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Barchi LC, Ramos MFKP, Dias AR, Andreollo NA, Weston AC, LourenÇo LG, Malheiros CA, Kassab P, Zilberstein B, Ferraz ÁAB, Charruf AZ, Brandalise A, Silva AMD, Alves B, Marins CAM, Leite CV, Bresciani CJC, Szor D, Mucerino DR. II BRAZILIAN CONSENSUS ON GASTRIC CANCER BY THE BRAZILIAN GASTRIC CANCER ASSOCIATION. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2020; 33:e1514. [PMID: 32844884 PMCID: PMC7448865 DOI: 10.1590/0102-672020190001e1514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. AIM This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. METHODS Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. RESULTS Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. CONCLUSION The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
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Affiliation(s)
- Leandro Cardoso Barchi
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - André Roncon Dias
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Paulo Kassab
- Department of Surgery, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Bruno Zilberstein
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Kim WJ, Lee CM, An L, Kim JH, Park S. Effect of Biologic Material Reinforcement on Surgical Anastomosis After Gastrectomy-A Pilot Study. Front Oncol 2019; 9:1184. [PMID: 31781494 PMCID: PMC6851234 DOI: 10.3389/fonc.2019.01184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/21/2019] [Indexed: 01/24/2023] Open
Abstract
Background: Acellular dermal matrix is a biologic material derived from the skin of human cadaveric donors. It has been used successfully in the past to reduce complications in breast surgery and hernia repair. This investigation was aimed at assessing the feasibility of using acellular dermal matrix to support the anastomosis after gastrectomy with the aim of reducing anastomotic site leakage complications. Methods: Patients were randomly assigned to standard anastomotic reconstruction (control arm) or anastomotic reconstruction with acellular dermal matrix reinforcement (intervention arm). Surgical outcomes related to anastomotic complications were collected. Because actual anastomotic leaks found on imaging studies are infrequent and thus require a very high number of patient recruitment to detect statistically significant difference between the two groups, in this pilot investigation other clinical and laboratory measures that have been shown to correlate to or predict anastomotic leaks were also collected. Each surgical outcome was compared. Results: A total of 94 patients (intervention arm: 50, control arm: 44), were included in the analysis. Two patients in the control arm (4.55%) and one patient in the intervention arm (2.00%) experienced anastomotic leakage (p = 0.598), a difference without statistical significance. However, average postoperative C-reactive protein (CRP) levels and NUn scores, both of which have been shown to reflect likelihood of progressing to anastomotic leakage, were significantly lower for the intervention arm. The control arm showed an average CRP level of 128.77 mg/dL (SD: 97.08) while the intervention arm showed 77.38 mg/dL (SD: 49.08, p = 0.049). Conclusions: Leakage rate reduction with acellular dermal matrix reinforcement of anastomotic site was not detected in this investigation. However, postoperative inflammation levels and numerical predictors of anastomotic leakage development were significantly lower with acellular dermal matrix reinforcement of surgical anastomosis. This finding is worthy of further investigation, as reduction of inflammation with anastomotic site reinforcement is a novel finding, and more in-depth research may lead to discoveries on the physiologic role of the surgical anastomosis in post-gastrectomy patients. In addition, lower CRP and NUn scores for the intervention arm suggest potential for larger studies to detect reduction in clinical leak rates after acellular dermal matrix reinforcement.
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Affiliation(s)
- Won Jun Kim
- Korea University Medical Center, College of Medicine, Seoul, South Korea
| | - Chang Min Lee
- Department of Surgery, Korea University Medical Center, Ansan Hospital, Ansan, South Korea
| | - Liang An
- Korea University Medical Center, College of Medicine, Seoul, South Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University Medical Center, Guro Hospital, Seoul, South Korea
| | - Sungsoo Park
- Department of Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
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Ryu DG, Choi CW, Kim SJ, Kang DH, Kim HW, Park SB, Nam HS. Possible indication of endoscopic resection in undifferentiated early gastric cancer. Sci Rep 2019; 9:16869. [PMID: 31728024 PMCID: PMC6856523 DOI: 10.1038/s41598-019-53374-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022] Open
Abstract
Endoscopic resection for early gastric cancer (EGC) without lymph node metastasis may be a valuable treatment option. To date, endoscopic resection for undifferentiated EGC is being investigated. We evaluated the risk of lymph node metastasis in undifferentiated EGC by examining the preoperative endoscopic findings and operated pathologic specimen. The medical records of patients who underwent surgical resection because of undifferentiated EGC between November 2008 and December 2015 were reviewed retrospectively. The risk factors associated with lymph node metastasis and the lymph node metastasis rate in the expanded indication of undifferentiated EGC were evaluated. A total of 376 patients with undifferentiated EGC (233 signet ring cell type and 143 poorly differentiated type) were analyzed. Lymph node metastasis was found in 9.8% of the patients. Among the patients who met the expanded criteria (59 patients), only one patient had lymph node metastasis (signet ring cell type without ulceration and 15 mm in size). The risk factors associated with lymph node metastasis were lesion size >20 mm (OR 3.013), scar deformity (OR 2.248), surface depression (OR 2.360), submucosal invasion (OR 3.427), and lymphovascular invasion (OR 6.296). Before endoscopic resection of undifferentiated EGC, careful selection of patients should be considered. The undifferentiated EGC with size ≥15 mm, scar deformity, surface depression, submucosal invasion, and lymphovascular invasion should be considered surgical resection instead of endoscopic resection.
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Affiliation(s)
- Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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54
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Park HS, Kwon WS, Park S, Jo E, Lim SJ, Lee CK, Lee JB, Jung M, Kim HS, Beom SH, Park JY, Kim TS, Chung HC, Rha SY. Comprehensive immune profiling and immune-monitoring using body fluid of patients with metastatic gastric cancer. J Immunother Cancer 2019; 7:268. [PMID: 31639056 PMCID: PMC6805480 DOI: 10.1186/s40425-019-0708-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/14/2019] [Indexed: 02/08/2023] Open
Abstract
Background The aim of this study is to profile the cytokines and immune cells of body fluid from metastatic gastric cancer (mGC), and evaluate the potential role as a prognostic factor and the feasibility as a predictive biomarker or monitoring source for immune checkpoint inhibitor. Methods Body fluid including ascites and pleural fluid were obtained from 55 mGC patients and 24 matched blood. VEGF-A, IL-10, and TGF-β1 were measured and immune cells were profiled by fluorescence assisted cell sorting (FACS). Results VEGF-A and IL-10 were significantly higher in body fluid than in plasma of mGC. Proportion of T lymphocytes with CD69 or PD-1, memory T cell marked with CD45RO, and number of Foxp3+ T regulatory cells (Tregs) were significantly higher in body fluid than those in blood of mGC. Proportion of CD8 T lymphocyte with memory marker (CD45RO) and activation marker (HLA-DR), CD3 T lymphocyte with PD-1, and number of FoxP3+ Tregs were identified as independent prognostic factors. When patients were classified by molecular subgroups of primary tumor, VEGF-A was significantly higher in genomically stable (GS)-like group than that in chromosomal instability (CIN)-like group while PD-L1 positive tumor cells (%) showed opposite results. Monitoring immune dynamics using body fluid was also feasible. Early activated T cell marked with CD25 was significantly increased in chemotherapy treated group. Conclusions By analyzing cytokines and proportion of immune cells in body fluid, prognosis of patients with mGC can be predicted. Immune monitoring using body fluid may provide more effective treatment for patients with mGC. Electronic supplementary material The online version of this article (10.1186/s40425-019-0708-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyung Soon Park
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea.,Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Sun Kwon
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - Sejung Park
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunji Jo
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - So Jung Lim
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jii Bum Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Minkyu Jung
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Hyo Song Kim
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Seung-Hoon Beom
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jun Yong Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Soo Kim
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Cheol Chung
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Sun Young Rha
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea. .,Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea. .,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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Xue F, An C, Chen L, Liu G, Ren F, Guo X, Sun H, Mei L, Sun X, Li J, Tang Y, An X, Zheng P. 4.1B suppresses cancer cell proliferation by binding to EGFR P13 region of intracellular juxtamembrane segment. Cell Commun Signal 2019; 17:115. [PMID: 31492173 PMCID: PMC6731589 DOI: 10.1186/s12964-019-0431-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gastric cancer (GC) has high incidence and mortality worldwide. However, the underlying mechanisms that regulate gastric carcinogenesis are largely undefined. 4.1B is an adaptor protein found at the interface of membrane and the cytoskeleton. Previous studies demonstrated that 4.1B serves as tumor suppressor. RESULTS We showed that 4.1B expression was decreased or lost in most GC patients. The expression pattern of it was tightly correlated with tumor size, TNM stage and overall survival (OS). We further showed that 4.1B inhibited the proliferation of two GC cell lines, MGC-803 and MKN-45, by impeding the EGFR/MAPK/ERK1/2 and PI3K/AKT pathways. A similar phenotype was also observed in immortalized mouse embryonic fibroblasts (MEF) derived from wild type (WT) and 4.1B knock-out (BKO) mice. Additionally, immunofluorescence (IF) staining and Co-IP showed that protein 4.1B bound to EGFR. Furthermore, the FERM domain of 4.1B interacted with EGFR through the initial 13 amino acids (P13) of the intracellular juxtamembrane (JM) segment of EGFR. The binding of 4.1B to EGFR inhibited dimerization and autophosphorylation of EGFR. CONCLUSION Our present work revealed that 4.1B plays important regulatory roles in the proliferation of GC cells by binding to EGFR and inhibiting EGFR function through an EGFR/MAPK/ERK1/2 pathway. Our results provide novel insight into the mechanism of the development and progression of GC.
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Affiliation(s)
- Fumin Xue
- Department of Gastroenterology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
- Key Laboratory of H. pylori and Gastrointestinal Microecology of Henan Province, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Chao An
- Department of Hematology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Lixiang Chen
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Gang Liu
- Department of Public Health, Zibo Integrate traditional Chinese & Western Medicine Hospital, Zibo, 255000 Shandong China
| | - Feifei Ren
- Key Laboratory of H. pylori and Gastrointestinal Microecology of Henan Province, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Xinhua Guo
- Red Cell Physiology, New York Blood Center, New York, NY 10065 USA
| | - Haibin Sun
- Department of Pathology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Lu Mei
- Department of Gastroenterology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Xiangdong Sun
- Key Laboratory of H. pylori and Gastrointestinal Microecology of Henan Province, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Jinpeng Li
- Department of Gastroenterology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Youcai Tang
- Department of Pediatrics, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
| | - Xiuli An
- Laboratory of Membrane Biology, New York Blood Center, New York, NY 10065 USA
| | - Pengyuan Zheng
- Department of Gastroenterology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan China
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56
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Jeon J, Cheong JH. Clinical Implementation of Precision Medicine in Gastric Cancer. J Gastric Cancer 2019; 19:235-253. [PMID: 31598369 PMCID: PMC6769368 DOI: 10.5230/jgc.2019.19.e25] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/28/2019] [Indexed: 12/24/2022] Open
Abstract
Gastric cancer (GC) is one of the deadliest malignancies in the world. Currently, clinical treatment decisions are mostly made based on the extent of the tumor and its anatomy, such as tumor-node-metastasis staging. Recent advances in genome-wide molecular technology have enabled delineation of the molecular characteristics of GC. Based on this, efforts have been made to classify GC into molecular subtypes with distinct prognosis and therapeutic response. Simplified algorithms based on protein and RNA expressions have been proposed to reproduce the GC classification in the clinical field. Furthermore, a recent study established a single patient classifier (SPC) predicting the prognosis and chemotherapy response of resectable GC patients based on a 4-gene real-time polymerase chain reaction assay. GC patient stratification according to SPC will enable personalized therapeutic strategies in adjuvant settings. At the same time, patient-derived xenografts and patient-derived organoids are now emerging as novel preclinical models for the treatment of GC. These models recapitulate the complex features of the primary tumor, which is expected to facilitate both drug development and clinical therapeutic decision making. An integrated approach applying molecular patient stratification and patient-derived models in the clinical realm is considered a turning point in precision medicine in GC.
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Affiliation(s)
- Jaewook Jeon
- Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Department of Biochemistry & Molecular Biology, Yonsei University College of Medicine, Seoul, Korea.,Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
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57
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Lee KE, Lim KH. Differences in Factors Affecting the Quality of Life Over Time After the Gastrectomy in Patients With Stage I Gastric Cancer. Gastroenterol Nurs 2019; 43:241-248. [PMID: 32487956 PMCID: PMC7329215 DOI: 10.1097/sga.0000000000000416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
Abstract
Patients with Stage I gastric cancer experience decreased postgastrectomy quality of life (QoL) despite the excellent surgical outcomes. We need to find foundational data required to develop effective nursing care plans designed to improve their QoL. This study examined QoL of patients with Stage I gastric cancer over time following gastrectomy and the effects of QoL subdomains on the patients' overall QoL over time after surgery. Data were collected from 138 patients with Stage I gastric cancer who had undergone gastrectomy within the previous 3 years. Data were classified into 3 groups according to the length of postsurgery time: 12 months or less (Group 1), 13-24 months (Group 2), and 25-36 months (Group 3). A confirmatory factor analysis was performed to examine the effects of QoL subdomains. Quality of life of patients with Stage I gastric cancer improves over time following gastrectomy. Postoperative physical symptoms influenced QoL most in Group 1 patients, whereas physical well-being and emotional well-being were the highest contributors to QoL in Groups 2 and 3, respectively. Nursing interventions must be tailored to meet the particular needs of patients at each period of recovery in order to improve QoL of patients with Stage I gastric cancer after a gastrectomy.
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Affiliation(s)
- Kyung Eun Lee
- Kyung Eun Lee, PhD, RN, KOCN (Korean Oncology Certification Nurse), is Assistant Professor, Department of Nursing, Keimyung College University, Daegu, Republic of Korea
- Kyung Hee Lim, PhD, RN, is Assistant Professor, College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Kyung Hee Lim
- Correspondence to: Kyung Hee Lim, PhD, RN, College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea ()
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58
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Factors associated with conversion to snare resection during gastric endoscopic submucosal dissection. Surg Endosc 2019; 34:1585-1591. [DOI: 10.1007/s00464-019-06918-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
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59
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Mogal H, Fields R, Maithel SK, Votanopoulos K. In Patients with Localized and Resectable Gastric Cancer, What is the Optimal Extent of Lymph Node Dissection-D1 Versus D2 Versus D3? Ann Surg Oncol 2019; 26:2912-2932. [PMID: 31076930 DOI: 10.1245/s10434-019-07417-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite advances in the treatment of patients with gastric cancer, the debate over the optimal extent of lymphadenectomy continues. METHOD A review of the classification, rationale for, and boundaries of lymphadenectomy is presented. A review of the available literature comparing D1 versus D2 versus D3 lymphadenectomy was performed and included randomized controlled trials, and prospective and retrospective comparative and non-comparative studies. RESULTS Earlier studies demonstrated increased morbidity with D2 compared with D1 lymphadenectomy, with no significant survival benefit. More recent studies have demonstrated survival benefit of a pancreas and spleen-sparing D2 lymphadenectomy in patients with advanced, node-positive tumors. Para-aortic/D3 dissections contribute to increased morbidity, with no survival benefit. CONCLUSIONS In patients with resectable gastric adenocarcinoma, a D2 lymph node dissection preserving the pancreas and spleen should be considered standard for optimal staging and treatment, provided it is performed by surgeons with sufficient expertise. Extended lymph node dissections beyond D2 should not be routinely performed as it has been shown to have increased morbidity, with no improvement in outcomes. While systemic chemotherapy should be considered standard in patients undergoing D2 lymphadenectomy, the role of adjuvant radiation continues to evolve.
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Affiliation(s)
- Harveshp Mogal
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
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60
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Kano M, Hayano K, Hayashi H, Hanari N, Gunji H, Toyozumi T, Murakami K, Uesato M, Ota S, Matsubara H. Survival Benefit of Neoadjuvant Chemotherapy with S-1 Plus Docetaxel for Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol 2019; 26:1805-1813. [PMID: 30977014 PMCID: PMC6510880 DOI: 10.1245/s10434-019-07299-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 12/16/2022]
Abstract
Background Postoperative docetaxel plus S-1 (DS) chemotherapy is expected to be the standard therapeutic strategy for pStage III gastric cancer based on the results of the JACCRO GC-07 study. Neoadjuvant chemotherapy (NAC) is thought to have several advantages over adjuvant settings. Objective This study aimed to compare the efficacies of NAC DS and the surgery-first strategy for advanced gastric cancer patients with D2 gastrectomy. Methods This was a retrospective, single-institution observational study. Of 171 patients with locally advanced (cStage IIB or III) gastric cancer who underwent curative D2 gastrectomy and received NAC DS and/or S-1 adjuvant chemotherapy between 2011 and 2017, 76 (after propensity score matching for 132 patients who met the eligibility criteria) were enrolled in this study. The 3-year progression-free survival (PFS) rate was used to directly compare efficacies between NAC DS patients and surgery-first patients. Results The 3-year PFS rates for the NAC DS group were significantly higher than those for the surgery-first group (80.0 vs. 58.7; p = 0.037), and the progression hazard ratio of the NAC DS group compared with the surgery-first group was 0.394 (95% confidence interval 0.159–0.978; p = 0.045). Conclusions The NAC DS group showed a high 3-year PFS compared with the surgery-first group, with standard S-1 postoperative chemotherapy or observation. NAC DS can be expected to be beneficial as the standard therapy for advanced gastric cancer and should be adopted for the test arm of a randomized controlled phase III trial. Electronic supplementary material The online version of this article (10.1245/s10434-019-07299-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masayuki Kano
- Department of Frontier Surgery, Chiba University, Chiba, Japan.
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University, Chiba, Japan
| | - Hideki Hayashi
- Department of Frontier Surgery, Chiba University, Chiba, Japan
| | - Naoyuki Hanari
- Department of Frontier Surgery, Chiba University, Chiba, Japan
| | - Hisashi Gunji
- Department of Frontier Surgery, Chiba University, Chiba, Japan
| | | | | | - Masaya Uesato
- Department of Frontier Surgery, Chiba University, Chiba, Japan
| | - Satoshi Ota
- Department of Frontier Surgery, Chiba University, Chiba, Japan
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Ryu WJ, Lee JE, Cho YH, Lee G, Seo MK, Lee SK, Hwang JH, Min DS, Noh SH, Paik S, Kim S, Cheong JH, Choi KY. A Therapeutic Strategy for Chemotherapy-Resistant Gastric Cancer via Destabilization of Both β-Catenin and RAS. Cancers (Basel) 2019; 11:cancers11040496. [PMID: 30965636 PMCID: PMC6521309 DOI: 10.3390/cancers11040496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
Treatment of advanced gastric cancer patients with current standard chemotherapeutic agents frequently results in resistance, leading to poor overall survival. However, there has been no success in developing strategies to overcome it. We showed the expression levels of both β-catenin and RAS were significantly increased and correlated in tissues of 756 gastric cancer (GC) patients and tissues of primary- and acquired-resistance patient-derived xenograft tumors treated with 5-fluorouracil and oxaliplatin modulated with leucovorin (FOLFOX). On the basis of our previous studies, where small molecules to suppress colorectal cancer (CRC) via degrading both β-catenin and RAS were developed, we tested the effectiveness of KYA1797K, a representative compound functioning by binding axin, in the growth of GC cells. The efficacy test of the drugs using gastric tumor organoids of Apc1638N mice showed that the CD44 and ALDH1A3 cancer stem cell markers were induced by FOLFOX, but not by KYA1797K. KYA1797K also efficiently suppressed tumors generated by re-engrafting the FOLFOX-resistant patient-derived xenograft (PDX) tumors, which also showed resistance to paclitaxel. Overall, the small-molecule approach degrading both β-catenin and RAS has potential as a therapeutic strategy for treating GC patients resistant to current standard chemotherapies.
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Affiliation(s)
- Won-Ji Ryu
- Translational Research Center for Protein Function Control, Yonsei University, Seoul 03722, Korea.
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Korea.
| | - Jae Eun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Yong-Hee Cho
- Translational Research Center for Protein Function Control, Yonsei University, Seoul 03722, Korea.
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Korea.
| | - Gunho Lee
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Korea.
- Graduate Program for Nanomedical Science, Yonsei University, Seoul 03722, Korea.
| | - Mi-Kyoung Seo
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Korea.
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Sang-Kyu Lee
- Translational Research Center for Protein Function Control, Yonsei University, Seoul 03722, Korea.
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Korea.
| | - Jeong-Ha Hwang
- Translational Research Center for Protein Function Control, Yonsei University, Seoul 03722, Korea.
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Korea.
| | - Do Sik Min
- Translational Research Center for Protein Function Control, Yonsei University, Seoul 03722, Korea.
- Department of Molecular Biology, College of Natural Science, Pusan National University, Pusan 46241, Korea.
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Soonmyung Paik
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Sangwoo Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Korea.
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Korea.
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Kang-Yell Choi
- Translational Research Center for Protein Function Control, Yonsei University, Seoul 03722, Korea.
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Korea.
- CK Biotechnology Inc., Rm 417, Engineering Research Park, 50 Yonsei Ro, Seodaemun-Gu, Seoul 03722, Korea.
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62
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Jeung YJ, Lee K, Lee HJ, Kim E, Son MJ, Ahn J, Kim HG, Kim W, Lee HJ, Kim JM, Chung KS. Cationic amino acid transporter PQLC2 is a potential therapeutic target in gastric cancer. Cancer Sci 2019; 110:1453-1463. [PMID: 30729615 PMCID: PMC6447956 DOI: 10.1111/cas.13966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 12/11/2022] Open
Abstract
Tumor cells overexpress amino acid transporters to meet the increased demand for amino acids. PQ loop repeat‐containing (PQLC)2 is a cationic amino acid transporter that might be involved in cancer progression. Here, we show that upregulation of PQLC2 is critical to gastric cancer (GC) development in vitro and in vivo. Both PQLC2 mRNA and protein were overexpressed in GC tissues, especially of the diffuse type. Overexpression of PQLC2 promoted cell growth, anchorage independence, and tumor formation in nude mice. This was due to activation of MEK/ERK1/2 and PI3K/AKT signaling. Conversely, PQLC2 knockdown caused growth arrest and cell death of cancer cells and suppressed tumor growth in a mouse xenograft model. These results suggest that targeting PQLC2 is an effective strategy for GC treatment.
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Affiliation(s)
- Yun-Ji Jeung
- Biomedical Translational Research Center, KRIBB, Daejeon, Korea.,Department of Pathology and Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyeong Lee
- College of Pharmacy, Dongguk University-Seoul, Goyang, Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eunah Kim
- Stem Cell Convergence Research Center, KRIBB, Daejeon, Korea
| | - Myung Jin Son
- Stem Cell Convergence Research Center, KRIBB, Daejeon, Korea.,Department of Functional Genomics, KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon, Korea
| | - Jiwon Ahn
- Biomedical Translational Research Center, KRIBB, Daejeon, Korea
| | - Han-Gyeul Kim
- Biomedical Translational Research Center, KRIBB, Daejeon, Korea.,Department of Functional Genomics, KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon, Korea
| | - Wantae Kim
- Biomedical Translational Research Center, KRIBB, Daejeon, Korea
| | - Ho-Joon Lee
- Stem Cell Convergence Research Center, KRIBB, Daejeon, Korea
| | - Jin Man Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung-Sook Chung
- Biomedical Translational Research Center, KRIBB, Daejeon, Korea.,Stem Cell Convergence Research Center, KRIBB, Daejeon, Korea.,Department of Functional Genomics, KRIBB School of Bioscience, Korea University of Science and Technology (UST), Daejeon, Korea
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63
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Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach. J Gastric Cancer 2019; 19:1-48. [PMID: 30944757 PMCID: PMC6441770 DOI: 10.5230/jgc.2019.19.e8] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
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Li H, Feng LQ, Bian YY, Yang LL, Liu DX, Huo ZB, Zeng L. Comparison of endoscopic submucosal dissection with surgical gastrectomy for early gastric cancer: An updated meta-analysis. World J Gastrointest Oncol 2019; 11:161-171. [PMID: 30788042 PMCID: PMC6379758 DOI: 10.4251/wjgo.v11.i2.161] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/17/2018] [Accepted: 12/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are several surgical options for treating early gastric cancers (EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection (ESD) in treating EGC is not well established, especially when compared with resection surgery cases in a long-term follow-up scope.
AIM To compare the safety and efficacy of the short- and long-term outcomes between ESD and resection surgery.
METHODS We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short- or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software (version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed- or random-effects models depending on heterogeneity across studies.
RESULTS Fourteen studies comprising 5112 patients were eligible for analysis (2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference (WMD): -140.02 min, 95%CI: -254.23 to -34.82 min, P = 0.009], shorter hospital stay (WMD: -5.41 d, 95% CI: -5.93 to -4.89 d, P < 0.001), and lower postoperative complication rate [Odds ratio (OR) = 0.39, 95%CI: 0.28-0.55, P < 0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate (OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients. However, the long-term survival including overall survival [Hazard ratio (HR) = 0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival (HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.
CONCLUSION In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the long-term survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications.
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Affiliation(s)
- Hua Li
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
- Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
| | - Li-Qian Feng
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Yao-Yao Bian
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Li-Li Yang
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Deng-Xiang Liu
- Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
| | - Zhi-Bin Huo
- Department of Surgical Oncology, Affiliated Xing Tai People Hospital of Hebei Medial University, Xingtai 054001, Hebei Province, China
| | - Li Zeng
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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65
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Zhang Y, Liu S, Feng Q, Huang X, Wang X, Peng Y, Zhao Z, Liu Z. Perilaldehyde activates AMP-activated protein kinase to suppress the growth of gastric cancer via induction of autophagy. J Cell Biochem 2019; 120:1716-1725. [PMID: 30378150 DOI: 10.1002/jcb.27491] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/18/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIM Perillaldehyde (PAH), one of the major oil components in Perilla frutescens, is very critical to health maintenance, for a wide range of human chronic diseases, including cancers. AMP-activated protein kinase (AMPK) has been implicated in the activation of autophagy in distinct tissues. This study was designed to explore whether PAH prevents gastric cancer growth and to investigate the molecular mechanism. METHODS AND RESULTS In cultured mouse gastric cancer cell line MFCs and human gastric cancer cell lines GC9811-P, PAH activated AMPK by increasing the Thr172 phosphorylation and activity in a time-/concentration-dependent manner. Furthermore, incubation of MFCs with PAH also increased autophagy as determined by monodansylcadaverine (MDC) staining, which was reversed by AMPK inhibitor compound C. PAH further decreased MFCs cell survival, which was abolished by compound C or autophagy inhibitor 3-Methyladenine (3-MA). In vivo studies indicated that 4-week administration of PAH (100 mg/kg/day) suppressed the growth of gastric cancer and increased the levels of autophagy-related proteins, including beclin-1, LC3-II, cathepsin, caspase-3, p53, and cathepsin in tumors isolated from the xenograft model of gastric cancer in mice. Moreover, these anticancer effects produced by PAH were abolished by coadministration of compound C or 3-MA in vivo. CONCLUSIONS PAH increases AMPK phosphorylation and activity to induce gastric cancer cell autophagy to inhibit the growth of gastric cancer. In perspective, therapy of PAH should be applied to treat patients with gastric cancer.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Suosi Liu
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Qin Feng
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Xiuyun Huang
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Xiangyang Wang
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Ya Peng
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
| | - Zhan Liu
- Department of Gastroenterology and Clinical Nutrition, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, Hunan, China
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66
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Bang CS, Baik GH. Pitfalls in the Interpretation of Publications about Endoscopic Submucosal Dissection of Early Gastric Cancer with Undifferentiated-Type Histology. Clin Endosc 2019; 52:30-35. [PMID: 30650945 PMCID: PMC6370935 DOI: 10.5946/ce.2018.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is a standard treatment for patients with gastrointestinal neoplasms with a negligible risk of lymph node metastasis. ESD enables en bloc resection of gastrointestinal neoplasms and organ preservation, thereby, avoiding surgical treatment. Although small (<2 cm) intramucosal early gastric cancer with undifferentiated-type histology (EGC-UH) without ulceration is included in the expanded criteria for ESD, controversies remain due to different biology and characteristics compared to EGC with differentiated-type histology. The authors previously presented studies about the technical feasibility of ESD for these lesions using a meta-analysis and retrospective multicenter analysis. However, many pitfalls were identified in the interpretation of studies analyzing histologic discrepancy, mixed-type histology, criteria-based analysis of therapeutic outcomes, interpretation of curative resection, and long-term clinical outcomes. In this review, the authors discuss pitfalls in the interpretation of publications on ESD for EGC-UH.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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67
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Chung HW, Kim JH, Sung IK, Lee SY, Park HS, Shim CS, Bang HY, So Y, Lee EJ. FDG PET/CT to predict the curability of endoscopic resection for early gastric cancer. J Cancer Res Clin Oncol 2019; 145:759-764. [DOI: 10.1007/s00432-018-02832-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022]
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68
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Kim YJ, Chung WC, Youn GJ, Jun KH, Chin HM. The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:537-542. [DOI: 10.17235/reed.2019.6041/2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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69
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Muro K, Van Cutsem E, Narita Y, Pentheroudakis G, Baba E, Li J, Ryu MH, Zamaniah WIW, Yong WP, Yeh KH, Kato K, Lu Z, Cho BC, Nor IM, Ng M, Chen LT, Nakajima TE, Shitara K, Kawakami H, Tsushima T, Yoshino T, Lordick F, Martinelli E, Smyth EC, Arnold D, Minami H, Tabernero J, Douillard JY. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with metastatic gastric cancer: a JSMO-ESMO initiative endorsed by CSCO, KSMO, MOS, SSO and TOS. Ann Oncol 2019; 30:19-33. [PMID: 30475956 DOI: 10.1093/annonc/mdy502] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of gastric cancer (GC) was published in 2016, and covered the management and treatment of local, locoregional, locally advanced and metastatic disease. At the ESMO Asia Meeting in November 2017 it was decided by both ESMO and The Japanese Society of Medical Oncology (JSMO) to convene a special guidelines meeting immediately after the JSMO Annual Meeting in 2018. The aim was to adapt the ESMO 2016 guidelines to take into account the ethnic differences associated with the treatment of metastatic GC in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with metastatic GC representing the oncological societies of Japan (JSMO), China (CSCO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of both the current treatment practices and the drug availability and reimbursement situations in the individual participating Asian countries.
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Affiliation(s)
- K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Y Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - E Baba
- Department of Comprehensive Clinical Oncology, Kyushu University, Fukuoka, Japan
| | - J Li
- Department of Oncology, Tongji University affiliated East Hospital, Shanghai, China
| | - M-H Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - W I Wan Zamaniah
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, c
| | - W-P Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - K-H Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei; National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - K Kato
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Z Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - B C Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - I M Nor
- Department of Radiotherapy & Oncology, General Hospital, Kuala Lumpur, Malaysia
| | - M Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - L-T Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - T E Nakajima
- Department of Clinical Oncology, School of Medicine, St. Marianna University, Kawasaki
| | - K Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa
| | - H Kawakami
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka
| | - T Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa
| | - F Lordick
- University Cancer Centre Leipzig, Leipzig; 1st Department of Medicine (Hematology and Medical Oncology), University Hospital Leipzig, Leipzig, Germany
| | - E Martinelli
- Department of Precision Medicine - Medical Oncology, Università degli Studi della Campania L Vanvitelli, Napoli, Italy
| | - E C Smyth
- Department of Oncology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | - H Minami
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - J Tabernero
- Medical Oncology Department, Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology (V.H.I.O.), Barcelona, Spain
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You X, Wang Y, Wu J, Liu Q, Chen D, Tang D, Wang D. Aberrant Cytokeratin 20 mRNA Expression in Peripheral Blood and Lymph Nodes Indicates Micrometastasis and Poor Prognosis in Patients With Gastric Carcinoma. Technol Cancer Res Treat 2019; 18:1533033819832856. [PMID: 30827194 PMCID: PMC6856971 DOI: 10.1177/1533033819832856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Several studies suggest that peripheral blood and lymph node micrometastases may be a causative factor for gastric cancer recurrence. Cytokeratin 20 shows enriched expression in intestinal epithelial cells. This study aimed to evaluate the clinical utility of monitoring cytokeratin 20 levels in peripheral blood and lymph nodes of patients with gastric cancer for detecting micrometastasis and predicting prognosis. We detected messenger RNA levels of cytokeratin 20 in gastric cancer cell lines and in the peripheral blood of 125 patients (85 patients with gastric cancer and 40 patients with benign neoplasm) by fluorescence quantitative real-time polymerase chain reaction both before and after radical resection. In all, 1586 lymph node samples from 85 patients with gastric cancer were evaluated for cytokeratin 20 expression using real-time polymerase chain reaction, as well as by immunohistochemistry staining with anti-pan-keratin and anti-cytokeratin 20 antibodies. All patients underwent follow-up until cancer-related death or for more than 3 years after tumor resection. We found that elevated cytokeratin 20 expression in peripheral blood as detected by quantitative real-time polymerase chain reaction closely correlates with poor clinicopathological characteristics. Detecting cytokeratin 20 messenger RNA in the lymph nodes by quantitative real-time polymerase chain reaction enabled more accurate determination of the clinicopathological staging of gastric cancer, best treatment approach, and prognosis. Our findings show that patients with increased cytokeratin 20 messenger RNA expression in the peripheral blood or lymph nodes have a shorter time to recurrence and poorer overall survival.
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Affiliation(s)
- Xiaolan You
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical
School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu Province,
China
- Xiaolan You, PhD, Department of Gastrointestinal
Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou
People's Hospital), No 8 South Dongfeng Road, Taizhou 225300, Jiangsu Province, China.
| | - Yuanjie Wang
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical
School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu Province,
China
| | - Jian Wu
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical
School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu Province,
China
| | - Qinghong Liu
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical
School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu Province,
China
| | - Dehu Chen
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical
School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu Province,
China
| | - Dong Tang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou
University, Subei People’s Hospital of Jiangsu Province, Yangzhou Jiangsu Province,
China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou
University, Subei People’s Hospital of Jiangsu Province, Yangzhou Jiangsu Province,
China
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71
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Lim H, Lee JH, Park YS, Na HK, Ahn JY, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma. J Gastric Cancer 2018; 18:400-408. [PMID: 30607303 PMCID: PMC6310761 DOI: 10.5230/jgc.2018.18.e40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/01/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection. Materials and Methods We retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017. Results Forty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed. Conclusions In patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.
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Affiliation(s)
- Hyun Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Internal Medicine, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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72
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Pyo JH, Lee H, Min YW, Min BH, Lee JH, Kim KM, Yoo H, Kim K, Choi YH, Kim JJ, Kim S. Effect of age on the clinical outcomes of patients with early gastric cancer with undifferentiated-type histology. Surgery 2018; 165:802-807. [PMID: 30551867 DOI: 10.1016/j.surg.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undifferentiated-type early gastric cancers account for a large proportion of gastric cancers in younger patients. Therefore, the clinical outcomes of endoscopic resection in younger patients are a major concern. We aimed to investigate the influence of age on lymph node metastasis and long-term survival after surgery for undifferentiated-type early gastric cancers. METHODS We identified 4,236 patients who underwent surgery for undifferentiated-type early gastric cancers. For each T stage, the correlation between age and lymph node metastasis was analyzed using a multivariate logistic regression. Lymph node metastasis rates were compared between younger (<40 years) and older patients (≥40 years) who fulfilled the expanded criteria for endoscopic resection. The Kaplan-Meier method was used to compare long-term survival between younger and older patients. RESULTS Younger age groups (20-29 and 30-39 years) had the highest lymph node metastasis rate within each T stage (5.7% and 5.7% for T1a, 26.3% and 24.1% for T1b, respectively). After adjusting for possible covariates, however, age did not have a significant effect on lymph node metastasis in either T stage (P = .127 for T1a, P = .114 for T1b). Among patients fulfilling the expanded indication for endoscopic resection, younger patients had a slightly higher lymph node metastasis rate compared with older patients (2.7% versus 2.0%), although this difference was not statistically significant. Although younger patients had a significantly better overall survival (P < .001), no significant age-related differences were observed in recurrence-free and disease-specific survival (P = .051 and P = .069) CONCLUSION: Endoscopic resection may be feasible in young patients with undifferentiated-type early gastric cancers because these patients share a similar lymph node metastasis rate and long-term survival outcomes with older patients.
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Affiliation(s)
- Jeung Hui Pyo
- Center for Health Promotion, Samsung Medical Center, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heejin Yoo
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Yoon-Ho Choi
- Center for Health Promotion, Samsung Medical Center, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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73
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Bang CS, Choi JH, Yang YJ, Lee JJ, Baik GH. Endoscopic submucosal dissection of early gastric cancer with mixed-type histology: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13838. [PMID: 30572552 PMCID: PMC6320129 DOI: 10.1097/md.0000000000013838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who have a negligible risk of lymph node metastasis satisfying specific criteria. These criteria are histologically categorized by EGC with differentiated-type histology (EGC-DH) and undifferentiated-type histology (EGC-UH). However, gastric cancer is histologically heterogenous and there has been no specific criteria for EGC with mixed-type histology (EGC-MH). Moreover, therapeutic outcomes of ESD for EGC-MH have not been clearly described. METHODS We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to November 2018 using pre-established searching strategy by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC-MH, Intervention: ESD, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence or procedure-related adverse event that enabled an evaluation of feasibility of ESD. All types of study design will be sought and publications in English with full-text will be included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned and quantitative synthesis will be used if the included studies are sufficiently homogenous (pooled therapeutic outcomes data with 95% confidence intervals). Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled. RESULTS The results will provide evidence for validity of current ESD criteria in addition to the technical feasibility of ESD for EGC-MH. CONCLUSION This study will provide evidence of ESD for EGC-MH.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine
- Institute of New Frontier Research
| | | | - Young Joo Yang
- Department of Internal Medicine
- Institute of New Frontier Research
| | - Jae Jun Lee
- Institute of New Frontier Research
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
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74
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Bang CS, Choi JH, Lee JJ, Baik GH. Endoscopic submucosal dissection of papillary adenocarcinoma of stomach; protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13905. [PMID: 30593208 PMCID: PMC6314761 DOI: 10.1097/md.0000000000013905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who has a negligible risk of lymph node metastasis. Papillary adenocarcinoma (PAC) of stomach is a rare histologic variant of gastric cancer and categorized into EGC with differentiated-histology. However, aggressive features such as higher rate of lymphovascular invasion (LVI) or submucosal invasion have been reported, whereas comparable lymph node metastasis (LNM) rate to the lesions meeting the current ESD criteria also has been reported. This study aimed to evaluate the feasibility of ESD for EGC with PAC. METHODS We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to December 2018 by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC with PAC, Intervention: ESD or surgery, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence, procedure-related adverse event, LVI or LNM that enabled an evaluation of the feasibility of ESD. All types of study design with full text will be sought and included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned, and quantitative synthesis will be used if the included studies are sufficiently homogenous. Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled. RESULTS The results will provide evidence for efficacy and safety of ESD for EGC with PAC. CONCLUSION This study will provide evidence of ESD for EGC with PAC.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine
- Institute of New Frontier Research
| | | | - Jae Jun Lee
- Institute of New Frontier Research
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
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75
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Zurleni T, Gjoni E, Altomare M, Rausei S. Conversion surgery for gastric cancer patients: A review. World J Gastrointest Oncol 2018; 10:398-409. [PMID: 30487951 PMCID: PMC6247102 DOI: 10.4251/wjgo.v10.i11.398] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/25/2018] [Accepted: 10/07/2018] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer (GC) is the third most common cancer-related cause of death worldwide. In locally advanced tumors, neoadjuvant chemotherapy has recently been introduced in most international Western guidelines. For metastatic and unresectable disease, there is still debate regarding correct management and the role of surgery. The standard approach for stage IV GC is palliative chemotherapy. Over the last decade, an increasing number of M1 patients who responded to palliative regimens of induction chemotherapy have been subsequently undergone surgery with curative intent. The objective of the present review is to analyze the literature regarding this approach, known as “conversion surgery”, which has become one of the most commonly adopted therapeutic options. It is defined as a treatment aiming at an R0 resection after chemotherapy in initially unresectable tumors. The 13 retrospective studies analyzed, with a total of 411 patients treated with conversion therapy, clearly show that even if standardization of unresectable and metastatic criteria, post-chemotherapy resectability evaluation and timing of surgery has not yet been established, an R0 surgery after induction chemotherapy with partial or complete response seems to offer superior survival results than chemotherapy alone. Additional larger sample-size randomized control trials are needed to identify subgroups of well-stratified patients who could benefit from this multimodal approach.
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Affiliation(s)
- Tommaso Zurleni
- Department of Surgery, ASST Valle Olona, Busto Arsizio 21052, Italy
| | - Elson Gjoni
- Department of Surgery, ASST Valle Olona, Busto Arsizio 21052, Italy
| | - Michele Altomare
- Department of Surgery, ASST Valle Olona, Busto Arsizio 21052, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate. 21013, Italy
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76
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Kwak DS, Min YW, Lee JH, Kang SH, Jang SH, Lee H, Min BH, Kim JJ, Kim KM, Sohn TS, Kim S. Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort. Gut Liver 2018; 12:263-270. [PMID: 29271182 PMCID: PMC5945257 DOI: 10.5009/gnl17247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/19/2017] [Accepted: 08/18/2017] [Indexed: 12/23/2022] Open
Abstract
Background/Aims Outcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database. Methods Among 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated. Results Among the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type. Conclusions In undifferentiated-type EGC, ESD should be considered in selected patients with tumor sizes <1 cm and SRC histology.
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Affiliation(s)
- Dong Shin Kwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Hoon Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyeon Jang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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77
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Arroyo-Martinez Q, Han WH, Eom BW, Yoon HM, Kim YI, Cho SJ, Lee JY, Kim CG, Morales-Conde S, Padillo-Ruiz J, Kook MC, Choi IJ, Kim YW, Ryu KW. The distribution pattern of metastatic lymph nodes after non-curative endoscopic resection in early gastric cancer. J Surg Oncol 2018; 118:1257-1263. [PMID: 30367687 DOI: 10.1002/jso.25279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Additional surgery should be done after non-curative endoscopic resection (ER) in early gastric cancer (EGC) due to the risk of lymph node metastasis (LNM). However, the distribution pattern of LNM in these patients is complicated and unpredictable. The aim of this study is to identify any different distribution patterns of LNM in patients with EGC who underwent additional surgery after non-curative (ER) comparing to those without ER. METHODS Patients who underwent surgery for EGC between 2001 and 2016 were included. Enrolled patients were divided into two groups, those who underwent additional surgery after non-curative ER and those who underwent direct surgery without a history of ER. Demographics, tumor characteristics and LNM distribution pattern were analyzed. RESULTS Among 4295 patients with EGC, 404 patients had a history of preoperative ER, and 3891 patients did not. After the application of exclusion criteria, 23 (7.1%) of 322 patients undergoing additional surgery had LNM. The additional surgery group showed less LNM, fewer nodal stations and more restricted distribution pattern of LNM. CONCLUSIONS The distribution pattern of LNM in EGC is complicated. However, more restricted locoregional LNM could be expected in cases of additional surgery after non-curative ER than after direct surgery.
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Affiliation(s)
- Quetzalihuitl Arroyo-Martinez
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea.,Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - Won Ho Han
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Young Il Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Soo Jeong Cho
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - Javier Padillo-Ruiz
- Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Young Woo Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Korea
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78
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Kim JW, Kim JG, Kang BW, Chung IJ, Hong YS, Kim TY, Song HS, Lee KH, Zang DY, Ko YH, Song EK, Baek JH, Koo DH, Oh SY, Cho H, Lee KW. Treatment Patterns and Changes in Quality of Life during First-Line Palliative Chemotherapy in Korean Patients with Advanced Gastric Cancer. Cancer Res Treat 2018; 51:223-239. [PMID: 30584995 PMCID: PMC6333995 DOI: 10.4143/crt.2018.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/23/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose The purpose of this study was to evaluate chemotherapy patterns and changes in quality of life (QOL) during first-line palliative chemotherapy for Korean patients with unresectable or metastatic/recurrent gastric cancer (GC). Materials and Methods Thiswas a non-interventional, multi-center, prospective, observational study of 527 patients in Korea. QOL assessments were conducted using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-STO22 every 3 months over a 12-month period during first-line palliative chemotherapy. The specific chemotherapy regimens were selected by individual clinicians. Results Most patients (93.2%) received combination chemotherapy (mainly fluoropyrimidine plus platinum) as their first-line palliative chemotherapy. The median progression-free survival and overall survival were 8.2 and 14.8 months, respectively. Overall, “a little” changes (differences of 5-10 points from baseline)were observed in some of the functioning or symptom scales; none of the QOL scales showed either “moderate” or “very much” change (i.e., ≥ 11 point difference from baseline). When examining the best change in each QOL domain from baseline, scales related to some aspects of functioning, global health status/QOL, and most symptoms revealed significant improvements (p < 0.05). Throughout the course of first-line palliative chemotherapy, most patients’ QOL was maintained to a similar degree, regardless of their actual response to chemotherapy. Conclusion This observational study provides important information on the chemotherapy patterns and QOL changes in Korean patientswith advanced GC. Overall, first-line palliative chemotherapy was found to maintain QOL, and most parameters showed an improvement compared with the baseline at some point during the course.
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Affiliation(s)
- Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Gwang Kim
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung Woog Kang
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ik-Joo Chung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Young Seon Hong
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Suk Song
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Kyung Hee Lee
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Medical Center, Hallym University, Anyang, Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Eun-Kee Song
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin Ho Baek
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong-Hoe Koo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Oh
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Hana Cho
- Medical Department of Genzyme, Sanofi Korea, Seoul, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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79
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Yang F, Li A, Liu H, Zhang H. Gastric cancer combination therapy: synthesis of a hyaluronic acid and cisplatin containing lipid prodrug coloaded with sorafenib in a nanoparticulate system to exhibit enhanced anticancer efficacy and reduced toxicity. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3321-3333. [PMID: 30323564 PMCID: PMC6174904 DOI: 10.2147/dddt.s176879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose Gastric cancer is one of the most common human epithelial malignancies, and using nanoparticles (NPs) in the diagnosis and treatment of cancer has been extensively studied. The aim of this study was to develop hyaluronic acid (HA) containing lipid NPs coloaded with cisplatin (CDDP) and sorafenib (SRF) for the treatment of gastric cancer. Materials and methods HA and CDDP containing lipid prodrug was synthesized using polyethylene glycol (PEG) as a linker (HA-PEG-CDDP). HA-PEG-CDDP and SRF were entrapped into the lipid NPs by nanoprecipitation method (H-CS-NPs). The physicochemical and biochemical properties such as size, zeta potential, and drug release pattern were studied. In vitro viability was also evaluated with MKN28 and SGC7901 human gastric cancer cells. In vivo testing including biodistribution and accumulation in tumor tissue was applied in gastric tumor-bearing mice to confirm the inhibition of gastric cancer. Results H-CS-NP has a particle size of 173.2±5.9 nm, with a zeta potential of −21.5±3.2 mV. At day 21 of in vivo treatment, H-CS-NPs inhibited the tumor volume from 1,532.5±41.3 mm3 to 259.6±16.3 mm3 with no obvious body weight loss. In contrast, mice treated with free drugs had body weight loss from 20 to 15 g at the end of study. Conclusion The results indicate that H-CS-NPs enhanced the antitumor effect of drugs and reduced the systemic toxicity effects. It could be used as a promising nanomedicine for gastric cancer combination therapy.
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Affiliation(s)
- Feng Yang
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining 272029, Shandong, People's Republic of China,
| | - Aimei Li
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining 272029, Shandong, People's Republic of China
| | - Han Liu
- Department of Gastroenterology, The First Affiliated Hospital of South China, Hengyang 421000, Hunan, People's Republic of China
| | - Hairong Zhang
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining 272029, Shandong, People's Republic of China,
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80
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Kwon J, Han HS, Kim HK, Baek SW, Yang Y, Lee KH, Son SM, Kim WD, Kim DH, Yun HY. Long-term Survival after Repeated Local Therapy and Salvage Chemotherapy for Recurrent Metastases from Gastric Cancer: a Case Report and Literature Review. J Gastric Cancer 2018; 18:305-312. [PMID: 30276007 PMCID: PMC6160522 DOI: 10.5230/jgc.2018.18.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of long-term survival in a patient who received local therapy and salvage chemotherapy for recurrent metastases, along with a literature review. A 65-year-old male patient underwent subtotal gastrectomy for advanced gastric adenocarcinoma. Six months after gastrectomy, 2 metastatic intra-abdominal lymph node enlargements were detected, which were treated with radiotherapy. At 55 months after gastrectomy, an abdominal wall mass was detected, which was treated by surgical resection. The patient received 5-fluorouracil/leucovorin/irinotecan chemotherapy for 27 months before and after radiotherapy and docetaxel chemotherapy for 6 months after surgical resection of the abdominal wall metastasis. At the last visit, 7.8 years since the initial resection of the primary gastric cancer and 6.2 years since detection of the first metastases, the patient was disease-free and required no further chemotherapy. This case suggests that repeated local therapy offers potential for long-term survival in a carefully selected subset of patients with recurrent metastases.
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Affiliation(s)
- Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Seung-Woo Baek
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Won-Dong Kim
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea.,Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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81
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Huang SJ, Zhu YF, Liu Z, Li QF, Li ZY, Fu WR. Study of miR-143 expression in stomach cancer. Oncol Lett 2018; 16:4367-4371. [PMID: 30214571 PMCID: PMC6126331 DOI: 10.3892/ol.2018.9173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/10/2017] [Indexed: 12/31/2022] Open
Abstract
The present study was planned to investigate miR-143 expression during stomach cancer. The study explored the relationship between miR-143 expression and clinicopathological characteristics including proliferation, migration and apoptosis of stomach cancer cells. Sixty-three samples from each of stomach cancer tissue and surrounding tissue were obtained. Total RNA was extracted. The expression levels of miR-143 from stomach cancer tissue as well as from surrounding tissue were measured by semi-quantitative PCR. The effects of miR-143 overexpression on the migration of stomach cancer cells were examined by Transwell assay. The effects of miR-143 overexpression on the apoptosis of stomach cancer cells were examined by flow cytometer. The expression level of miR-143 was significantly decreased in stomach cancer tissues in comparison to surrounding tissues (P<0.01). Moreover, the expression of miR-143 related well with the tumor size, TNM stage, lymphatic metastasis and relapse (P<0.01). On the other hand, stomach cancer cell line with overexpression of miR-143, showed significant decline in proliferation rate and migration rate comparison to control cells (P<0.01). However, it showed significant higher in apoptosis rate (P<0.01). The present study concluded that expression of miR-143 is low during stomach cancer. Further, higher expression levels of miR-143 have the ability to decline proliferation and migration of stomach cancer cells. In this manner, the expression level of miR-143 could be used as an important factor to determine the severity of stomach cancer.
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Affiliation(s)
- Shao-Jun Huang
- Department of Medical Laboratory, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Yu-Fang Zhu
- Department of Medical Laboratory, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Zeng Liu
- Department of Oncology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Qing-Feng Li
- Department of Oncology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Zhao-Yuan Li
- Department of Oncology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Wen-Rong Fu
- Department of Pathology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
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82
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Mu J, Wang X, Dong L, Sun P. Curcumin derivative L6H4 inhibits proliferation and invasion of gastric cancer cell line BGC-823. J Cell Biochem 2018; 120:1011-1017. [PMID: 30242876 DOI: 10.1002/jcb.27542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022]
Abstract
Curcumin and its chalcone derivatives have well-known, explicit biological antitumor properties, such as instance antiproliferative and apoptotic effects via multiple molecular targets. In this study, we investigated the anticancer activity of curcumin derivative L6H4 (curcumin L6H4) on gastric cancer cells. Inhibitory effects of curcumin L6H4 on gastric cancer cells (BGC-823) were studied by the diphenyltetrazolium (MTT) assay, and cell apoptosis was detected by Annexin-V/propidium iodide (PI) staining and then analyzed by flow cytometry. A mouse xenotransplant gastric tumor model was established to detect the role of curcumin L6H4 in vivo. The apoptosis-related proteins p53, p21, Bax, and Bcl-2 in BGC-823 cells and mouse xenotransplant models treated with curcumin L6H4 were determined by Western blot analysis. Curcumin L6H4 can significantly inhibit the proliferation and induce the apoptosis of BGC-823 cells, thus enhancing the expression levels of p53, p21, Bax, and Bcl-2 noticeably in vivo and in vitro. Meanwhile, curcumin L6H4 can remarkably suppress the growth of tumor cells in animal models. These results suggest that curcumin derivative L6H4 has potent of antitumor properties in vitro or in vivo.
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Affiliation(s)
- Jianfeng Mu
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xiaodong Wang
- Department of Digestive Endoscopy, The Second Hospital of Jilin Unersity, Changchun, China
| | - Lihua Dong
- Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Pengda Sun
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, China
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83
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Nam HS, Kim HW, Choi CW, Kang DH, Park SB, Kim SJ, Choi JS. Characteristics of overlooked synchronous gastric epithelial neoplasia after endoscopic submucosal dissection. Medicine (Baltimore) 2018; 97:e12536. [PMID: 30278545 PMCID: PMC6181554 DOI: 10.1097/md.0000000000012536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/31/2018] [Indexed: 12/13/2022] Open
Abstract
Since endoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for early gastric cancer (EGC) without risk of lymph node metastasis, synchronous gastric epithelial neoplasia is no longer rare in the clinical practice. Knowledge about the characteristics associated with synchronous gastric epithelial neoplasia is of great importance to prevent delayed diagnosis.Between November 2008 and December 2014, a retrospective study was conducted in a single tertiary referral hospital. Consecutive patients who underwent ESD due to EGC or high-grade dysplasia were analyzed to evaluate the incidence of synchronous gastric epithelial neoplasia and the factors associated with synchronous and overlooked synchronous lesions.A total of 488 patients were analyzed in this study. Synchronous lesions were found in 59 patients (12.1%) during the mean 37.7 months of follow-up. Among 77 synchronous lesions, 25 lesions (32.4%) were overlooked at the time of initial ESD. Age of ≥ 65 years, moderate to severe endoscopic atrophic gastritis, and elevated morphology of primary lesions were associated with synchronous gastric epithelial neoplasia. An important factor associated with overlooked lesions is the non-elevated morphology of lesions.Careful endoscopic examination of the whole stomach is necessary in patients who are older and who have moderate to severe atrophic gastritis and elevated morphology of lesions to prevent delayed diagnosis of synchronous gastric epithelial neoplasia, especially non-elevated lesions.
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Affiliation(s)
- Hyeong Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Jung Sik Choi
- Inje University College of Medicine, Busan Paik Hospital, Pusan, Korea
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84
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Saumoy M, Schneider Y, Shen N, Kahaleh M, Sharaiha RZ, Shah SC. Cost Effectiveness of Gastric Cancer Screening According to Race and Ethnicity. Gastroenterology 2018; 155:648-660. [PMID: 29778607 DOI: 10.1053/j.gastro.2018.05.026] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/18/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS There are marked racial and ethnic differences in non-cardia gastric cancer prevalence within the United States. Although gastric cancer screening is recommended in some regions of high prevalence, screening is not routinely performed in the United States. Our objective was to determine whether selected non-cardia gastric cancer screening for high-risk races and ethnicities within the United States is cost effective. METHODS We developed a decision analytic Markov model with the base case of a 50-year-old person of non-Hispanic white, non-Hispanic black, Hispanic, or Asian race or ethnicity. The cost effectiveness of a no-screening strategy (current standard) for non-cardia gastric cancer was compared with that of 2 endoscopic screening modalities initiated at the time of screening colonoscopy for colorectal cancer: upper esophagogastroduodenoscopy with biopsy examinations and continued surveillance only if intestinal metaplasia or more severe pathology is identified or esophagogastroduodenoscopy with biopsy examinations continued every 2 years even in the absence of identified pathology. We used prevalence rates, transition probabilities, costs, and quality-adjusted life years (QALYs) from publications and public data sources. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay threshold of $100,000/QALY. RESULTS Compared with biennial and no screening, screening esophagogastroduodenoscopy with continued surveillance only when indicated was cost effective for non-Hispanic blacks ($80,278/QALY), Hispanics ($76,070/QALY), and Asians ($71,451/QALY), but not for non-Hispanic whites ($122,428/QALY). The model was sensitive to intestinal metaplasia prevalence, transition rates from intestinal metaplasia to dysplasia to local and regional cancer, cost of endoscopy, and cost of resection (endoscopic or surgical). CONCLUSIONS Based on a decision analytic Markov model, endoscopic non-cardia gastric cancer screening for high-risk races and ethnicities could be cost effective in the United States.
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Affiliation(s)
- Monica Saumoy
- Division of Gastroenterology & Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Yecheskel Schneider
- Division of Gastroenterology & Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Nicole Shen
- Division of Gastroenterology & Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Robert Wood Johnson School of Medicine, New Brunswick New Jersey
| | - Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Shailja C Shah
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York; Department of Medicine, Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee.
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85
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Bang CS, Shin WG, Seo SI, Choi MH, Jang HJ, Park SW, Kae SH, Yang YJ, Shin SP, Baik GH, Kim HY. Effect of ilaprazole on the healing of endoscopic submucosal dissection-induced gastric ulcer: randomized-controlled, multicenter study. Surg Endosc 2018; 33:1376-1385. [PMID: 30167954 DOI: 10.1007/s00464-018-6412-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal treatment regimen or the duration of treatment for an endoscopic submucosal dissection (ESD)-induced gastric ulcer has not been established. The aim of this study was to assess the efficacy of novel proton-pump inhibitor, ilaprazole, for the treatment of ESD-induced gastric ulcer. METHODS This was a prospective, open-label, randomized multicenter study. Between June 2015 and March 2018, a total of 176 patients (178 lesions) who underwent ESD for a gastric neoplasm were randomly allocated to receive the oral proton-pump inhibitor ilaprazole 20 mg or rabeprazole 20 mg daily for 8 weeks. The primary outcome was the ulcer healing rate at 4 and 8 weeks. RESULTS A total of 155 (157 lesions) and 154 patients (156 lesions) were included in the modified intention-to-treat (mITT) and per-protocol analyses, respectively. There was no significant difference in the ulcer healing rate (ilaprazole vs. rabeprazole, 97.4% vs. 97.0 p = 0.78 at 4 weeks, 100% vs. 100%, p = 0.95 at 8 weeks in the mITT analysis) or stage of ulcer (scar stage, 25.6% vs. 17.7%, p = 0.25 at 4 weeks, 92.3% vs. 88.6%, p = 0.59 at 8 weeks in the mITT analysis) between the treatment groups. The quality of ulcer healing was not significantly different between the two groups. No independent predictive factor for higher-quality ulcer healing was found in the multivariate analysis. CONCLUSIONS According to this trial, ilaprazole and rabeprazole showed no significant difference in the healing of artificial gastric ulcers. Most of the ulcers achieved complete healing within 4-8 weeks. TRIAL REGISTRATION ClinicalTrial.gov NCT02638584.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea.,Institue of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea. .,Division of Gastroenterology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
| | - Seung In Seo
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Min Ho Choi
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hyun Joo Jang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Se Woo Park
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Sea Hyub Kae
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Young Joo Yang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Suk Pyo Shin
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hak Yang Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
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86
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Ryu DG, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ, Nam HS. Pathologic outcomes of endoscopic submucosal dissection for gastric epithelial neoplasia. Medicine (Baltimore) 2018; 97:e11802. [PMID: 30113468 PMCID: PMC6112879 DOI: 10.1097/md.0000000000011802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) has been widely implemented for the treatment of gastric superficial neoplasia. However, the final pathologic diagnosis after ESD may be different from that indicated by the results of endoscopic forceps biopsy. This study identified risk factors for gastric epithelial lesions so that early gastric cancer (EGC) could be diagnosed after ESD.From December 2008 to January 2017, 1541 lesions (1410 patients) diagnosed as initial adenoma or indefinite for neoplasia by endoscopic forceps biopsy were enrolled. The EGC rate and factors predicting upstaged diagnoses were analyzed retrospectively.The diagnostic discrepancy rate was 31.1%. Upstaged and downstaged diagnostic rates after ESD were 23.8% and 7.3%, respectively. The upstaged diagnosis rate for EGC was 18.8%. Gross depression (OR, 16.017) and surface redness (OR, 22.136) were significantly associated with EGC and lesions indefinite for neoplasia during the initial endoscopic forceps biopsy. Central depression (OR, 2.959), nodular surface (OR, 6.581), and surface redness (OR, 6.399) were significantly associated with EGC and lesions with low-grade dysplasia during the initial endoscopic forceps biopsy. Central depression (OR, 1.999), nodular surface (OR, 1.733), surface redness (OR 2.283), lesion location (upper third of the stomach) (OR, 3.989), and tumor size ≥10 mm (OR, 2.200) were significantly associated with EGC and lesions with high-grade dysplasia during the initial endoscopic forceps biopsy.Central depression, nodular surface, surface redness, lesion location, and tumors >10 mm were associated with EGC. Gastric epithelial lesions with these characteristics require attention before ESD.
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87
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Guner A, Kim SY, Yu JE, Min IK, Roh YH, Roh C, Seo WJ, Cho M, Choi S, Choi YY, Son T, Cheong JH, Hyung WJ, Noh SH, Kim HI. Parameters for Predicting Surgical Outcomes for Gastric Cancer Patients: Simple Is Better Than Complex. Ann Surg Oncol 2018; 25:3239-3247. [PMID: 30069658 DOI: 10.1245/s10434-018-6684-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Various parameters are used to predict perioperative surgical outcomes. However, no comprehensive studies in gastrectomy have been conducted. This study aimed to compare the performance of each parameter in patients with gastric cancer. METHODS The medical records of 1032 gastric cancer patients who underwent curative gastrectomy between 2009 and 2015 were reviewed. Laboratory values and associated parameters (neutrophil count, lymphocyte count, platelet count, albumin level, Prognostic Nutritional Index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Systemic Immune-Inflammation Index) as well as body weight-related data and associated parameters [body mass index (BMI), percentage of weight loss, Nutritional Risk Screening 2002 assessment, the Malnutrition Universal Screening Tool, and the Nutritional Risk Index] were measured and calculated. The study end points were major complications, operative mortality, prolonged hospital stay, overall survival (OS), and recurrence-free survival (RFS). RESULTS Multivariable logistic regression analysis showed that male gender, total gastrectomy, advanced-stage gastric cancer, and low albumin level were risk factors for major complications. Old age, total gastrectomy, advanced-stage cancer, and high BMI were risk factors for operative mortality. Old age, open approach, and total gastrectomy were risk factors for prolonged hospital stay. Multivariable Cox proportional hazards models showed that old age, total gastrectomy, advanced-stage cancer, and high neutrophil count were unfavorable risk factors for OS. Old age, advanced-stage cancer, high neutrophil count, and high BMI were unfavorable risk factors for RFS. CONCLUSIONS Albumin level, BMI, and neutrophil count are the most useful parameters for predicting short- and long-term surgical outcomes. Compared with complex parameters, simple-to-measure parameters are better for predicting surgical outcomes for gastric cancer patients.
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Affiliation(s)
- Ali Guner
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sang Yong Kim
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Jae Eun Yu
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - In Kyung Min
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Chulkyu Roh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jun Seo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Young Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Hospital, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. .,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea. .,Gastric Cancer Center, Yonsei Cancer Hospital, Seoul, Korea. .,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.
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88
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Indications and benefits of intraoperative esophagogastroduodenoscopy. Wideochir Inne Tech Maloinwazyjne 2018; 13:164-175. [PMID: 30002748 PMCID: PMC6041574 DOI: 10.5114/wiitm.2018.72740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Intraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy. Aim To evaluate the indications, benefits and risks of IOG. Material and methods A single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed. Results The cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG. Conclusions The IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.
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89
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Mahawongkajit P, Tomtitchong P. A survey of early and advanced gastric cancer treatment by surgeons in Thailand. Oncol Rev 2018; 12:369. [PMID: 30344960 PMCID: PMC6176547 DOI: 10.4081/oncol.2018.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/07/2018] [Indexed: 12/29/2022] Open
Abstract
This study shows the first survey of patterns about surgeons’ approaches and current practices in early and advanced gastric cancer in Thailand. Gastric cancer is a significant health problem worldwide. International guidelines for treatment differ in their recommendations including the accompanying therapy, but the condition is potentially curable. Surgeons have played an important role in Thailand but the limitation of institutional resources and the practices for gastric cancer vary between treatment options. The aim of this study is to investigate the current practices and approaches of Thai surgeons in relation to early and advanced gastric cancer treatment. A survey was conducted on 112 surgeons who claimed to have performed clinical practice upon gastric cancer patients. Information was collected on participant demographic data, the practices approaches in early and advanced stage without metastasis and the preferable adjuvant chemotherapy. The majority of participants were 100 general surgeons (89.4%). The preferred early gastric cancer treatment proved to be endoscopic resection 83.9%, cT1bN0 group preferred laparoscopic surgery 75.9%, cT2-T4aN0 group preferred open surgery 67.8%, cT4bN0 group preferred open surgery with En bloc resection 85.7% and cN+ group preferred open surgery 70.5%. For adjuvant treatment with chemotherapy, the study showed the surgeons who prescribed and treated by themselves was 41.9%. The preferred adjuvant regimens were S-1 50.9% and capecitabine and oxaliplatin 31.3%. This study is the first survey of the patterns of surgeons’ approaches and current practices in early and advanced gastric cancer in Thailand.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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90
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Karavokyros I, Michalinos A. Favoring D 2-Lymphadenectomy in Gastric Cancer. Front Surg 2018; 5:42. [PMID: 29930941 PMCID: PMC6001702 DOI: 10.3389/fsurg.2018.00042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/03/2018] [Indexed: 12/14/2022] Open
Abstract
The role of extended lymphadenectomy in the surgical treatment of gastric cancer has been debated for many years. So far six prospective randomized trials and a number of meta-analyses comparing D1- to D2-lymphadenectomy in open surgery have been published with contradicting results. The possible oncologic benefit of radical lymphadenectomy has been blurred by a number of reasons. In most of the trials the strategies under comparison were made similar after protocol violations. Imperfect design of the trials could not exclude the influence of cofounding factors. Inappropriate endpoints could not detect evidently the difference between the two surgical strategies. On the other hand radical lymphadenectomy was characterized by increased morbidity and mortality. This was mostly caused by the addition of pancreatico-splenectomy in all D2-dissections, even when not indicated. A careful analysis of the available evidence indicates that D2-lymphadenectomy performed by adequately trained surgeons without resection of the pancreas and/or spleen, unless otherwise indicated, decreases Gastric Cancer Related Deaths and increases Disease Specific Survival. This evidence is not compelling but cannot be ignored. D2-lymphadendctomy is nowadays considered to be the standard of care for resectable gastric cancer.
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Affiliation(s)
- Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Adamantios Michalinos
- First Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
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91
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Mengardo V, Bencivenga M, Weindelmayer J, Pavarana M, Giacopuzzi S, de Manzoni G. Para-aortic lymphadenectomy in surgery for gastric cancer: current indications and future perspectives. Updates Surg 2018; 70:207-211. [PMID: 29846892 DOI: 10.1007/s13304-018-0549-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/13/2018] [Indexed: 12/20/2022]
Abstract
Involvement of para-aortic nodes (PAN) has been detected at pathological examination in 10-25% of locally advanced gastric cancer. Based on these data of nodal diffusion, the lymphadenectomy of para-aortic stations would be desirable in locally advanced gastric cancer. However, the debate on the oncological benefit of para-aortic nodes dissection is still not solved. A review of the literature was performed and papers reporting either the rate of para-aortic nodal metastases or the long-term survival outcomes after D2+ para-aortic nodes dissection (PAND) or D3 lymphadenectomy were descriptively reported. The literature survey yielded 14 studies. Most of the papers show the outcome of series of advanced gastric cancer treated with surgery alone, while starting from 2012, 3 articles report the outcomes of D2 + PAND or D3 lymphadenectomy after preoperative chemotherapy. The rate of PAN metastases ranges between 8.5 and 28% in surgical series. Survival outcomes largely improved in series of patients treated with multimodal approach compared to those of surgery alone. In patients with clinically detected para-aortic nodal metastases, preoperative chemotherapy followed by PAND is indicated. More data are needed to clarify the indication to prophylactic PAND in the era of multimodal treatment, anyway super-extended lymphadenectomies have to be performed by experienced surgeons in dedicated centres.
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Affiliation(s)
- Valentina Mengardo
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Michele Pavarana
- Department of Medical Oncology, Ospedale Civile Maggiore of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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92
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Marrelli D, Polom K, Neri A, Roviello F. Clinical impact of molecular classifications in gastric cancer. Updates Surg 2018; 70:225-232. [PMID: 29796937 DOI: 10.1007/s13304-018-0546-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/15/2018] [Indexed: 02/08/2023]
Abstract
Treatment options to gastric cancer (GC) have been changing in recent years from a standard to a tailored approach. Different individualized procedures can range from endoscopic resection, D2 with open or minimally invasive approach, to neo-adjuvant therapy followed by extended surgery. In more advanced stages, a combined approach with the inclusion of intraperitoneal chemo-hyperthermia (HIPEC) may represent a new advanced option. The inclusion of histological type according to Laurén classification in the flowchart of treatment could increase both accuracy and effectiveness of such tailored approach. New molecular classifications of GC have been introduced recently and translational clinical studies are ongoing. These classifications are expected to be included in multidisciplinary treatment of GC. In particular, in the group with microsatellite instability a less extended lymphadenectomy may be proposed. Also tailored neo-adjuvant treatment may be proposed according to molecular classifications. The group of patients with epithelial-to-mesenchymal transition shows very high propensity to peritoneal dissemination, as well as N-metastases, and may benefit from prophylactic HIPEC and extended lymphadenectomy when confirmed in prospective trials.
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Affiliation(s)
- Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
| | - Karol Polom
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Alessandro Neri
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
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93
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Chun SJ, Jeon SH, Chie EK. A Case Report of Salvage Radiotherapy for a Patient with Recurrent Gastric Cancer and Multiple Comorbidities Using Real-time MRI-guided Adaptive Treatment System. Cureus 2018; 10:e2471. [PMID: 29900091 PMCID: PMC5997429 DOI: 10.7759/cureus.2471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The stomach is one of the most deforming organs caused by respiratory motions and daily variation by food intake. Applying radiotherapy has been quite a challenge due to the high risk of missing the target as well as radiation exposure to large volumes of normal tissue. However, real-time magnetic resonance (MR)-guided radiotherapy with adaptive planning could focus the high dose radiation to the target area while minimizing neighboring normal tissue exposure and compensate for not only daily but real-time variation. Here is a case report of a patient with recurrent gastric cancer and multiple co-morbidities, unsuitable for both resection and chemotherapy, who underwent MR guided adaptive radiotherapy.
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Affiliation(s)
- Seok-Joo Chun
- Department of Radiation Oncology, Seoul National University Hospital
| | - Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University Hospital
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University Hospital
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94
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Xin J, Wang S, Wang B, Wang J, Wang J, Zhang L, Xin B, Shen L, Zhang Z, Yao C. AlPcS 4-PDT for gastric cancer therapy using gold nanorod, cationic liposome, and Pluronic ® F127 nanomicellar drug carriers. Int J Nanomedicine 2018; 13:2017-2036. [PMID: 29670347 PMCID: PMC5894760 DOI: 10.2147/ijn.s154054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose As a promising photodynamic therapy (PDT) agent, Al(III) phthalocyanine chloride tetrasulfonic acid (AlPcS4) provides deep penetration into tissue, high quantum yields, good photostability, and low photobleaching. However, its low delivery efficiency and high binding affinity to serum albumin cause its low penetration into cancer cells, further limiting its PDT effect on gastric cancer. In order to improve AlPcS4/PDT effect, the AlPcS4 delivery sys tems with different drug carriers were synthesized and investigated. Materials and methods Gold nanorods, cationic liposomes, and Pluronic® F127 nanomicellars were used to formulate the AlPcS4 delivery systems. The anticancer effect was evaluated by CCK-8 assay and colony formation assay. The delivery efficiency of AlPcS4 and the binding affinity to serum proteins were determined by fluorescence intensity assay. The apoptosis and necrosis ability, reactive oxygen species and singlet oxygen generation, mitochondrial transmembrane potential and ([Ca2+]i) concentration were further measured to evaluate the mechanism of cell death. Results The series of synthesized AlPcS4 delivery systems with different drug carriers improve the limited PDT effect in varying degrees. In contrast, AlPcS4 complex with gold nanorods has significant anticancer effects because gold nanorods are not only suitable for AlPcS4 delivery, but also exhibit enhanced singlet oxygen generation effect and photothermal effect to induce cell death directly. Moreover, AlPcS4 complex with cationic liposomes shows the potent inhibition effect because of its optimal AlPcS4 delivery efficiency and ability to block serum albumin. In addition, AlPcS4 complex with Pluronic F127 exhibits inferior PDT effect but presents lower cytotoxicity, slower dissociation rate, and longer retention time of incorporated drugs; thus, F127–AlPcS4 is used for prolonged gastric cancer therapy. Conclusion The described AlPcS4 drug delivery systems provide promising agents for gastric cancer therapy.
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Affiliation(s)
- Jing Xin
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sijia Wang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bing Wang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiazhuang Wang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Wang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Luwei Zhang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bo Xin
- School of Innovation and Entrepreneurship, Xi'an Fan Yi University, Xi'an, Shaanxi, China
| | - Lijian Shen
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhenxi Zhang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Cuiping Yao
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Analytical Technology and Instrumentation, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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95
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Choi IJ, Kook MC, Kim YI, Cho SJ, Lee JY, Kim CG, Park B, Nam BH. Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer. N Engl J Med 2018; 378:1085-1095. [PMID: 29562147 DOI: 10.1056/nejmoa1708423] [Citation(s) in RCA: 437] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with early gastric cancers that are limited to gastric mucosa or submucosa usually have an advanced loss of mucosal glandular tissue (glandular atrophy) and are at high risk for subsequent (metachronous) development of new gastric cancer. The long-term effects of treatment to eradicate Helicobacter pylori on histologic improvement and the prevention of metachronous gastric cancer remain unclear. METHODS In this prospective, double-blind, placebo-controlled, randomized trial, we assigned 470 patients who had undergone endoscopic resection of early gastric cancer or high-grade adenoma to receive either H. pylori eradication therapy with antibiotics or placebo. Two primary outcomes were the incidence of metachronous gastric cancer detected on endoscopy performed at the 1-year follow-up or later and improvement from baseline in the grade of glandular atrophy in the gastric corpus lesser curvature at the 3-year follow-up. RESULTS A total of 396 patients were included in the modified intention-to-treat analysis population (194 in the treatment group and 202 in placebo group). During a median follow-up of 5.9 years, metachronous gastric cancer developed in 14 patients (7.2%) in the treatment group and in 27 patients (13.4%) in the placebo group (hazard ratio in the treatment group, 0.50; 95% confidence interval, 0.26 to 0.94; P=0.03). Among the 327 patients in the subgroup that underwent histologic analysis, improvement from baseline in the atrophy grade at the gastric corpus lesser curvature was observed in 48.4% of the patients in the treatment group and in 15.0% of those in the placebo group (P<0.001). There were no serious adverse events; mild adverse events were more common in the treatment group (42.0% vs. 10.2%, P<0.001). CONCLUSIONS Patients with early gastric cancer who received H. pylori treatment had lower rates of metachronous gastric cancer and more improvement from baseline in the grade of gastric corpus atrophy than patients who received placebo. (Funded by the National Cancer Center, South Korea; ClinicalTrials.gov number, NCT02407119 .).
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Affiliation(s)
- Il Ju Choi
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Myeong-Cherl Kook
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Young-Il Kim
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Soo-Jeong Cho
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Jong Yeul Lee
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Chan Gyoo Kim
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Boram Park
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
| | - Byung-Ho Nam
- From the Center for Gastric Cancer (I.J.C., M.-C.K., Y.-I.K., S.-J.C., J.Y.L., C.G.K.) and the Biometrics Research Branch, Research Institute (B.P., B.-H.N.), National Cancer Center, Goyang, South Korea
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96
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Jang SH, Jung YJ, Kim MG, Kwon SJ. The Prognostic Significance of Compliance with Postoperative Adjuvant Chemotherapy in Patients with Stage III Gastric Cancer: an Observational Study. J Gastric Cancer 2018; 18:48-57. [PMID: 29629220 PMCID: PMC5881010 DOI: 10.5230/jgc.2018.18.e4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Postoperative adjuvant chemotherapy is usually prescribed to improve the survival of patients with advanced gastric cancer who undergo curative surgery. This study was designed to determine the impact that the degree of compliance with chemotherapy has on the prognosis of patients with gastric cancer. Materials and Methods Among 252 patients with stage III gastric cancer who underwent curative surgery between July 2004 and December 2014, 85 patients were postoperatively treated with S-1, the oral fluoropyrimidine derivative, 23 received no chemotherapy, and 144 received other regimens. Overall survival was compared between the complete compliance group (who received 8 cycles of S-1 chemotherapy, n=44) and the incomplete compliance group (who received less than 8 cycles of S-1 chemotherapy, n=41). Factors that influenced patient compliance with chemotherapy were also analyzed. Results The overall 5-year survival rate was significantly different between the complete chemotherapy and incomplete chemotherapy groups (80.0% vs. 42.7%, P<0.001). Based on univariate and multivariate survival analyses of patients who received S-1 chemotherapy, the independent prognostic factors were tumor, node, and metastasis (TNM) stage (IIIa vs. IIIb vs. IIIc) and compliance with chemotherapy. TNM stage and age are significant factors that influence compliance with chemotherapy. Conclusions TNM stage and compliance with chemotherapy are independent prognostic factors in patients with stage III gastric cancer who received postoperative chemotherapy. TNM stage and age are significant factors that influence patient compliance with chemotherapy.
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Affiliation(s)
- Sung Ho Jang
- Department of Surgery, Hanyang University Seoul Hospital, Hanyang University School of Medicine, Seoul, Korea
| | - Young Jae Jung
- Department of Surgery, Hanyang University Seoul Hospital, Hanyang University School of Medicine, Seoul, Korea
| | - Min Gyu Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| | - Sung Joon Kwon
- Department of Surgery, Hanyang University Seoul Hospital, Hanyang University School of Medicine, Seoul, Korea
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97
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Koh J, Ock CY, Kim JW, Nam SK, Kwak Y, Yun S, Ahn SH, Park DJ, Kim HH, Kim WH, Lee HS. Clinicopathologic implications of immune classification by PD-L1 expression and CD8-positive tumor-infiltrating lymphocytes in stage II and III gastric cancer patients. Oncotarget 2018; 8:26356-26367. [PMID: 28412752 PMCID: PMC5432263 DOI: 10.18632/oncotarget.15465] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/06/2017] [Indexed: 12/11/2022] Open
Abstract
We co-assessed PD-L1 expression and CD8+ tumor-infiltrating lymphocytes in gastric cancer (GC), and categorized into 4 microenvironment immune types. Immunohistochemistry (PD-L1, CD8, Foxp3, E-cadherin, and p53), PD-L1 mRNA in situ hybridization (ISH), microsatellite instability (MSI), and EBV ISH were performed in 392 stage II/III GCs treated with curative surgery and fluoropyrimidine-based adjuvant chemotherapy, and two public genome databases were analyzed for validation. PD-L1+ was found in 98/392 GCs (25.0%). The proportions of immune types are as follows: PD-L1+/CD8High, 22.7%; PD-L1−/CD8Low, 22.7%; PD-L1+/CD8Low, 2.3%; PD-L1−/CD8High, 52.3%. PD-L1+/CD8High type accounted for majority of EBV+ and MSI-high (MSI-H) GCs (92.0% and 66.7%, respectively), and genome analysis from public datasets demonstrated similar pattern. PD-L1−/CD8High showed the best overall survival (OS) and PD-L1−/CD8Low the worst (P < 0.001). PD-L1 expression alone was not associated with OS, however, PD-L1−/CD8High type compared to PD-L1+/CD8High was independent favorable prognostic factor of OS by multivariate analysis (P = 0.042). Adaptation of recent molecular classification based on EBV, MSI, E-cadherin, and p53 showed no significant survival differences. These findings support the close relationship between PD-L1/CD8 status based immune types and EBV+, MSI-H GCs, and their prognostic significance in stage II/III GCs.
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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Republic of Korea
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Soo Kyung Nam
- Department of Pathology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Sumi Yun
- Department of Pathology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul 04401, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
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98
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Choe WH, Kim JH, Park JH, Kim HU, Cho DH, Lee SP, Lee TY, Lee SY, Sung IK, Park HS, Shim CS. Endoscopic Submucosal Dissection of Early Gastric Cancer in Patients with Liver Cirrhosis. Dig Dis Sci 2018; 63:466-473. [PMID: 29282635 DOI: 10.1007/s10620-017-4814-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/17/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Endoscopic submucosal dissection (ESD) has become widely accepted method for treating early gastric cancer (EGC), but little is known about its role in patients with liver cirrhosis (LC). The aims of this study were to evaluate the outcomes of ESD in treating EGC in patients with LC. METHODS The multicenter retrospective study identified 43 patients with chronic hepatitis B (CHB)-related cirrhosis undergoing ESD for treating EGC. The patients (LC group) were subdivided into two groups based on their Child-Pugh classification (CP-class): 32 with CP-class A (LC-A) and 11 with CP-class B (LC-B). The patients were compared to 47 non-cirrhotic CHB patients who underwent ESD (CHB group). Eight patients had a past history of hepatocellular carcinoma (HCC) prior to ESD, but no patients had viable HCC when ESD was performed. RESULTS Procedural outcomes (en bloc, lateral/basal margins resection) and post-procedural complications (bleeding or perforation) did not differ significantly between the LC and CHB groups or between the LC-A and LC-B groups. No patients experienced worsening of the Child-Pugh score 1 month after ESD compared with the baseline score. During a median observation period of 66 months, the recurrence rates of gastric cancers were similar between the LC and CHB groups (5-year recurrence rates: 2.4 vs. 2.3%, p = 0.925), and all recurrent gastric cancers were completely resected by additional ESD. The overall mortality rate was increased in the LC group (5-year mortality rates: 17.9 vs. 5.7%, p = 0.034), and 8 of 10 deaths were attributed to liver-related diseases (such as HCC, complications of portal hypertension, hepatic failure). CONCLUSIONS ESD is feasible in patients with EGC and comorbid LC, even those with CP-class B cirrhosis. Their prognosis depends on LC-related diseases and not recurrent EGC.
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Affiliation(s)
- Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
| | - Jung Ho Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbook Samsung Hospital, Seoul, South Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju University College of Medicine, Jeju, South Korea
| | - Dae Hyeon Cho
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, South Korea
| | - Sang Pyo Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Tae Yoon Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - In Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Chan Sup Shim
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
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99
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Reddavid R, Sofia S, Chiaro P, Colli F, Trapani R, Esposito L, Solej M, Degiuli M. Neoadjuvant chemotherapy for gastric cancer. Is it a must or a fake? World J Gastroenterol 2018; 24:274-289. [PMID: 29375213 PMCID: PMC5768946 DOI: 10.3748/wjg.v24.i2.274] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the neoadjuvant chemotherapy (NAC) effect on the survival of patients with proper stomach cancer submitted to D2 gastrectomy.
METHODS We proceeded to a review of the literature with PubMed, Embase, ASCO and ESMO meeting abstracts as well as computerized use of the Cochrane Library for randomized controlled trials (RCTs) comparing NAC followed by surgery (NAC + S) with surgery alone (SA) for gastric cancer (GC). The primary outcome was the overall survival rate. Secondary outcomes were the site of the primary tumor, extension of node dissection according to Japanese Gastric Cancer Association (JGCA) performed in both arms, disease-specific (DSS) and disease-free survival (DFS) rates, clinical and pathological response rates and resectability rates after perioperative treatment.
RESULTS We identified a total of 16 randomized controlled trials comparing NAC + S (n = 1089) with SA (n = 973) published in the period from January 1993 - March 2017. Only 6 of these studies were well-designed, structured trials in which the type of lymph node (LN) dissection performed or at least suggested in the trial protocol was reported. Two out of three of the RCTs with D2 lymphadenectomy performed in almost all cases failed to show survival benefit in the NAC arm. In the third RCT, the survival rate was not even reported, and the primary end points were the clinical outcomes of surgery with and without NAC. In the remaining three RCTs, D2 lymph node dissection was performed in less than 50% of cases or only recommended in the “Study Treatment” protocol without any description in the results of the procedure really perfomed. In one of the two studies, the benefit of NAC was evident only for esophagogastric junction (EGJ) cancers. In the second study, there was no overall survival benefit of NAC. In the last trial, which documented a survival benefit for the NAC arm, the chemotherapy effect was mostly evident for EGJ cancer, and more than one-fourth of patients did not have a proper stomach cancer. Additionally, several patients did not receive resectional surgery. Furthermore, the survival rates of international reference centers that provide adequate surgery for homogeneous stomach cancer patients’ populations are even higher than the survival rates reported after NAC followed by incomplete surgery.
CONCLUSION NAC for GC has been rapidly introduced in international western guidelines without an evidence-based medicine-related demonstration of its efficacy for a homogeneous population of patients with only stomach tumors submitted to adequate surgery following JGCA guidelines with extended (D2) LN dissection. Additional larger sample-size multicentre RCTs comparing the newer NAC regimens including molecular therapies followed by adequate extended surgery with surgery alone are needed.
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Affiliation(s)
- Rossella Reddavid
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Silvia Sofia
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Paolo Chiaro
- Department of Surgical Sciences, Digestive and Oncological Surgery, University of Turin, Molinette Hospital, Turin 10126, Italy
| | - Fabio Colli
- Department of Surgical Sciences, Digestive and Oncological Surgery, University of Turin, Molinette Hospital, Turin 10126, Italy
| | - Renza Trapani
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Laura Esposito
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Mario Solej
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
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100
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Macalindong SS, Kim KH, Nam BH, Ryu KW, Kubo N, Kim JY, Eom BW, Yoon HM, Kook MC, Choi IJ, Kim YW. Effect of total number of harvested lymph nodes on survival outcomes after curative resection for gastric adenocarcinoma: findings from an eastern high-volume gastric cancer center. BMC Cancer 2018; 18:73. [PMID: 29329569 PMCID: PMC5766983 DOI: 10.1186/s12885-017-3872-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Greater lymph node retrieval in gastric cancer improves staging accuracy and may improve survival from increased clearance of nodal micrometastasis. This retrospective cohort study investigated if more lymph nodes removed in gastric cancer increases survival and if such effect is stage-specific due to differential risks of nodal micrometastasis and systemic disease. METHODS The prospectively collected database of curatively resected gastric cancer patients in National Cancer Center, South Korea between 2000 and 2009 was reviewed. Disease-free survival (DFS) and overall survival (OS) for all patients and for each stage according to number of lymph nodes examined (1-30, 31-45, > 45) were analyzed. RESULTS Of 4049 patients, 96.6% and 98.4% underwent D2 (perigastric and extragastric) lymphadenectomy and had ≥ 15 lymph nodes examined. Mean number of nodes examined was 43. Five-year OS & DFS rates were 83.3% and 80.7%. Patients with > 45 nodes examined had significantly lower DFS (p = 0.002) and OS (p = 0.007) compared to those with 1-30 and 31-45 nodes. However, proportion of patients with > 45 nodes examined increased with stage (p = 0.0005). Per stage, there was no significant difference in DFS and OS according to number of nodes examined except for stage IIIA favoring more nodes (p = 0.018 and p = 0.044, respectively). Similar trend was seen in stage IIB. Number of examined nodes positively correlated with number of pathologic nodes for all patients (r = 0.144, p < .001) but not for stage IIB and IIIA. Number of nodes examined was a significant survival predictor in stage IIIA. CONCLUSION Greater lymph node harvest showed improved survival in intermediate-stage gastric cancer.
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Affiliation(s)
- Shiela S. Macalindong
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Surgery, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Kwang Hee Kim
- Biometric Research Branch, National Cancer Center, Goyang, Republic of Korea
| | - Byung-Ho Nam
- Biometric Research Branch, National Cancer Center, Goyang, Republic of Korea
| | - Keun Won Ryu
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Norihito Kubo
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ja Yeon Kim
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Bang Wool Eom
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hong Man Yoon
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Myeong-Cherl Kook
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Il Ju Choi
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Young Woo Kim
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
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