoscopic surgery should be performed carefully. Moreover, D3 lymphadenectomy could provide a benefit in diffuse-type and SRC histology. The role of surgery in gastric cancer with peritoneal carcinomatosis is still debated and studies on this topic should stratify the good results according to GC histotype. Finally, despite the evidences of chemoresistance in SRC, ongoing randomized trials suggest that multimodal therapy could be the best treatment. Based on the assumption that SRC tumours have specific features, they deserve a specific multimodal treatment. However, a preliminary step to generate strong evidences in this field is the standardization of terminology used to define signet ring cells carcinoma.
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Efficacy of a docetaxel-5FU-oxaliplatin regimen (TEFOX) in first-line treatment of advanced gastric signet ring cell carcinoma: an AGEO multicentre study. Br J Cancer 2018; 119:424-428. [PMID: 29872148 PMCID: PMC6133962 DOI: 10.1038/s41416-018-0133-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 02/08/2023] Open
Abstract
Background Triplet chemotherapy, with docetaxel-5FU-oxaliplatin (TEFOX), has
yielded promising results in patients with advanced and operable gastric
adenocarcinoma. This may prove useful in treating signet ring cell carcinoma
(SRCC), which is known to be chemoresistant and has a poor prognosis. We therefore
evaluated TEFOX in patients with untreated advanced SRCC. Methods Patients with metastatic or locally advanced non-resectable SRCC
were treated with TEFOX. Chemotherapy was administered every 14 days, with
combined docetaxel (50 mg/m2) and oxaliplatin
(85 mg/m2) followed by 5FU
(2400 mg/m2). Results Among 65 patients enrolled, including 17 with linitis plastica, ORR
and DCR were 66.1% and 87.6%, respectively. Median PFS and OS were 9.7 months (95%
CI [6.9–11.4]) and 14.3 months (95% CI [11.6–21.6]) respectively. Twenty-six
patients (40%) initially considered as unresectable had secondary resection
(n = 24) or radiotherapy (n = 2) with curative intent, with median PFS and OS of
12.4 and 26.2 months, respectively. Conclusions TEFOX appears to be effective as first-line treatment in advanced
gastric SRCC and has an acceptable safety profile. It allowed a curative intent
approach in 40% of patients. Considering the low chemosensitivity of SRCC reported
with other chemotherapy regimens and pending for randomised studies, TEFOX might
be an option in advanced gastric SRCC.
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Heger U, Sisic L, Nienhüser H, Blank S, Hinz U, Haag GM, Ott K, Ulrich A, Büchler MW, Schmidt T. Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas. Ann Surg Oncol 2018; 25:2418-2427. [PMID: 29855828 DOI: 10.1245/s10434-018-6541-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Only a few studies have analyzed multimodal treatment concepts in the subgroup of signet-ring-cell containing upper gastrointestinal (GI) cancer. Recent retrospective, multicentric data favor primary resection without neoadjuvant chemotherapy for gastric signet-ring-cell containing carcinomas (SRCs). We compared the outcomes of primarily resected carcinomas with neoadjuvantly treated, locally advanced esophagogastric SRCs. METHODS A total of 310 patients with esophagogastric SRC-staged cT3/4/Nany/Many from a prospective unicentric database were included in this study; 192 (61.9%) received neoadjuvant therapy (NEO group) and 118 (38.1%) were primarily resected (RES group). RESULTS Overall, 128 (41.3%) patients presented with adenocarcinoma of the esophagogastric junction (AEG) and 182 (58.7%) presented with gastric cancer. Neoadjuvant therapy was significantly associated with resection in curative intent (NEO: 91.1%; RES: 75.4%; P = 0.001), improved (y)pT category (P = 0.035), improved (y)pN category (P < 0.001), and R0 resections (curative intent cohort: 76.0% in NEO vs. 60.7% in RES; P = 0.010), among others, but not with postoperative complications. Overall survival was significantly improved by neoadjuvant treatment {median survival 28.5 months (95% confidence interval [CI] 14.4-39.6) vs. RES: 14.9 months (10.6-17.5); P < 0.001}, as well as in subgroups (AEG and gastric tumors, R0-resected patients, and patients with and without relevant comorbidities). Independent prognostic factors were neoadjuvant therapy (hazard ratio [HR] 0.66; P = 0.023), pT4 category (HR 1.71; P = 0.041), pN2 category (HR 1.86; P = 0.013), pN3 category (HR 2.40; P < 0.001), pM1 category (HR 1.95; P = 0.003), age > 70 years (HR 1.79; P = 0.006), gastric localization (HR 0.69; P = 0.032), American Society of Anesthesiologists classification 3/4 (HR 1.71; P = 0.004), and incomplete resection R1/2 (HR 1.6; P = 0.014). CONCLUSIONS Our results demonstrate a survival advantage for advanced-stage esophagogastric SRC patients by neoadjuvant treatment.
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Affiliation(s)
- Ulrike Heger
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
| | - Katja Ott
- Department of Surgery, RoMed Klinikum, Rosenheim, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany.
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Li Z, Shan F, Wang Y, Zhang Y, Zhang L, Li S, Jia Y, Xue K, Miao R, Li Z, Ji J. Correlation of pathological complete response with survival after neoadjuvant chemotherapy in gastric or gastroesophageal junction cancer treated with radical surgery: A meta-analysis. PLoS One 2018; 13:e0189294. [PMID: 29370182 PMCID: PMC5784899 DOI: 10.1371/journal.pone.0189294] [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: 02/10/2017] [Accepted: 09/10/2017] [Indexed: 12/12/2022] Open
Abstract
Background Neoadjuvant chemotherapy before radical gastrectomy is preferred for locally advanced gastric cancer. To avoid the problematic use of pTNM for patients after neoadjuvant chemotherapy, the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) gastric cancer TNM staging system (8th edition) added ypTNM for the first time. But patients achieving pathological complete response were not covered by the new ypTNM staging system. To investigate whether pathological complete response is associated with better outcome in gastric cancer, as was reported in rectal, breast and bladder cancer. Methods We systematically searched the databases of PubMed, EMBASE, Web of Science and Cochrane Collaboration’s Central register of controlled trials from January 1988 to April 2015 for publications which reported outcomes of patients with and without pathological complete response (pCR) (pT0N0M0) to investigate whether pCR after neoadjuvant chemotherapy in gastric or gastroesophageal junction (GEJ) treated with radical surgery is associated with better survival. The primary outcome was overall survival (OS). The secondary outcome was disease-free survival (DFS). Both were measured with a relative risk (RR). A meta-analysis was performed using the fixed effects model. Forest plots and the Q test was used to evaluate overall heterogeneity for OS and DFS. Results A total of seven trials, 1143 patients were included and analyzed after neoadjuvant chemotherapy and radical surgery with no other preoperative treatment. The average rate of pCR was 6.74% (range: 3%-15%). The RR of patients who achieved pCR in the primary tumor and lymph nodes is 0.5 (95% confidence interval [CI], 0.25–0.98; p = 0.04), 0.34 (95% CI, 0.21–0.55; p<0.0001) and 0.44 (95% CI, 0.30–0.63; p<0.0001) for one-year-OS, three-year-OS and five-year-OS, respectively. The summary RR for three-year-DFS was 0.43 (95% CI, 0.25–0.72; p = 0.002). Conclusion Patients with resectable gastric or GEJ cancer who achieved pCR after neoadjuvant chemotherapy can gain a better outcome than patients without pCR.
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Affiliation(s)
- Ziyu Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Shan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yinkui Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lianhai Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuangxi Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yongning Jia
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kan Xue
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rulin Miao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhemin Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China
- * E-mail:
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Pai RK, Pai RK. Pathologic assessment of gastrointestinal tract and pancreatic carcinoma after neoadjuvant therapy. Mod Pathol 2018; 31:4-23. [PMID: 28776577 DOI: 10.1038/modpathol.2017.87] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/31/2017] [Accepted: 06/18/2017] [Indexed: 12/17/2022]
Abstract
Neoadjuvant therapy is increasingly used to treat patients with a wide variety of malignancies. Histologic evaluation of treated specimens provides important prognostic information and may guide subsequent chemotherapy. Neoadjuvant therapy is commonly employed in the treatment of locally advanced rectal adenocarcinoma, hepatic colorectal metastases, esophageal/esophagogastric junction carcinoma, and pancreatic ductal adenocarcinoma. Numerous tumor regression schemes have been used in these tumors and standardized approaches to evaluate these specimens are needed. In this review, the various tumor regression scoring systems that have been used in these organs are described and their associations with clinical outcomes are discussed. Recommendations regarding how to handle and report the histologic findings in these resections specimens are provided.
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Affiliation(s)
- Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
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Caggiari L, Miolo G, Canzonieri V, De Zorzi M, Alessandrini L, Corona G, Cannizzaro R, Santeufemia DA, Cossu A, Buonadonna A, De Re V. A new mutation of the CDH1 gene in a patient with an aggressive signet-ring cell carcinoma of the stomach. Cancer Biol Ther 2017; 19:254-259. [PMID: 29131691 PMCID: PMC5902241 DOI: 10.1080/15384047.2017.1394540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Germline mutations in CDH1, the gene coding for the E-cadherin adhesion protein, are known to cause hereditary diffuse gastric cancer. We identified a new truncating germline mutation (p.Asp538Thrfs*19) in exon 11 of the CDH1 gene in a 41-year-old male with a diffuse gastric cancer. Although he had no parental history of gastric cancer, the co-segregation study in the family detected the same mutation in his healthy 31-year-old brother. The mutation affects one of the extracellular repeat (CAD repeats) domains which is essential for the homophilic binding specificity that directs “E-cadherin” to bind with itself each others. In this case, immunohistochemical analysis showed no expression of E-cadherin in the tumor sample and was a useful prescreening tool to genetic testing. This finding was associated with a poor response to trastuzumab-based treatment.
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Affiliation(s)
- Laura Caggiari
- a Immunopathology and Cancer Biomarkers , IRCCS CRO National Cancer Institute , Aviano , Italy
| | - Gianmaria Miolo
- b Department of Medical Oncology , IRCCS CRO National Cancer Institute , Aviano , Italy
| | | | - Mariangela De Zorzi
- d Immunopathology and Cancer Biomarkers , IRCCS CRO National Cancer Institute , Aviano , Italy
| | | | - Giuseppe Corona
- f Immunopathology and Cancer Biomarkers , IRCCS CRO National Cancer Institute , Aviano , Italy
| | - Renato Cannizzaro
- g Gastroenterology, IRCCS CRO National Cancer Institute , Aviano , Italy
| | | | - Antonio Cossu
- i Operative Unit of Pathology , Azienda Ospedaliero Universitaria Sassari , Sassari , Italy
| | - Angela Buonadonna
- j Department of Medical Oncology , IRCCS CRO National Cancer Institute , Aviano , Italy
| | - Valli De Re
- k Immunopathology and Cancer Biomarkers , IRCCS CRO National Cancer Institute , Aviano , Italy
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Bringeland EA, Wasmuth HH, Grønbech JE. Perioperative chemotherapy for resectable gastric cancer - what is the evidence? Scand J Gastroenterol 2017; 52:647-653. [PMID: 28276825 DOI: 10.1080/00365521.2017.1293727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The UK MAGIC trial published in 2006 was the first RCT to identify improved long-term survival rates using preoperative chemotherapy for resectable gastric or gastroesophageal cancer. Overnight, the treatment regimen impacted European guidelines. However, the majority of patients underwent limited lymph node dissection, and analyses of the rates of curative resection, downsizing and downstaging were not by intention to treat, rightfully raising concerns about their validity. For the subset of true gastric cancers, meta-analyses may even question the claims of improved long-term survival rates by present-day regimens. A rhetorical question can be posed as to whether downstaging and improved survival rates by preoperative (radio)-chemotherapy for cancers of the distal esophagus or gastric cardia, has confounded our conclusions on the (lack of) effect of present-day regimens of perioperative chemotherapy for true gastric cancers, let alone in a situation with proper lymph node dissection. At present, a plea can be made to move one step back and revert to an RCT with a surgery alone arm. Inclusion criteria and analyses of future RCTs must stratify on tumor location and the Lauren type and embrace the newly developed scheme of sub-classification of gastric cancers based on extensive molecular profiling as reported in the seminal Cancer Genome Atlas Study.
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Affiliation(s)
- Erling A Bringeland
- a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Hans H Wasmuth
- a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Jon E Grønbech
- a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.,b Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology , Trondheim , Norway
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Giacopuzzi S, Bencivenga M, Weindelmayer J, Verlato G, de Manzoni G. Western strategy for EGJ carcinoma. Gastric Cancer 2017; 20:60-68. [PMID: 28039533 DOI: 10.1007/s10120-016-0685-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Abstract
In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.
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Affiliation(s)
- Simone Giacopuzzi
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Maria Bencivenga
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper G.I. Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
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Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v38-v49. [PMID: 27664260 DOI: 10.1093/annonc/mdw350] [Citation(s) in RCA: 1044] [Impact Index Per Article: 130.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- E C Smyth
- Department of Gastrointestinal Oncology, Royal Marsden Hospital, London and Surrey, UK
| | - M Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - W Allum
- Department of Surgery, Royal Marsden Hospital, London and Surrey
| | - D Cunningham
- Department of Medicine, Royal Marsden Hospital, London and Surrey, UK
| | - A Cervantes
- Medical Oncology Department, INCLIVA University of Valencia, Valencia, Spain
| | - D Arnold
- Instituto CUF de Oncologia (I.C.O.), Lisbon, Portugal
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Smyth EC, Fassan M, Cunningham D, Allum WH, Okines AFC, Lampis A, Hahne JC, Rugge M, Peckitt C, Nankivell M, Langley R, Ghidini M, Braconi C, Wotherspoon A, Grabsch HI, Valeri N. Effect of Pathologic Tumor Response and Nodal Status on Survival in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial. J Clin Oncol 2016; 34:2721-7. [PMID: 27298411 PMCID: PMC5019747 DOI: 10.1200/jco.2015.65.7692] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial. MATERIALS AND METHODS Pathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG). Differences in overall survival (OS) according to TRG were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards method established the relationships among TRG, clinical-pathologic variables, and OS. RESULTS Three hundred thirty resection specimens were analyzed. In chemotherapy-treated patients with a TRG of 1 or 2, median OS was not reached, whereas for patients with a TRG of 3, 4, or 5, median OS was 20.47 months. On univariate analysis, high TRG and lymph node metastases were negatively related to survival (Mandard TRG 3, 4, or 5: hazard ratio [HR], 1.94; 95% CI, 1.11 to 3.39; P = .0209; lymph node metastases: HR, 3.63; 95% CI, 1.88 to 7.0; P < .001). On multivariate analysis, only lymph node status was independently predictive of OS (HR, 3.36; 95% CI, 1.70 to 6.63; P < .001). CONCLUSION Lymph node metastases and not pathologic response to chemotherapy was the only independent predictor of survival after chemotherapy plus resection in the MAGIC trial. Prospective evaluation of whether omitting postoperative chemotherapy and/or switching to a noncross-resistant regimen in patients with lymph node-positive disease whose tumor did not respond to preoperative epirubicin, cisplatin, and fluorouracil may be appropriate.
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Affiliation(s)
- Elizabeth C Smyth
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matteo Fassan
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - David Cunningham
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - William H Allum
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alicia F C Okines
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea Lampis
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jens C Hahne
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Massimo Rugge
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Clare Peckitt
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthew Nankivell
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruth Langley
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michele Ghidini
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chiara Braconi
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrew Wotherspoon
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Heike I Grabsch
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicola Valeri
- Elizabeth C. Smyth, David Cunningham, William H. Allum, Alicia F.C. Okines, Clare Peckitt, Chiara Braconi, Andrew Wotherspoon, and Nicola Valeri, Royal Marsden Hospital; Andrea Lampis, Jens C. Hahne, Michele Ghidini, Chiara Braconi, and Nicola Valeri, The Institute of Cancer Research, London and Sutton; Matthew Nankivell and Ruth Langley, Medical Research Council Clinical Trials Unit at UCL, London; Heike I. Grabsch, University of Leeds, Leeds, United Kingdom; Matteo Fassan and Massimo Rugge, University of Padua, Padua, Italy; and Heike I. Grabsch, Maastricht University Medical Center, Maastricht, the Netherlands.
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Lu M, Yang Z, Feng Q, Yu M, Zhang Y, Mao C, Shen L, Tang J. The characteristics and prognostic value of signet ring cell histology in gastric cancer: A retrospective cohort study of 2199 consecutive patients. Medicine (Baltimore) 2016; 95:e4052. [PMID: 27399088 PMCID: PMC5058817 DOI: 10.1097/md.0000000000004052] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Although signet ring cell cancer (SRCC) has long been regarded as an adverse prognostic factor of gastric cancer, the findings of existing studies on this issue are inconsistent. We conducted a retrospective cohort study of 2199 consecutive patients with gastric cancer treated in a tertiary cancer hospital in Beijing, China, 1994 to 2013. The characteristics of SRCC and non-SRCC were compared. The prognostic effects of SRCC and other important clinicopathological factors on overall survival were evaluated by both univariate and multivariate Cox regression analyses and expressed as hazard ratio (HR) with 95% confidence interval (CI). SRCC accounted for 16.1% of gastric cancer, increasing from 6% to 20% over the last 2 decades, and was associated with younger age, female sex, poor differentiation, diffuse type, and distal location. SRCC (HR: 1.387, 95% CI: 1.177-1.634), stage (HR: 1.752, 95% CI: 1.458-2.106), surgery (palliative resection: HR: 0.712, 95% CI: 0.590-0.859; curative resection: HR: 0.490, 95% CI: 0.380-0.633), performance status (HR: 1.849, 95% CI: 1.553-2.201), and age (HR: 1.070, 95% CI: 1.001-1.143) were independent prognostic factors for gastric cancer, whereas time period of diagnosis, sex, and tumor location were not statistically significantly associated with overall survival. Subgroup analyses showed that the prognostic value of SRCC did not vary much with age, sex, performance status, stage, and surgery and chemotherapy status. As compared with non-SRCC, SRCC accounted for increasingly more of gastric cancer and was associated with younger age, female sex, poor differentiation, diffuse type, and distal location. It was an independent prognostic factor associated with worse survival in gastric cancer.
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Affiliation(s)
- Ming Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zuyao Yang
- Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Qi Feng
- Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mei Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuelun Zhang
- Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chen Mao
- Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China
- Correspondence: Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China (e-mail: )
| | - Jinling Tang
- Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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Sodergren M, Brammer K, Zentler-Munro PL, Cunningham D, Mudan S. An Unusual Recurrence of Signet Ring Cell Gastric Adenocarcinoma Treated by Right Hemicolectomy, Pancreaticoduodenectomy, and IVC Resection: Controversies and Dilemmas of Following Standard Treatment Pathways. Cureus 2015; 7:e424. [PMID: 26848413 PMCID: PMC4727801 DOI: 10.7759/cureus.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 67-year-old male patient with a past history of previously resected T3 right adrenocortical carcinoma and T3N1 signet ring cell adenocarcinoma of the stomach who presented with recurrence of gastric cancer in the form of a large solitary mass in the right abdomen. He was treated with ECX (epirubicin, cisplatin and capecitabine) chemotherapy and multivisceral resection. This recurrence pattern is the first such description in the literature, and we discuss the controversies and arguments in favour of offering surgical resection.
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Affiliation(s)
| | - Kirsty Brammer
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust
| | | | - David Cunningham
- Department of Gastrointestinal Oncology, The Royal Marsden NHS Foundation Trust
| | - Satvinder Mudan
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust ; Department of Surgery and Cancer, Imperial College London
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66
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Biondi A, Lirosi MC, D’Ugo D, Fico V, Ricci R, Santullo F, Rizzuto A, Cananzi FCM, Persiani R. Neo-adjuvant chemo(radio)therapy in gastric cancer: Current status and future perspectives. World J Gastrointest Oncol 2015; 7:389-400. [PMID: 26690252 PMCID: PMC4678386 DOI: 10.4251/wjgo.v7.i12.389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/03/2015] [Accepted: 10/15/2015] [Indexed: 02/05/2023] Open
Abstract
In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.
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67
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Pernot S, Voron T, Perkins G, Lagorce-Pages C, Berger A, Taieb J. Signet-ring cell carcinoma of the stomach: Impact on prognosis and specific therapeutic challenge. World J Gastroenterol 2015; 21:11428-11438. [PMID: 26523107 PMCID: PMC4616218 DOI: 10.3748/wjg.v21.i40.11428] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/14/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
While the incidence of gastric cancer has decreased worldwide in recent decades, the incidence of signet-ring cell carcinoma (SRCC) is rising. SRCC has a specific epidemiology and oncogenesis and has two forms: early gastric cancer, which can be resected endoscopically in some cases and which has a better outcome than non-SRCC, and advanced gastric cancer, which is generally thought to have a worse prognosis and lower chemosensitivity than non-SRCC. However, the prognosis of SRCC and its chemosensitivity with specific regimens are still controversial as SRCC is not specifically identified in most studies and its poor prognosis may be due to its more advanced stage. It therefore remains unclear if a specific therapeutic strategy is justified, as the benefit of perioperative chemotherapy and the value of taxane-based chemotherapy are unclear. In this review we analyze recent data on the epidemiology, oncogenesis, prognosis and specific therapeutic strategies in both early and advanced SRCC of the stomach and in hereditary diffuse gastric cancer.
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68
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Understanding Complete Pathologic Response in Oesophageal Cancer: Implications for Management and Survival. Gastroenterol Res Pract 2015; 2015:518281. [PMID: 26246803 PMCID: PMC4515501 DOI: 10.1155/2015/518281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/28/2015] [Accepted: 06/25/2015] [Indexed: 12/18/2022] Open
Abstract
Despite significant improvement over recent decades, oesophageal cancer survival rates remain poor. Neoadjuvant chemoradiotherapy followed by oesophageal resection is mainstay of therapy for resectable oesophageal tumours. Operative morbidity and mortality associated with oesophagectomy remain high and complications arise in up to 60% of patients. Management strategies have moved towards definitive chemoradiotherapy for a number of tumour sites (head and neck, cervical, and rectal) particularly for squamous pathology. We undertook to perform a review of the current status of morbidity and mortality associated with oesophagectomy, grading systems determining pathologic response, and data from clinical trials managing patients with definitive chemoradiotherapy to inform a discussion on the topic.
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69
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Königsrainer I, Horvath P, Struller F, Königsrainer A, Beckert S. Initial clinical experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in signet-ring cell gastric cancer with peritoneal metastases. J Gastric Cancer 2014; 14:117-22. [PMID: 25061539 PMCID: PMC4105376 DOI: 10.5230/jgc.2014.14.2.117] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/13/2014] [Accepted: 06/15/2014] [Indexed: 12/13/2022] Open
Abstract
Purpose Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in select patients with gastric cancer and peritoneal metastases. It remains unclear, however, whether this multimodal treatment protocol is also beneficial for signet-ring cell gastric cancer (SRC) patients with peritoneal metastases. Materials and Methods Clinical data of patients scheduled for upfront systemic chemotherapy consisting of 5-FU (2,600 mg/m2), folinic acid (200 mg/m2), docetaxel (50 mg/m2), and oxaliplatin (85 mg/m2) followed by CRS and HIPEC using cisplatin (50 mg/m2) at the Comprehensive Cancer Center, University Hospital Tübingen, Germany were retrospectively analyzed. Results Eighteen consecutive patients for whom irresectability has been ruled out by a computed tomography scan were enrolled. However, complete cytoreduction could only be achieved in 72% of patients. When categorizing patients with respect to the completeness of cytoreduction, we found no difference between both groups considering tumor- or patient-related factors. The overall complication rate following complete cytoreduction and HIPEC was 46%. Within a median follow-up of 6.6 (0.5~31) months, the median survival for CRS and HIPEC patients was 8.9 months as opposed to 1.1 months for patients where complete cytoreduction could not be achieved. Following complete cytoreduction and HIPEC, progression-free survival was 6.2 months. Conclusions In SRC with peritoneal metastases, the prognosis appears to remain poor irrespective of complete CRS and HIPEC. Moreover, complete cytoreduction could not be achieved in a considerable percentage of patients. In SRC, CRS and HIPEC should be restricted to highly selective patients in order to avoid exploratory laparotomy.
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Affiliation(s)
- Ingmar Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen, Germany
| | - Philipp Horvath
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen, Germany
| | - Florian Struller
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen, Germany
| | - Stefan Beckert
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen, Germany
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Ott K, Schmidt T, Lordick F, Herrmann K. [Importance of PET in surgery of esophageal cancer]. Chirurg 2014; 85:505-12. [PMID: 24817185 DOI: 10.1007/s00104-013-2668-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perioperative or preoperative radiochemotherapy (RCTx) is nowadays standard for locally advanced esophageal cancer in Europe, as randomized studies have shown a significant survival benefit for patients with multimodal treatment. As responders and nonresponders have a significantly different prognosis, a response-based tailored preoperative treatment would be of utmost interest. An established method is a metabolic response evaluation by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). The level of metabolic response is known to be dependent on the localization, tumor entity and type of preoperative treatment. Association of FDG-PET with later response and prognosis was shown for absolute standardized uptake values (SUV) or a decrease of SUV levels before and after therapy but there are also contradictory findings in the literature and no prospective validation. However, neither time points nor cut-off for metabolic response evaluation have been defined so far. The most interesting approach seems to be early response monitoring during preoperative chemotherapy, which has shown promising results in prospective single center trials (MUNICON I/II) during chemotherapy of adenocarcinoma of the esophagogastric junction (AEG), but needs to be validated in prospective multicenter trails.
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Affiliation(s)
- K Ott
- Chirurgische Klinik, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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