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Fabbi M, Milani MS, Giacopuzzi S, De Werra C, Roviello F, Santangelo C, Galli F, Benevento A, Rausei S. Adherence to Guidelines for Diagnosis, Staging, and Treatment for Gastric Cancer in Italy According to the View of Surgeons and Patients. J Clin Med 2024; 13:4240. [PMID: 39064280 PMCID: PMC11277783 DOI: 10.3390/jcm13144240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Despite the strong declining trends in incidence and mortality over the last decades, gastric cancer (GC) is still burdened with high mortality, even in high-income countries. To improve GC prognosis, several guidelines have been increasingly published with indications about the most appropriate GC management. The Italian Society of Digestive System Pathology (SIPAD) and Gastric Cancer Italian Research Group (GIRCG) designed a survey for both surgeons and patients with the purpose of evaluating the degree of application and adherence to guidelines in GC management in Italy. Materials and Methods: Between January and May 2022, a questionnaire has been administered to a sample of Italian surgeons and, in a simplified version, to members of the Patient Association "Vivere Senza Stomaco" (patients surgically treated for GC between 2008 and 2021) to investigate the diagnosis, staging, and treatment issues. Results: The survey has been completed by 125 surgeons and 125 patients. Abdominal CT with gastric hydro-distension before treatment was not widespread in both groups (47% and 42%, respectively). The rate of surgeons stating that they do not usually perform minimally invasive gastrectomy was 15%, but the rate of patients who underwent a minimally invasive approach was 22% (between 2011 and 2022). The percentage of surgeons declaring to perform extended lymphadenectomy (>D2) was 97%, although a limited lymph node dissection rate was observed in about 35% of patients. Conclusions: This survey shows several important discrepancies from surgical attitudes declared by surgeons and real data derived from the reports available to the patients, suggesting heterogeneous management in clinical practice and, thus, a not rigorous adherence to the guidelines.
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Affiliation(s)
- Manrica Fabbi
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy; (M.S.M.); (S.R.)
| | - Marika Sharmayne Milani
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy; (M.S.M.); (S.R.)
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, 37134 Verona, Italy;
| | - Carlo De Werra
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
| | - Franco Roviello
- Department of Medical Surgical Sciences and Neurosciences, Section of General Surgery and Surgical Oncology, Istituto Toscano Tumori (ITT), University Hospital of Siena, University of Siena, 53100 Siena, Italy;
| | | | - Federica Galli
- Department of General Surgery, Gallarate Hospital, ASST Valle Olona, 21013 Gallarate, Italy; (F.G.); (A.B.)
| | - Angelo Benevento
- Department of General Surgery, Gallarate Hospital, ASST Valle Olona, 21013 Gallarate, Italy; (F.G.); (A.B.)
| | - Stefano Rausei
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy; (M.S.M.); (S.R.)
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Herrera Kok JH, Marano L, van den Berg JW, Shetty P, Vashist Y, Lorenzon L, Rau B, van Hillegersberg R, de Manzoni G, Spallanzani A, Seo WJ, Nagata H, Eveno C, Mönig S, van der Sluis K, Solaini L, Wijnhoven BP, Puccetti F, Chevallay M, Lee E, D'Ugo D. Current trends in the management of Gastro-oEsophageal cancers: Updates to the ESSO core curriculum (ESSO-ETC-UGI-WG initiative). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108387. [PMID: 38796969 DOI: 10.1016/j.ejso.2024.108387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Gastro-oEsophageal Cancers (GECs) are severe diseases whose management is rapidly evolving. The European Society of Surgical Oncology (ESSO) is committed to the generation and spread of knowledge, and promotes the multidisciplinary management of cancer patients through its core curriculum. The present work discusses the approach to GECs, including the management of oligometastatic oesophagogastric cancers (OMEC), the diagnosis and management of peritoneal metastases from gastric cancer (GC), the management of Siewert Type II tumors, the importance of mesogastric excision, the role of robotic surgery, textbook outcomes, organ preserving options, the use of molecular markers and immune check-point inhibitors in the management of patients with GECs, as well as the improvement of current clinical practice guidelines for the management of patients with GECs. The aim of the present review is to provide a concise overview of the state-of-the-art on the management of patients with GECs and, at the same time, to share the latest advancements in the field and to foster the debate between surgical oncologists treating GECs worldwide. We are sure that our work will, at the same time, give an update to the advanced surgical oncologists and help the training surgical oncologists to settle down the foundations for their future practice.
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Affiliation(s)
- Johnn Henry Herrera Kok
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; ESSO-European Young Surgeons and Alumni Club (EYSAC), Research Academy (RA), Belgium; Department of General and Digestive Surgery, Upper GI Unit, University Hospital of León, León, Spain.
| | - Luigi Marano
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Department of Medicine, Academy of Applied Medical and Social Sciences (AMiSNS), Akademia Medycznych i Społecznych Nauk Stosowanych, Elbląg, Poland
| | - Jan Willem van den Berg
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Preethi Shetty
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Department of Surgical Oncology, Kasturba Medical College, MAHE Manipal, India
| | - Yogesh Vashist
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura Lorenzon
- ESSO-European Young Surgeons and Alumni Club (EYSAC), Research Academy (RA), Belgium; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Beate Rau
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany
| | | | - Giovanni de Manzoni
- Department of General Surgery, Upper GI Unit, University Hospital of Verona, Verona, Italy
| | - Andrea Spallanzani
- Department of Oncology and Hematology, University of Modena and Reggio Emilia Hospital, Modena, Italy
| | - Won Jun Seo
- Department of Surgery, Korea University Guro Hospital, Seoul, Republic of Korea; PIPS-GC Study Group, Republic of Korea
| | - Hiromi Nagata
- Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Clarisse Eveno
- Department of Surgery, Lille University Hospital, Lille, France
| | - Stefan Mönig
- Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Karen van der Sluis
- Department of Surgery, The Netherlands Cancer Institute Antoni van Leewenhoek, Amsterdam, the Netherlands
| | - Leonardo Solaini
- Department of General and Oncologic Surgery, Morgagni Pierantoni Hospital, Forli, Italy
| | - Bas Pl Wijnhoven
- Department of Surgery, Erasmus Medical Center Cancer Institute, Amsterdam, the Netherlands
| | - Francesco Puccetti
- Gastrointestinal Surgery Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mickael Chevallay
- Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Eunju Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Republic of Korea
| | - Domenico D'Ugo
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; ESSO Past-President, Republic of Korea
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3
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van Hootegem SJM, Chmelo J, van der Sluis PC, Lagarde SM, Phillips AW, Wijnhoven BPL. The yield of diagnostic laparoscopy with peritoneal lavage in gastric adenocarcinoma: A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108233. [PMID: 38428107 DOI: 10.1016/j.ejso.2024.108233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Diagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer (GC). Evaluation of the value of DL is important given ongoing improvements in diagnostic imaging and treatment. As contemporary data from European centres are sparse, this retrospective cohort study aimed to assess the yield of DL in patients with potentially curable gastric cancer, and to identify predictive factors for peritoneal metastases. METHODS Patients with adenocarcinoma of the stomach, treated between January 2016 and December 2018, were identified from institutional databases of two high volume European Upper-GI centres. Patients who underwent a DL with peritoneal lavage for potentially curable disease after clinical staging with imaging (cT1-4N0-3M0) were included. The primary outcome was the proportion of patients with a positive DL, defined as macroscopic metastatic disease, positive peritoneal cytology washings (PC+) or locally irresectable disease. RESULTS Some 80 of 327 included patients (24.5%) had a positive DL, excluding these patients from neoadjuvant treatment (66 of 327; 20.2%) and/or surgical resection (76 of 327; 23.2%). In 34 of 327 patients (10.3%), macroscopic metastatic disease was seen, with peritoneal deposits in 30 of these patients. Only 16 of 30 patients with peritoneal disease had positive cytology. Some 41 of 327 patients (12.5%) that underwent DL had PC+ in the absence of macroscopic metastases and five patients (1.5%) had an irresectable primary tumour. Diffuse type carcinoma had the highest risk of peritoneal dissemination, irrespective of cT and cN categories. CONCLUSION The diagnostic yield of staging laparoscopy is high, changing the management in approximately one quarter of patients. DL should be considered in patients with diffuse type carcinoma irrespective of cT and cN categories.
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Affiliation(s)
- S J M van Hootegem
- Department of Surgery, Erasmus MC University, Rotterdam, the Netherlands.
| | - J Chmelo
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - P C van der Sluis
- Department of Surgery, Erasmus MC University, Rotterdam, the Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC University, Rotterdam, the Netherlands
| | - A W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK; School of Medical Education, Newcastle University, UK
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC University, Rotterdam, the Netherlands
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Schena CA, Laterza V, De Sio D, Quero G, Fiorillo C, Gunawardena G, Strippoli A, Tondolo V, de'Angelis N, Alfieri S, Rosa F. The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives. Cancers (Basel) 2023; 15:3425. [PMID: 37444535 DOI: 10.3390/cancers15133425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
A significant proportion of patients diagnosed with gastric cancer is discovered with peritoneal metastases at laparotomy. Despite the continuous improvement in the performance of radiological imaging, the preoperative recognition of such an advanced disease is still challenging during the diagnostic work-up, since the sensitivity of CT scans to peritoneal carcinomatosis is not always adequate. Staging laparoscopy offers the chance to significantly increase the rate of promptly diagnosed peritoneal metastases, thus reducing the number of unnecessary laparotomies and modifying the initial treatment strategy of gastric cancer. The aim of this review was to provide a comprehensive summary of the current literature regarding the role of staging laparoscopy in the management of gastric cancer. Indications, techniques, accuracy, advantages, and limitations of staging laparoscopy and peritoneal cytology were discussed. Furthermore, a focus on current evidence regarding the application of artificial intelligence and image-guided surgery in staging laparoscopy was included in order to provide a picture of the future perspectives of this technique and its integration with modern tools in the preoperative management of gastric cancer.
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Affiliation(s)
- Carlo Alberto Schena
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Davide De Sio
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gayani Gunawardena
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenzo Tondolo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fausto Rosa
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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5
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Chidambaram S, Guiral DC, Markar SR. Novel Multi-Modal Therapies and Their Prognostic Potential in Gastric Cancer. Cancers (Basel) 2023; 15:3113. [PMID: 37370723 DOI: 10.3390/cancers15123113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Gastric cancer has a poor prognosis and involves metastasis to the peritoneum in over 40% of patients. The optimal treatment modalities have not been established for gastric cancer patients with peritoneal carcinomatosis (GC/PC). Although studies have reported favourable prognostic factors, these have yet to be incorporated into treatment guidelines. Hence, our review aims to appraise the latest diagnostic and treatment developments in managing GC/PC. METHODS A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review, and Scopus databases. Articles were evaluated for the use of hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurised intraperitoneal aerosolised chemotherapy (PIPAC) in GC/PC. A meta-analysis of studies reporting on overall survival (OS) in HIPEC and comparing the extent of cytoreduction as a prognostic factor was also carried out. RESULTS The database search yielded a total of 2297 studies. Seventeen studies were included in the qualitative and quantitative analyses. Eight studies reported the short-term OS at 1 year as the primary outcome measure, and our analysis showed a significantly higher OS for the HIPEC/CRS cohort compared to the CRS cohort (pooled OR = 0.53; p = 0.0005). This effect persisted longer term at five years as well (pooled OR = 0.52; p < 0.0001). HIPEC and CRS also showed a longer median OS compared to CRS (pooled SMD = 0.61; p < 0.00001). Three studies reporting on PIPAC demonstrated a pooled OS of 10.3 (2.2) months. Prognostic factors for longer OS include a more complete cytoreduction (pooled OR = 5.35; p < 0.00001), which correlated with a peritoneal carcinomatosis index below 7. CONCLUSIONS Novel treatment strategies, such as HIPEC and PIPAC, are promising in the management of GC/PC. Further work is necessary to define their role within the treatment algorithm and identify relevant prognostic factors that will assist patient selection.
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Affiliation(s)
| | - Delia Cortés Guiral
- Surgical Oncology and General Surgery Department, King Khaled Hospital, Najran 66262, Saudi Arabia
| | - Sheraz Rehan Markar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
- Nuffield Department of Surgery, University of Oxford, Oxford OX3 9DU, UK
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Sandø AD, Fougner R, Røyset ES, Dai HY, Grønbech JE, Bringeland EA. Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer. Cancers (Basel) 2023; 15:cancers15082318. [PMID: 37190246 DOI: 10.3390/cancers15082318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The method of response evaluation following neoadjuvant chemotherapy (NAC) in resectable gastric cancer has been widely debated. An essential prerequisite is the ability to stratify patients into subsets of different long-term survival rates based on the response mode. Histopathological measures of regression have their limitations, and interest resides in CT-based methods that can be used in everyday settings. METHODS We conducted a population-based study (2007-2016) on 171 consecutive patients with gastric adenocarcinoma who were receiving NAC. Two methods of response evaluation were investigated: a strict radiological procedure using RECIST (downsizing), and a composite radiological/pathological procedure comparing the initial radiological TNM stage to the pathological ypTNM stage (downstaging). Clinicopathological variables that could predict the response were searched for, and correlations between the response mode and long-term survival rates were assessed. RESULTS RECIST failed to identify half of the patients progressing to metastatic disease, and it was unable to assign patients to subsets with different long-term survival rates based on the response mode. However, the TNM stage response mode did achieve this objective. Following re-staging, 48% (78/164) were downstaged, 15% (25/164) had an unchanged stage, and 37% (61/164) were upstaged. A total of 9% (15/164) showed a histopathological complete response. The 5-year overall survival rate was 65.3% (95% CI 54.7-75.9%) for TNM downstaged cases, 40.0% (95% CI 20.8-59.2%) for stable disease, and 14.8% (95% CI 6.0-23.6%) for patients with TNM progression, p < 0.001. In a multivariable ordinal regression model, the Lauren classification and tumor site were the only significant determinants of the response mode. CONCLUSIONS Downsizing, as a method for evaluating the response to NAC in gastric cancer, is discouraged. TNM re-staging by comparing the baseline radiological CT stage to the pathological stage following NAC is suggested as a useful method that may be used in everyday situations.
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Affiliation(s)
- Alina Desiree Sandø
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Reidun Fougner
- Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Elin Synnøve Røyset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Hong Yan Dai
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Jon Erik Grønbech
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Erling Audun Bringeland
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7034 Trondheim, Norway
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Chatterjee A, Shah D, Roy B, Ghosh J, Ray S, Patra A, Gehani A, Gupta B, Ghosh P, Mukhopadhyay S, Chandra A, Lingegowda D, Sen S. Imaging Recommendations for Diagnosis, Staging, and Management of Gastric Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractGastric cancer is the second most common cause of cancer-related death in Indian men and women aged between 15 and 44 years. Most patients present at an advanced stage of disease. Surgically resectable disease usually requires a standard gastric resection and D2 lymphadenectomy. Imaging, especially with computed tomography scan of abdomen as well as thorax, is necessary for localization, nodal mapping, and metastatic workup of gastric cancer. In this review, we discuss current imaging recommendations for gastric carcinoma.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Diva Shah
- Consultant Radiologist, HCG Cancer Center, Ahmedabad, Gujarat, India
| | - Bipradas Roy
- Department of GI and HPB Surgery, Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Soumendranath Ray
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Anurima Patra
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Anisha Gehani
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Bharat Gupta
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Aditi Chandra
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Dayananda Lingegowda
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
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8
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Romero-peña M, Suarez L, Valbuena DE, Rey Chaves CE, Conde Monroy D, Guevara R. Laparoscopic and open gastrectomy for locally advanced gastric cancer: a retrospective analysis in Colombia. BMC Surg 2023; 23:19. [PMID: 36703124 PMCID: PMC9878750 DOI: 10.1186/s12893-023-01901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Radical gastrectomy has traditionally been the pillar treatment with curative intent for malignant tumors of the stomach. The safety of the laparoscopic approach for advanced gastric cancer (AGC) is still under debate. In our institution, laparoscopic gastrectomy is the most performed approach. OBJECTIVE Our aim is to describe the experience of a high-volume center in the treatment of AGC in Colombia and to analyze the short-term results and the overall survival rate at 1, 3, and 5 years comparing the open and laparoscopic approaches. METHODS A cross-sectional retrospective study of patients who underwent gastrectomy for advanced gastric cancer by open or laparoscopic approaches were performed. A Will-Coxon Mann Whitney test was performed in terms of lymph node status and surgical approach. Survival analysis was performed using the Kaplan-Meier method for overall survival at 1, 3, and 5 years. An initial log-rank test was performed to test the relationships between the operative variables and overall survival, the statistical value was accepted if p < 0.20. Data with an initial statistical relationship in the log-rank test were included in a secondary analysis using multivariate Cox proportional regression, variables with a value of p < 0.05 were considered statistically significant. RESULTS 310 patients met the inclusion criteria. 89% underwent laparoscopic gastrectomy and 10.9% open gastrectomy. The resection margins were negative at 93.5% and the In terms of lymph node dissection, the median lymph nodes extracted was 20 (12;37), with statistically significant differences between the approaches in favor of the laparoscopic approach (Median 21 vs 12; z = - 2.19, p = 0.02). The survival rate was at 1, 3, and 5 years of 84.04%, 66.9%, and 65.47% respectively. The presence of complications and the ICU requirement have a negative impact on survival at 1 year (p 0.00). CONCLUSION A laparoscopic approach is safe with acceptable morbidity and mortality rates for treating gastric cancer. D2 Lymphadenectomy could be performed successfully in a laparoscopic approach in a high-volume center and a properly standardized technique. Major postoperative morbidity with intensive care unit requirement seems to influence overall survival rates.
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Affiliation(s)
| | - Liliana Suarez
- Clínica Universitaria Colombia, Bogotá D.C, 110111 Colombia
| | | | - Carlos Eduardo Rey Chaves
- grid.41312.350000 0001 1033 6040School of Medicine, Pontificia Universidad Javeriana, Carrera 6A# 51A - 48, Bogotá D.C, 110111 Colombia
| | - Danny Conde Monroy
- grid.412191.e0000 0001 2205 5940Hospital Universitario Mayor - Méderi, Universidad del Rosario, Bogotá D.C, 110111 Colombia
| | - Raúl Guevara
- Clínica Universitaria Colombia, Bogotá D.C, 110111 Colombia
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SAKAMOTO E, RAMOS MFKP, PEREIRA MA, DIAS AR, RIBEIRO U, ZILBERSTEIN B, NAHAS SC. STAGING LAPAROSCOPY IS STILL A VALUABLE TOOL FOR OPTIMAL GASTRIC CANCER MANAGEMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 35:e1700. [PMID: 36629683 PMCID: PMC9830676 DOI: 10.1590/0102-672020220002e1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Complete surgical resection is the main determining factor in the survival of advanced gastric cancer patients, but is not indicated in metastatic disease. The peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect it. AIM The aim of this study was to evaluate the role of staging laparoscopy in the staging of advanced gastric cancer patients in a Western tertiary cancer center. METHODS A total of 130 patients with gastric adenocarcinoma who underwent staging laparoscopy from 2009 to 2020 were evaluated from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of peritoneal metastasis and were also evaluated the accuracy and strength of agreement between computed tomography and staging laparoscopy in detecting peritoneal metastasis and the change in treatment strategy after the procedure. RESULTS The peritoneal metastasis was identified in 66 (50.76%) patients. The sensitivity, specificity, and accuracy of computed tomography in detecting peritoneal metastasis were 51.5, 87.5, and 69.2%, respectively. According to the Kappa coefficient, the concordance between staging laparoscopy and computed tomography was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected peritoneal metastasis on computed tomography (p=0.007) were statistically correlated with peritoneal metastasis. In 40 (30.8%) patients, staging and treatment plans changed after staging laparoscopy (32 patients avoided unnecessary laparotomy, and 8 patients, who were previously considered stage IVb by computed tomography, were referred to surgical treatment). CONCLUSION The staging laparoscopy demonstrated an important role in the diagnosis of peritoneal metastasis, even with current advances in imaging techniques.
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Affiliation(s)
- Erica SAKAMOTO
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | | | - Marina Alessandra PEREIRA
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - André Roncon DIAS
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - Ulysses RIBEIRO
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - Bruno ZILBERSTEIN
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - Sergio Carlos NAHAS
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
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10
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Hall CE, Maegawa F, Patel AD, Lin E. Management of Gastric Cancer. Am Surg 2023:31348221148359. [PMID: 36609184 DOI: 10.1177/00031348221148359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Gastric adenocarcinoma is a complex disease that requires a thorough multidisciplinary approach for appropriate management. Management strategies vary in different regions of the world and have changed over time. In spite of improvements in chemotherapy and surgical techniques and an improvement in outcomes over the last several decades, overall survival remains low. The best outcomes are likely related to early detection, preoperative reduction of tumor burden with immunochemotherapy, consistent surgical technique for resection, and postoperative eradication of tumor cells. We aim to describe the management for gastric cancer, from the specifics of staging and imaging workup to the tenets of surgical resection and reconstruction as well as the adjuvant treatment strategies in this broad review of gastric cancer management.
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Affiliation(s)
- Caroline E Hall
- Department of Surgery, Division of Gastrointestinal & General Surgery, 23034Emory University School of Medicine, Atlanta, GA, USA
| | - Felipe Maegawa
- Department of Surgery, Division of Gastrointestinal & General Surgery, 23034Emory University School of Medicine, Atlanta, GA, USA
| | - Ankit D Patel
- Department of Surgery, Division of Gastrointestinal & General Surgery, 23034Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Lin
- Department of Surgery, Division of Gastrointestinal & General Surgery, 23034Emory University School of Medicine, Atlanta, GA, USA
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11
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Rawicz-Pruszyński K, Sędłak K, Pelc Z, Mlak R, Litwiński J, Mańko P, Zinkiewicz K, Paśnik I, Cięszczyk K, Pawlik T, Märkl B, Erodotou M, Polkowski WP. Staging LaParoscopy to Assess Lymph NOde InvoLvement in Advanced GAstric Cancer (POLA)-Study protocol for a single-arm prospective observational multicenter study. PLoS One 2023; 18:e0285758. [PMID: 37205666 DOI: 10.1371/journal.pone.0285758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION In the era of neoadjuvant chemotherapy in advanced gastric cancer (GC), the role of staging laparoscopy (SL) will become more established. However, despite guidelines recommendations, SL for optimal preoperative staging remains underutilized. Diagnostic value of near-infrared (NIR) / indocyanine green (ICG) guided sentinel node (SN) mapping in GC confirmed its technical feasibility, however no data exist regarding its potential role in pathological nodal staging. To the best of our knowledge, current study is the first to evaluate the role of ICG in nodal staging of advanced GC patients undergoing SL. MATERIALS AND METHODS This single-arm prospective observational multicenter study was approved by the Bioethical Committee of Medical University of Lublin (Ethic Code: KE-0254/331/2018). The protocol is registered at clinicaltrial.gov (NCT05720598), and the study results will be reported according to the Strengthening of Reporting of Observational Studies in Epidemiology (STROBE) statement. The primary endpoint of this study is the identification rate of ICG-guided SN in advanced GC patients. The secondary endpoints include pathological and molecular assessment of retrieved SNs and other pretreatment clinical variables potentially associated with SL: pattern of perigastric ICG distribution according to patients' pathological and clinical characteristics, neoadjuvant chemotherapy compliance, 30-day morbidity, and mortality. CONCLUSION POLA study is the first to investigate the clinical value of ICG-enhanced sentinel node biopsy during staging laparoscopy in advanced GC patients in a Western cohort. Identifying pN status before multimodal treatment will improve GC staging process.
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Affiliation(s)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Radosław Mlak
- Body Composition Research Laboratory, Department of Preclinical Sciences, Medical University of Lublin, Lublin, Poland
| | - Jakub Litwiński
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Paweł Mańko
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Iwona Paśnik
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Cięszczyk
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Timothy Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio, United States of America
| | - Bruno Märkl
- Institute of Pathology, Klinikum Augsburg, Augsburg, Germany
| | - Maria Erodotou
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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12
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Siddiqi A, Johnston FM. The Perioperative and Operative Management of Esophageal and Gastric Cancer. Surg Oncol Clin N Am 2023; 32:65-81. [PMID: 36410922 DOI: 10.1016/j.soc.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optimal management of esophageal and gastric cancer during the perioperative period requires a coordinated multidisciplinary treatment effort. Accurate staging guides treatment strategy. Advances in minimally invasive surgery and endoscopy have reduced risks associated with resection while maintaining oncological standards. Although the standard perioperative chemo-and radiotherapy regimens have not yet been established, randomized control trials exploring this subject show promising results.
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Affiliation(s)
- Amn Siddiqi
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Fabian M Johnston
- Division of Gastrointestinal Surgical Oncology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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13
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Kubo N, Cho H, Lee D, Yang H, Kim Y, Khalayleh H, Yoon HM, Ryu KW, Hanna GB, Coit DG, Hakamada K, Kim YW. Risk prediction model of peritoneal seeding in advanced gastric cancer: A decision tool for diagnostic laparoscopy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:853-861. [PMID: 36586786 DOI: 10.1016/j.ejso.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Selective diagnostic laparoscopy in gastric cancer patients at high risk of peritoneal metastasis is essential for optimal treatment planning. In this study available clinicopathologic factors predictive of peritoneal seeding in advanced gastric cancer (AGC) were identified, and this information was translated into a clinically useful tool. METHODS Totally 2833 patients underwent surgery for AGC between 2003 and 2013. The study identified clinicopathologic factors associated with the risk of peritoneal seeding for constructing nomograms using a multivariate logistic regression model with backward elimination. A nomogram was constructed to generate a numerical value indicating risk. Accuracy was validated using bootstrapping and cross-validation. RESULTS The proportion of seeding positive was 12.7% in females and 9.6% in males. Of 2833 patients who underwent surgery for AGC, 300 (10.6%) were intraoperatively identified with peritoneal seeding. Multivariate analysis revealed the following factors associated with peritoneal seeding: high American Society of Anesthesiologists score, fibrinogen, Borrmann type 3 or 4 tumors, the involvement of the middle, anterior, and greater curvature, cT3 or cT4cN1 or cN2 or cN3, cM1, and the presence of ascites or peritoneal thickening or plaque or a nodule on the peritoneal wall on computed tomography. The bootstrap analysis revealed a robust concordance between mean and final parameter estimates. The area under the ROC curve for the final model was 0.856 (95% CI, 0.835-0.877), which implies good performance. CONCLUSIONS This nomogram provides effective risk estimates of peritoneal seeding from gastric cancer and can facilitate individualized decision-making regarding the selective use of diagnostic laparoscopy.
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Affiliation(s)
- Norihito Kubo
- Center for Gastric Cancer, National Cancer Center, Korea; Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan
| | - Hyunsoon Cho
- Department of Cancer Control and Population Science, Graduate School of Cancer Science and Policy, National Cancer Center, Korea
| | - Dahhay Lee
- Department of Cancer Control and Population Science, Graduate School of Cancer Science and Policy, National Cancer Center, Korea
| | - Hannah Yang
- Center for Gastric Cancer, National Cancer Center, Korea; Division of Biology and Biological Engineering, California Institute of Technology Pasadena, California, 91125, USA
| | - Youngsook Kim
- Center for Gastric Cancer, National Cancer Center, Korea
| | - Harbi Khalayleh
- Center for Gastric Cancer, National Cancer Center, Korea; Faculty of Medicine, Hebrew University of Jerusalem, Israel; The Department of Surgery, Kaplan Medical Center, Israel
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Korea
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College of London, United Kingdom
| | - Daniel G Coit
- Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, USA
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Korea; Department of Cancer Control and Population Science, Graduate School of Cancer Science and Policy, National Cancer Center, Korea.
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14
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Kim DJ, Hyung WJ, Park YK, Lee HJ, An JY, Kim HI, Kim HH, Ryu SW, Hur H, Kim MC, Kong SH, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Yang HK, Han SU, Kim W. Accuracy of preoperative clinical staging for locally advanced gastric cancer in KLASS-02 randomized clinical trial. Front Surg 2022; 9:1001245. [PMID: 36211302 PMCID: PMC9537949 DOI: 10.3389/fsurg.2022.1001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The discrepancy between preoperative and final pathological staging has been a long-standing challenge for the application of clinical trials or appropriate treatment options. This study aimed to demonstrate the accuracy of preoperative staging of locally advanced gastric cancer using data from a large-scale randomized clinical trial. Materials and methods Of the 1050 patients enrolled in the clinical trial, 26 were excluded due to withdrawal of consent (n = 20) or non-surgery (n = 6). The clinical and pathological staging was compared. Risk factor analysis for underestimation was performed using univariate and multivariate analyses. Results Regarding T staging by computed tomography, accuracy rates were 74.48, 61.62, 58.56, and 85.16% for T1, T2, T3 and T4a, respectively. Multivariate analysis for underestimation of T staging revealed that younger age, ulcerative gross type, circular location, larger tumor size, and undifferentiated histology were independent risk factors. Regarding nodal status estimation, 54.9% of patients with clinical N0 disease were pathologic N0, and 36.4% of patients were revealed to have pathologic N0 among clinical node-positive patients. The percentage of metastasis involvement at the D1, D1+, and D2 lymph node stations significantly increased with the advanced clinical N stage. Among all patients, 29 (2.8%), including 26 with peritoneal seeding, exhibited distant metastases. Conclusions Estimating the exact pathologic staging remains challenging. A thorough evaluation is mandatory before treatment selection or trial enrollment. Moreover, we need to set a sufficient case number when we design the clinical trial considering the stage migration.
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Affiliation(s)
- Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Busan, South Korea
| | - Seong-Ho Kong
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Young Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Jong Won Kim
- Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Joo-Ho Lee
- Department of Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
- Correspondence: Wook Kim
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15
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Gęca K, Skórzewska M, Rawicz-Pruszyński K, Mlak R, Sędłak K, Pelc Z, Małecka-Massalska T, Polkowski WP. Prognostic value of molecular cytology by one-step nucleic acid amplification (OSNA) assay of peritoneal washings in advanced gastric cancer patients. Sci Rep 2022; 12:12477. [PMID: 35864130 PMCID: PMC9304381 DOI: 10.1038/s41598-022-16761-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/14/2022] [Indexed: 01/31/2023] Open
Abstract
Peritoneal dissemination is a common form of gastric cancer (GC) recurrence, despite surgery with curative intent. This study aimed to evaluate the prognostic value of intraperitoneal lavage One-Step Nucleic Acid Amplification (OSNA) assay in advanced GC patients. OSNA assay targeting CK-19 mRNA was applied to detect free cancer cells (FCC) in intraperitoneal lavage samples obtained during gastrectomy. A total of 82 GC patients were enrolled to investigate the correlation between OSNA assay and patient's prognosis. Of the 82 patients, OSNA assay was positive in 25 (30.5%) patients. The median OS in OSNA positive patients was significantly lower than in OSNA negative patients (19 vs 45 months). Positive OSNA assay result was a significant unfavourable prognostic factor in both, univariable (HR 3.45, 95% CI 0.95-12.48; p = 0.0030) and multivariable analysis (HR 3.10, 95% CI 1.22-8.54; p = 0.0298). Positive OSNA assay in intraperitoneal lavage is a valuable indicator of poor survival in advanced GC patients after multimodal treatment. After further confirmation on larger sample size, OSNA assay of peritoneal washings could be considered an adjunct tool to conventional cytology, the current gold standard, to provide precise intraoperative staging and additional prognostic information.
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Affiliation(s)
- Katarzyna Gęca
- grid.411484.c0000 0001 1033 7158Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Magdalena Skórzewska
- grid.411484.c0000 0001 1033 7158Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Karol Rawicz-Pruszyński
- grid.411484.c0000 0001 1033 7158Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Radosław Mlak
- grid.411484.c0000 0001 1033 7158Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland
| | - Katarzyna Sędłak
- grid.411484.c0000 0001 1033 7158Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Zuzanna Pelc
- grid.411484.c0000 0001 1033 7158Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Teresa Małecka-Massalska
- grid.411484.c0000 0001 1033 7158Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland
| | - Wojciech P. Polkowski
- grid.411484.c0000 0001 1033 7158Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
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16
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Tham E, Sestito M, Markovich B, Garland-Kledzik M. Current and future imaging modalities in gastric cancer. J Surg Oncol 2022; 125:1123-1134. [PMID: 35481912 DOI: 10.1002/jso.26875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
Abstract
Gastric adenocarcinoma treatment can include endoscopic mucosal resection, surgery, chemotherapy, radiation, and palliative measures depending on staging. Both invasive and noninvasive staging techniques have been used to dictate the best treatment pathway. Here, we review the current imaging modalities used in gastric cancer as well as novel techniques to accurately stage and screen these patients.
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Affiliation(s)
- Elwin Tham
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Michael Sestito
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brian Markovich
- Department of Diagnostic Radiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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17
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Pikuła A, Skórzewska M, Pelc Z, Mlak R, Gęca K, Sędłak K, Ciseł B, Kwietniewska M, Rawicz-Pruszyński K, Polkowski WP. Prognostic Value of Systemic Inflammatory Response Markers in Patients Undergoing Neoadjuvant Chemotherapy and Gastrectomy for Advanced Gastric Cancer in the Eastern European Population. Cancers (Basel) 2022; 14:cancers14081997. [PMID: 35454903 PMCID: PMC9029795 DOI: 10.3390/cancers14081997] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/26/2022] Open
Abstract
Simple Summary This study aimed to verify the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in GC patients undergoing neoadjuvant chemotherapy (NAC) and gastrectomy. Elevated NLR and PLR prior to NAC were associated with significantly higher risk of death (mOS: 36 vs. 87 months; HR = 2.21; p = 0.0255 and mOS: 30 vs. 87 months; HR = 2.89; p = 0.0034, respectively). Additionally, a significantly higher risk of death was observed in patients with elevated NLR after NAC (mOS: 35 vs. 87 months; HR = 1.94; p = 0.0368). Selected systemic inflammatory response markers (NLR, PLR) are significant prognostic factors in patients with advanced GC treated with NAC and gastrectomy, as shown in the Eastern European population. Abstract The prognostic value of the systemic inflammatory response markers, namely neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) has not yet been clarified in patients undergoing neoadjuvant chemotherapy (NAC) and gastrectomy for advanced gastric cancer (GC) in the Eastern European population. This study aimed to verify the prognostic value of NLR, PLR, and LMR in GC patients undergoing multimodal treatment. One hundred six GC patients undergoing NAC and gastrectomy between 2012 and 2020 were included. Analysed blood samples were obtained prior to NAC (pre-NAC group) and before surgical treatment (post-NAC group). To evaluate the prognostic value of the NLR, LMR, and PLR, univariable and multivariable overall survival (OS) analyses were performed. In the pre-NAC group, elevated NLR and PLR were associated with significantly higher risk of death (mOS: 36 vs. 87 months; HR = 2.21; p = 0.0255 and mOS: 30 vs. 87 months; HR = 2.89; p = 0.0034, respectively). Additionally, a significantly higher risk of death was observed in patients with elevated NLR in the post-NAC group (mOS: 35 vs. 87 months; HR = 1.94; p = 0.0368). Selected systemic inflammatory response markers (NLR, PLR) are significant prognostic factors in patients with advanced GC treated with NAC and gastrectomy, as shown in the Eastern European population.
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Affiliation(s)
- Agnieszka Pikuła
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland;
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Bogumiła Ciseł
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Magdalena Kwietniewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
- Correspondence: ; Tel.: +48-81-531-8126
| | - Wojciech P. Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland; (A.P.); (M.S.); (Z.P.); (K.G.); (K.S.); (B.C.); (M.K.); (W.P.P.)
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18
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ZC3H15 promotes gastric cancer progression by targeting the FBXW7/c-Myc pathway. Cell Death Dis 2022; 8:32. [PMID: 35064102 PMCID: PMC8782901 DOI: 10.1038/s41420-022-00815-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/28/2021] [Accepted: 12/14/2021] [Indexed: 12/30/2022]
Abstract
Zinc finger CCCH-type containing 15 (ZC3H15), a highly conserved eukaryotic protein, which was associated with several cellular processes and was ubiquitously expressed in various human tissues. Recent studies indicated that ZC3H15 was involved in tumorigenesis and may be a potential biomarker in hepatocellular carcinoma (HCC) and acute myeloid leukemia (AML). However, the biological function and molecular mechanism of ZC3H15 in gastric cancer (GC) have not been studied. In this study, we revealed that ZC3H15 was highly expressed in GC and high ZC3H15 expression was closely linked to poor survival of patients with GC. We found that ZC3H15 promoted cell proliferation, migration, and invasion by increasing c-Myc expression. Next, we found that ZC3H15 could modulate c-Myc protein stability by suppressing the transcription of FBXW7, which was mainly responsible for c-Myc degradation. Moreover, silencing of FBXW7 in ZC3H15-knockdown GC cells could partly abrogate the effects induced by ZC3H15 downregulation. Taken together, our data unearth the important roles of ZC3H15 in GC development and suggest that ZC3H15 may be a potential target for the treatment of GC.
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Li X, Ai S, Lu X, Liu S, Guan W. Nanotechnology-based strategies for gastric cancer imaging and treatment. RSC Adv 2021; 11:35392-35407. [PMID: 35493171 PMCID: PMC9043273 DOI: 10.1039/d1ra01947c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Gastric cancer is the second biggest cause of cancer-related deaths worldwide. Despite the improvement in deciphering molecular mechanisms, advances of detection and imaging, implementation of prevention programs, and personalized treatment, the overall curative rate remains low. In particular, with the emergence of nanomaterials, different imaging modalities can be integrated into one single platform, and combined therapies with synergetic effects against gastric cancer were established. Moreover, the development of theranostic strategies with simultaneous diagnostic and therapeutic ability was boosted by multifunctional nanoparticles. Herein, we present a comprehensive review of major nanotechnology-based breakthroughs for gastric cancer imaging and treatment. We will describe the superiority of nanomaterials used in gastric cancer and summarize nanotechnology applications for the improvement of cancer imaging and therapeutic efficacy.
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Affiliation(s)
- Xianghui Li
- Affiliated Drum Tower Hospital, Medical School of Nanjing University 321 Zhongshan RD Nanjing 210008 China +86-25-68182222. ext. 60930, 60931, 60932
| | - Shichao Ai
- Affiliated Drum Tower Hospital, Medical School of Nanjing University 321 Zhongshan RD Nanjing 210008 China +86-25-68182222. ext. 60930, 60931, 60932
| | - Xiaofeng Lu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University 321 Zhongshan RD Nanjing 210008 China +86-25-68182222. ext. 60930, 60931, 60932
| | - Song Liu
- Affiliated Drum Tower Hospital, Medical School of Nanjing University 321 Zhongshan RD Nanjing 210008 China +86-25-68182222. ext. 60930, 60931, 60932
| | - Wenxian Guan
- Affiliated Drum Tower Hospital, Medical School of Nanjing University 321 Zhongshan RD Nanjing 210008 China +86-25-68182222. ext. 60930, 60931, 60932
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Misra S, Yeshala SK, Singh S, Singh RK, Maria Das KJ, Kumar S, Kumar S. A Pilot Study of Perioperative Cisplatin-Capecitabine Chemotherapy With Preoperative Chemoradiation for Resectable Gastric Cancers. Am J Clin Oncol 2021; 44:475-481. [PMID: 34183522 DOI: 10.1097/coc.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The standard of care for resectable gastric cancers (GCs) includes perioperative chemotherapy (CT) or postoperative chemo/chemoradiotherapy (CRT) strategies. Poor treatment compliance postsurgery suggests that intensified surgical adjuvant treatment is more likely deliverable preceding surgery and, therefore, the safety and efficacy of perioperative cisplatin-capecitabine (CX) with preoperative chemoradiation (preopCRT) were ascertained. MATERIALS AND METHODS Between January 2017 and December 2018, 28 potentially resectable locally advanced GC patients were offered neoadjuvant CT-2 cycles of CX at 3-weekly intervals, followed by preopCRT 45 Gy/25 fractions/5 weeks and concurrent capecitabine, followed by surgical resection and 3 adjuvant cycles of CX. RESULTS Neoadjuvant CT was commenced in 28 patients (100%), preopCRT in 18 patients (64%), and surgery performed in 13 patients (46%). At each treatment step, decreasing patient numbers were due mainly to disease progression (12 [43%]) or other reasons, including (3 [11%]) from treatment-related toxicity. The R0 resection rate was 92% (12/13); a median of 18 nodes was obtained after D2 nodal clearance in 92% (12/13). There were 20%/4%/4% grade 3/4/5 toxicities. The median radiotherapy dose/duration was 45 Gy/5.4 weeks. Adjuvant CT was started in 11 patients (39%) and the third cycle was received by 7 patients (25%). No tumor (ypT0N0) was noted in 23% of the operated patients (3/13), or 11% of the intention-to-treat population (3/28). The median, 1-year, and 2-year survivals were 12 months, 53%, and 32%, respectively. CONCLUSIONS Intensified preoperative treatment is doable in relatively unselected advanced GC patients in real-world settings of a public-sector hospital from a low-middle-income country. Disease progression during preoperative therapy allows patients destined for early clinical evidence of disease dissemination to avoid futile surgery, as opposed to a surgery-first strategy, without an overt increase in surgical morbidity or mortality, with encouraging R0 resection rates.
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Affiliation(s)
| | | | | | - Rajneesh K Singh
- Gastrosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| | | | | | - Shaleen Kumar
- Departments of Radiotherapy
- Superspeciality Cancer Institute and Hospital, CG City, Lucknow, Uttar Pradesh, India
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Staging laparoscopy in patients with advanced gastric cancer: A single center cohort study. Eur J Surg Oncol 2021; 48:362-369. [PMID: 34384656 DOI: 10.1016/j.ejso.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Most studies exploring the role of staging laparoscopy in gastric cancer are limited by low sample size and are predominantly conducted in Asian countries. This study sets out to determine the value of staging laparoscopy in patients with advanced gastric cancer in a Western population. METHODS All patients with gastric cancer from a tertiary referral center without definite evidence of non-curable disease after initial staging, and who underwent staging laparoscopy between 2013 and 2020, were identified from a prospectively maintained database. The proportion of patients in whom metastases or locoregional non-resectability was detected during staging laparoscopy was established. Secondary outcomes included the avoidable surgery rate (detection of non-curable disease during gastrectomy with curative intent) and diagnostic accuracy (sensitivity, specificity, accuracy, negative and positive predictive value). RESULTS A total of 216 patients were included. Staging laparoscopy revealed metastatic disease in 46 (21.3 %) patients and a non-resectable tumor in three (1.4 %) patients. During intended gastrectomy, non-curable disease was revealed in 13 (8.6 %) patients. Overall sensitivity, specificity and diagnostic accuracy were 76.6 %, 100 % and 92.6 %, respectively. The positive predictive value was 100 % and the negative predictive value was 90.3 %. CONCLUSION Staging laparoscopy is valuable in the staging process of gastric cancer with a high accuracy in detecting non-curable disease, thereby preventing futile treatment and its associated burden.
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Sandø AD, Fougner R, Grønbech JE, Bringeland EA. The value of restaging CT following neoadjuvant chemotherapy for resectable gastric cancer. A population-based study. World J Surg Oncol 2021; 19:212. [PMID: 34256790 PMCID: PMC8278640 DOI: 10.1186/s12957-021-02313-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Response evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC. Methods Retrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment. Results Of 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004–0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode. Conclusions Routine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.
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Affiliation(s)
- Alina Desiree Sandø
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway. .,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Reidun Fougner
- Department of Radiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Erik Grønbech
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Audun Bringeland
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
Surgery is an essential component of curative-intent treatment strategies for gastric cancer. However, the care of each patient with gastric cancer must be individualized based on patient and tumor characteristics. It is important that all physicians who will be caring for patient with gastric cancer understand the current best practices of surgical management to provide patients with the highest quality of care. This article aims to provide this information while acknowledging areas of surgical management that are still controversial.
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Affiliation(s)
- Ian Solsky
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Block Building #112, New York, NY 10461, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Block Building #112, New York, NY 10461, USA; Department of Surgery, Albert Einstein College of Medicine, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA.
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He H, Shao X, Li Y, Gihu R, Xie H, Zhou J, Yan H. Targeting Signaling Pathway Networks in Several Malignant Tumors: Progresses and Challenges. Front Pharmacol 2021; 12:675675. [PMID: 34135756 PMCID: PMC8203325 DOI: 10.3389/fphar.2021.675675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022] Open
Abstract
Malignant tumors remain the health problem of highest concern among people worldwide due to its high mortality and recurrence. Lung, gastric, liver, colon, and breast cancers are among the top five malignant tumors in terms of morbidity and mortality. In cancer biology, aberrant signaling pathway regulation is a prevalent theme that drives the generation, metastasis, invasion, and other processes of all malignant tumors. The Wnt/β-catenin, PI3K/AKT/mTOR, Notch and NF-kB pathways are widely concerned and signal crosstalks exist in the five solid tumors. This review provides an innovative summary of the recent progress in research on these signaling pathways, the underlying mechanism of the molecules involved in these pathways, and the important role of some miRNAs in tumor-related signaling pathways. It also presents a brief review of the antitumor molecular drugs that target these signaling pathways. This review may provide a theoretical basis for the study of the molecular biological mechanism of malignant tumors and vital information for the development of new treatment strategies with a focus on efficacy and the reduction of side effects.
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Affiliation(s)
- Hongdan He
- Qinghai Tibet Plateau Research Institute, Southwest Minzu University, Chengdu, China
| | - Xiaoni Shao
- Immunotherapy Laboratory, College of Pharmacology, Southwest Minzu University, Chengdu, China
| | - Yanan Li
- Immunotherapy Laboratory, College of Pharmacology, Southwest Minzu University, Chengdu, China
| | - Ribu Gihu
- Immunotherapy Laboratory, College of Pharmacology, Southwest Minzu University, Chengdu, China
| | - Haochen Xie
- Qinghai Tibet Plateau Research Institute, Southwest Minzu University, Chengdu, China
| | - Junfu Zhou
- Immunotherapy Laboratory, College of Pharmacology, Southwest Minzu University, Chengdu, China
| | - Hengxiu Yan
- Immunotherapy Laboratory, College of Pharmacology, Southwest Minzu University, Chengdu, China
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β-Galactosidase is a target enzyme for detecting peritoneal metastasis of gastric cancer. Sci Rep 2021; 11:10664. [PMID: 34021168 PMCID: PMC8139979 DOI: 10.1038/s41598-021-88982-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
Diagnosis of peritoneal metastasis in gastric cancer (GC) is essential for determining appropriate therapeutic strategies and avoiding non-essential laparotomy or gastrectomy. Recently, a variety of activatable fluorescence probes that can detect enzyme activities have been developed for cancer imaging. The aim of this study was to identify the key enzyme involved in peritoneal metastasis in GC. The enzymatic activity of gamma-glutamyl transpeptidase, dipeptidyl peptidase IV, and β-galactosidase (β-Gal) was assessed in lysates prepared from preserved human GC (n = 89) and normal peritoneal (NP; n = 20) samples. β-Gal activity was significantly higher in the human GC samples than in NP samples, whereas no differences were observed in the activities of the other enzymes. Therefore, we used SPiDER-βGal, a fluorescent probe that can be activated by β-Gal, for imaging GC cell lines, peritoneal metastasis in a mouse model, and fresh human resected GC samples (n = 13). All cell lines showed fluorescence after applying SPiDER-βGal, and metastatic nodules in the mice gradually developed high fluorescence that could be visualized with SPiDER-βGal. The human GC samples showed significantly higher fluorescence than NP samples. β-Gal is a useful target enzyme for fluorescence imaging of peritoneal metastasis in GC.
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Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment-Oncological and Surgical Perspective. Cancers (Basel) 2021; 13:cancers13102509. [PMID: 34065596 PMCID: PMC8160868 DOI: 10.3390/cancers13102509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Therefore, further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC. Abstract Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. A favourable prognostic impact for ypN0 patients is observed, either due to truly negative LN before the start of therapy or because preoperative therapy achieved a pathologically complete nodal response. Ongoing trials investigating the extent of lymphadenectomy after neoadjuvant therapy will standardise the LN dissection from the multimodal therapy perspective. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC.
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Ao S, Wang Y, Song Q, Ye Y, Lyu G. Current status and future perspectives on neoadjuvant therapy in gastric cancer. Chin J Cancer Res 2021; 33:181-192. [PMID: 34158738 PMCID: PMC8181872 DOI: 10.21147/j.issn.1000-9604.2021.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer, with high morbidity and mortality rates, is one of the most heterogeneous tumors. Radical gastrectomy and postoperative chemotherapy are the standard treatments. However, the safety and efficacy of neoadjuvant therapy (NAT) need to be confirmed by many trials before implementation, creating a bottleneck in development. Although clinical benefits of NAT have been observed, a series of problems remain to be solved. Before therapy, more contributing factors should be offered for choice in the intended population and ideal regimens. Enhanced computed tomography (CT) scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors (RECIST), yet CT scanning results sometimes differ from pathological responses. After NAT, the appropriate time for surgery is still empirically defined. Our review aims to discuss the abovementioned issues regarding NAT for GC, including indications, selection of regimens, lesion assessment and NAT-surgery interval time.
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Affiliation(s)
- Sheng Ao
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Yuchen Wang
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Qingzhi Song
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Guoqing Lyu
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
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Yüksel C, Erşen O, Basceken SI, Mercan Ü, Yalkın Ö, Culcu S, Bakırarar B, Bayar S, Ünal AE, Demirci S. The role of laparoscopic staging for the management of gastric cancer. POLISH JOURNAL OF SURGERY 2021; 93:1-8. [PMID: 33949319 DOI: 10.5604/01.3001.0014.7360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AİM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSİONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods.
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Affiliation(s)
- Cemil Yüksel
- University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital
| | - Ogün Erşen
- Ankara University School of Medicine Department of Surgical Oncology
| | | | - Ümit Mercan
- Ankara University School of Medicine, Department of Surgical Oncology
| | - Ömer Yalkın
- Bursa State Hospital Surgical Oncology Clinic
| | - Serdar Culcu
- University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital
| | | | - Sancar Bayar
- Ankara University School of Medicine, Department of Surgical Oncology
| | - Ali Ekrem Ünal
- Ankara University School of Medicine Department of Surgical Oncology
| | - Salim Demirci
- Ankara University School of Medicine, Department of Surgical Oncology
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De Vuysere S, Vandecaveye V, De Bruecker Y, Carton S, Vermeiren K, Tollens T, De Keyzer F, Dresen RC. Accuracy of whole-body diffusion-weighted MRI (WB-DWI/MRI) in diagnosis, staging and follow-up of gastric cancer, in comparison to CT: a pilot study. BMC Med Imaging 2021; 21:18. [PMID: 33546626 PMCID: PMC7866710 DOI: 10.1186/s12880-021-00550-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
Background Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed tomography (CT) is currently used as primary staging tool, being widely available with a relatively high accuracy for the detection of parenchymal metastases, but with low sensitivity for the detection of peritoneal metastases. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has a very high contrast resolution, suggesting a higher diagnostic performance in the detection of small peritoneal lesions. The aim of this study was to retrospectively evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for detection of peritoneal carcinomatosis (PC) and distant metastases in the preoperative staging of gastric cancer. Methods This retrospective study included thirty-two patients with a suspicion of gastric cancer/recurrence, who underwent WB-DWI/MRI at 1.5 T, in addition to CT of thorax and abdomen. Images were evaluated by two experienced abdominal radiologists in consensus. Histopathology, laparoscopy and/or 1-year follow-up were used as reference standard. Results For overall tumour detection (n = 32), CT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 83.3%, 100%, 100% and 82.4% respectively. For WB-DWI/MRI these values were 100%, 92.9%, 94.7% and 100%, respectively. For staging (n = 18) malignant lymph nodes and metastases, CT had a sensitivity, specificity/PPV/NPV of 50%/100%/100%/71.4%, and 15.4%/100%/100%/31.3% respectively. For WB-DWI/MRI, all values were 100%, for both malignant lymph nodes and metastases. WB-DWI/MRI was significantly better than CT in detecting tumour infiltration of the mesenteric root, serosal involvement of the small bowel and peritoneal metastases for which WB-DWI/MRI was correct in 100% of these cases, CT 0%. Conclusions WB-DWI/MRI is highly accurate for diagnosis, staging and follow-up of patients with suspected gastric cancer.
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Affiliation(s)
- Sofie De Vuysere
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Radiology, Imelda Hospital Bonheiden, Imeldalaan 9, 2820, Bonheiden, Belgium.
| | - Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Yves De Bruecker
- Department of Radiology, Imelda Hospital Bonheiden, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Saskia Carton
- Department of Gastroenterology, Imelda Hospital Bonheiden, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Koen Vermeiren
- Department of Surgery, Imelda Hospital Bonheiden, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Tim Tollens
- Department of Surgery, Imelda Hospital Bonheiden, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Frederik De Keyzer
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Raphaëla Carmen Dresen
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Takahashi K, Kurashina K, Saito S, Kanamaru R, Ohzawa H, Yamaguchi H, Miyato H, Hosoya Y, Lefor AK, Sata N, Kitayama J. Flow cytometry-based analysis of tumor-leukocyte ratios in peritoneal fluid from patients with advanced gastric cancer. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:666-675. [PMID: 33277773 PMCID: PMC9290827 DOI: 10.1002/cyto.b.21978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023]
Abstract
Background The frequency of tumor cell dissemination in the peritoneal cavity is critically related to the progression of peritoneal metastases (PM). Recently, flow cytometry (FCM) has been successfully used to detect tumor cells in malignant effusions. Methods A total of 143 single cell suspensions derived from ascites or peritoneal lavages from patients with advanced gastric cancer (GC) were stained with monoclonal antibodies to CD45 and to CD326 as well as 4,6‐diamidino‐2‐phenylindole (DAPI) and FVS780. Using FCM, tumor‐leukocyte ratio (TLR) were calculated from CD45(−)CD326(+) tumor cell counts/ CD45(+)CD326(+) leukocyte counts in DAPI (+) FVS780(−) gated area. In 54 patients, the ratios of CD11b(+), CD4(+) and CD8(+) cells in CD45(+) leukocytes were evaluated in parallel. Results TLR of 69 patients with PM were significantly higher than those of 74 without PM (p < .001) and log(TLR) showed strong correlation with peritoneal cancer index scores in 51 PM (+) patients (r = 0.439). TLR in PM (+) patients also correlated with the ratio of CD11b (+) myeloid cells (r = 0.547), and correlated inversely with those of CD4(+) (r = −0.490) and CD8(+) T cells (r = −0.648). In PM (−) patients who underwent gastrectomy, TLR never exceeded 0.1% in patients with primary GC without serosal involvement (<T4). However, TLR in patients with T4 GC were significantly higher (p < .05) and peritoneal recurrence occurred in 6/8 patients whose TLR exceeded 0.1%. Conclusion TLR in peritoneal fluid reflects tumor burden and the immune environment in peritoneal cavity. Multicolor FCM may provide additional information which can be used for the treatment of the patients with PM.
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Affiliation(s)
- Kazuya Takahashi
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Kentaro Kurashina
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Shin Saito
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Rihito Kanamaru
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hideyuki Ohzawa
- Department of Clinical Oncology, Jichi Medical University, Shimotsuke, Japan
| | - Hironori Yamaguchi
- Department of Clinical Oncology, Jichi Medical University, Shimotsuke, Japan
| | - Hideyo Miyato
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yoshinori Hosoya
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Alan Kawarai Lefor
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Sata
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Joji Kitayama
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
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He Q, Zhu J, Wang A, Ji K, Ji X, Zhang J, Wu X, Li X, Bu Z, Ji J. A decision analysis comparing three strategies for peritoneal lavage cytology testing in staging of gastric cancer in China. Cancer Med 2020; 9:8940-8949. [PMID: 33047873 PMCID: PMC7724308 DOI: 10.1002/cam4.3518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Positive peritoneal cytology (PCY) indicates metastasis (M1) in gastric cancer (GC) patients; both the American and Chinese guidelines recommend laparoscopic peritoneal lavage (LPL) for cytology. However, relatively high costs impair the widespread use of LPL in some resource-limited regions in China, and the cost-effectiveness of PCY testing remains unclear. Therefore, we performed a decision analysis to evaluate the cost-effectiveness of PCY testing by comparing the guideline-recommended intraoperative LPL, a newly proposed preoperative percutaneous peritoneal lavage (PPL), and a third strategy of exploratory laparotomy with no cytology testing (ELNC) among GC patients. METHODS We developed a decision-analytic Markov model of the aforementioned three strategies for a hypothetical cohort of GC patients with curative intent after initial imaging, from the perspective of Chinese society. We estimated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) as primary outcomes; we also conducted one-way and probabilistic sensitivity analyses to investigate the model's robustness. RESULTS We found that ELNC was dominated (i.e., more expensive and less effective) by PPL and LPL. LPL was the most cost-effective method with an ICER of US$17,200/QALY compared to PPL, which was below the Chinese willingness-to-pay (WTP) threshold of US$29,313 per QALY gained. In sensitivity analyses, PPL was more likely to be cost-effective with a lower WTP threshold. CONCLUSIONS Cytology testing through either LPL or PPL was less expensive and more effective than ELNC among GC patients. Moreover, LPL was the most cost-effective modality at the current WTP threshold, while PPL could potentially be cost-effective in lower-income areas.
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Affiliation(s)
- Qifei He
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Jinyi Zhu
- Center for Health Decision ScienceHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Anqiang Wang
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Ke Ji
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Xin Ji
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Ji Zhang
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Xiaojiang Wu
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Xia Li
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Zhaode Bu
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Jiafu Ji
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
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Shao JP, Su F, Zhang SP, Chen HK, Li ZJ, Xing GQ, Liu HJ, Li YY. miR-212 as potential biomarker suppresses the proliferation of gastric cancer via targeting SOX4. J Clin Lab Anal 2020; 34:e23511. [PMID: 32862489 PMCID: PMC7755761 DOI: 10.1002/jcla.23511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background Circulating microRNAs that post‐transcriptionally regulate gene expressions have been reported as promising biomarkers in cancer monitoring. This study was to identify the potential role of circulating miR‐212 in gastric cancer and whether it could serve as a novel biomarker for gastric cancer. Methods We detected the serum levels of miR‐212 in 100 health people and 110 gastric cancer patients and analyzed the relationships of the serum level of miR‐212 with gastric cancer. We detected the expression of miR‐212 in human gastric mucosal epithelial cell line (GES‐1) and human gastric cancer cell lines (NCI‐N87 and SNU‐16) using qRT‐PCR. Then, we detected the role of 5‐aza‐deoxycytidine on the epigenetic regulation of miR‐212 in human gastric cancer cell lines. Furthermore, luciferase reporter assay was used to detect binding activity of miR‐212 on SOX4 mRNA, and their functions on the cell proliferation and apoptosis. Results The expression of miR‐212 was higher in health people than that in gastric cancer patients, higher in gastric mucosal epithelial cell line than that in gastric cancer cells. miR‐212 can be a circulating biomarker and an independent prognostic factor of gastric cancer. Moreover, miR‐212 can directly regulate the 3′UTR of SOX4 mRNA to suppress p53 and Bax, resulting gastric cancer cells proliferation inhibition and apoptosis induction. Conclusion Our study demonstrated that miR‐212 was epigenetically downregulated in gastric cancer, and resulting low level of miR‐212 can be a potential circulating biomarker and poor prognosis predicator of gastric cancer.
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Affiliation(s)
- Jian-Ping Shao
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Feng Su
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Shu-Peng Zhang
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - He-Kai Chen
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Zhao-Jin Li
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Guo-Qiang Xing
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Hong-Jie Liu
- Department of Radiology, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Yong-Yuan Li
- Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin, China
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Renzulli M, Clemente A, Spinelli D, Ierardi AM, Marasco G, Farina D, Brocchi S, Ravaioli M, Pettinari I, Cescon M, Reginelli A, Cappabianca S, Carrafiello G, Golfieri R. Gastric Cancer Staging: Is It Time for Magnetic Resonance Imaging? Cancers (Basel) 2020; 12:cancers12061402. [PMID: 32485933 PMCID: PMC7352169 DOI: 10.3390/cancers12061402] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Gastric cancer (GC) is a common cancer worldwide. Its incidence and mortality vary depending on geographic area, with the highest rates in Asian countries, particularly in China, Japan, and South Korea. Accurate imaging staging has become crucial for the application of various treatment strategies, especially for curative treatments in early stages. Unfortunately, most GCs are still diagnosed at an advanced stage, with the peritoneum (61-80%), distant lymph nodes (44-50%), and liver (26-38%) as the most common metastatic locations. Metastatic disease is limited to the peritoneum in 58% of cases; in nonperitoneal distant metastases, the most involved GC metastasization site is the liver (82%). The eighth edition of the tumor-node-metastasis staging system is the most commonly used system for determining GC prognosis. Endoscopic ultrasonography, computed tomography, and 18-fluorideoxyglucose positron emission tomography are historically the most accurate imaging techniques for GC staging. However, studies have recently shown renewed interest in magnetic resonance imaging (MRI) as a useful tool in GC staging, especially for distant metastasis assessment. The technical improvement of diffusion-weighted imaging and the increasing use of hepatobiliary contrast agents have been shown to increase the diagnostic performance of MRI, particularly for detecting peritoneal and liver metastasis. However, no principal oncological guidelines have included the use of MRI as a first-line technique for distant metastasis evaluation during the GC staging process, such as the National Comprehensive Cancer Network Guidelines. This review analyzed the role of the principal imaging techniques in GC diagnosis and staging, focusing on the potential role of MRI, especially for assessing peritoneal and liver metastases.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Daniele Spinelli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25138 Brescia, Italy
| | - Stefano Brocchi
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Matteo Ravaioli
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Irene Pettinari
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Matteo Cescon
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Alfonso Reginelli
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy
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Roy AC, Shapiro J, Burge M, Karapetis CS, Pavlakis N, Segelov E, Chau I, Lordick F, Chen LT, Barbour A, Tebbutt N, Price T. Management of early-stage gastro-esophageal cancers: expert perspectives from the Australasian Gastrointestinal Trials Group (AGITG) with invited international faculty. Expert Rev Anticancer Ther 2020; 20:305-324. [PMID: 32202178 DOI: 10.1080/14737140.2020.1746185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: A multimodal approach in operable early-stage oesophago-gastric (OG) cancer has evolved in the last decade, leading to improvement in overall outcomes.Areas covered: A review of the published literature and conference abstracts was undertaken on the topic of optimal adjunctive chemotherapy or chemoradiotherapy in early-stage OG cancers. This review article focuses on the current evidence pertaining to neoadjuvant and perioperative strategies in curable OG cancers including the evolving landscape of immunotherapy and targeted drugs in this setting.Expert commentary: Adjunctive therapies in the form of preoperative chemo-radiotherapy (CRT) or chemotherapy and perioperative chemotherapy over surgery alone improve outcomes in patients with operable OG cancer. Although there are variations in practice around the world, a multi-disciplinary approach to patient care is of paramount importance. Immunotherapy and on treatment functional imaging are two examples of emerging strategies to improve the outcome for early-stage patients. A better understanding of the molecular biology of this disease may help overcome the problem of tumor heterogeneity and enable more rationally designed and targeted therapeutic interventions in the future.
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Affiliation(s)
- Amitesh C Roy
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Australia
| | | | - Matt Burge
- Department of Cancer Care Services, Royal Brisbane Hospital, University Of Queensland, Herston, Australia
| | - Christos S Karapetis
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - Eva Segelov
- Department of Medical Oncology, Monash University and Monash Health, Melbourne, Australia
| | - Ian Chau
- Department of Medical Oncology, Royal Marsden Hospital, Institute of Cancer Research, Surrey, London, UK
| | - Florian Lordick
- Leipzig University Medical Centre, University Cancer Centre Leipzig, Leipzig, Germany
| | - Li-Tong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Andrew Barbour
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Australia
| | - Niall Tebbutt
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
| | - Tim Price
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
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Yasufuku I, Nunobe S, Ida S, Kumagai K, Ohashi M, Hiki N, Sano T. Conversion therapy for peritoneal lavage cytology-positive type 4 and large type 3 gastric cancer patients selected as candidates for R0 resection by diagnostic staging laparoscopy. Gastric Cancer 2020; 23:319-327. [PMID: 31350702 DOI: 10.1007/s10120-019-00994-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The long-term outcomes of type 4 and large type 3 gastric cancer patients with positive peritoneal lavage cytology (CY1) remain unsatisfying. We evaluated our treatment strategy of conversion therapy for CY1 patients without peritoneal dissemination (P0). METHODS Diagnostic staging laparoscopy (DSL) was performed before treatment. Chemotherapy was applied for DSL-diagnosed P0CY1. The re-evaluation of peritoneal metastasis by staging laparoscopy (re-SL) was performed when a response to chemotherapy was identified by gastroscopy and/or CT. Gastrectomy with radical lymphadenectomy was applied as conversion therapy when peritoneal lavage cytology-negative (CY0) and P0 were diagnosed with re-SL, with the aim of achieving R0 resection. Chemotherapy was continued as palliative treatment in patients for whom re-SL was not applicable or when re-SL did not confirm P0CY0. The long-term outcomes were retrospectively evaluated. RESULTS Between 2009 and 2015, 214 patients with type 4 and large type 3 gastric cancer underwent DSL in the Cancer Institute Hospital. Thirty-nine patients were initially diagnosed with P0CY1. Seven patients received palliative gastrectomy first due to outlet obstruction or other reasons. Thirty-two patients received chemotherapy first. Among them, 13 patients underwent gastrectomy as conversion therapy and 19 were treated with palliative chemotherapy. The 3-year survival rate of patients who underwent conversion therapy, palliative chemotherapy and palliative gastrectomy was 76.9% [95% confidence interval (CI) 47.8-92.4%], 10.5% (95% CI 1.9-42.3%), and 0%, respectively. CONCLUSION Conversion therapy might be a promising treatment for P0CY1 type 4 and large type 3 gastric cancer patients. Re-SL was useful for selecting candidates for R0 resection.
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Affiliation(s)
- Itaru Yasufuku
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan.
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan
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36
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Strandby RB, Svendsen LB, Ambrus R, Rostved AA, Hasselby JP, Achiam MP. The Incidence of Free Peritoneal Tumor Cells before and after Neoadjuvant Chemotherapy in Gastroesophageal Junction Cancer. J Cytol 2019; 37:40-45. [PMID: 31942097 PMCID: PMC6947737 DOI: 10.4103/joc.joc_164_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/01/2019] [Accepted: 10/24/2019] [Indexed: 01/07/2023] Open
Abstract
Context The utility of peritoneal washing cytology in patients with gastroesophageal junction cancer has not been thoroughly evaluated. Aims The study aimed to determine the incidence of free peritoneal tumor cells by peritoneal washing cytology before and after neoadjuvant chemotherapy using conventional cytopathological methods and immunohistochemical staining for the analysis of peritoneal washings. Settings and Design A prospective study conducted at a single tertiary referral hospital. Materials and Methods Patients with gastroesophageal junction cancer and without suspicion of intra- or extraabdominal metastases before the staging laparoscopy were prospectively and consecutively enrolled. Peritoneal washing cytology was performed at staging laparoscopy (primary cytology) and after neoadjuvant chemotherapy during robot-assisted or open resection (secondary cytology). Peritoneal fluid samples were analyzed by conventional cytology and an immunohistochemical panel. Results Overall, 81 patients met the primary inclusion criteria. During primary cytology, positive cytology without overt metastases (C1M0) was detected in three patients (3.8%) while five patients (6.3%) had overt intra-abdominal metastases but negative cytology (C0M1). None of the patients with C1M0 underwent surgery due to extra-abdominal (n = 1) or intra-abdominal metastases (n = 2), and the overall survival was 4, 7, and 14 months. During secondary cytology, no patients with free peritoneal tumor cells were identified, but seven patients were classified as C0M1 (10.9%). Conclusions The incidence of C1M0 was 3.8% and 0% before and after neoadjuvant chemotherapy, respectively in patients with gastroesophageal junction cancer. Free peritoneal tumor cells were not identified in several patients with intra-abdominal metastases suggesting that peritoneal washing cytology with conventional cytology and immunohistochemical staining lack sensitivity.
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Affiliation(s)
- Rune B Strandby
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Lars B Svendsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Andreas A Rostved
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Jane P Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Li Y, Shi Y, Wang X, Yu X, Wu C, Ding S. Silencing of CHFR Sensitizes Gastric Carcinoma to PARP Inhibitor Treatment. Transl Oncol 2019; 13:113-121. [PMID: 31812083 PMCID: PMC6909066 DOI: 10.1016/j.tranon.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 01/11/2023] Open
Abstract
CHFR is a tumor suppressor that not only recognizes poly(ADP-ribosylation) (PARylation) signals at the sites of DNA damage but also is downregulated in many types of cancer. However, the underlying mechanism linking its role in PARylation-mediated DNA damage repair and tumor suppression is unclear. Here, we examined a panel of gastric cancer cell lines as well as primary tissue samples from gastric cancer patients, and found that CHFR expression was silenced by DNA hypermethylation in gastric cancer including 38.46% of primary gastric cancers. DNMT1 was associated with aberrant methylation of CHFR, and the expression of CHFR was restored by DNMT1 inhibitor 5-aza-2-deoxycytidine (5-aza-CdR) treatment. Moreover, we found that loss of CHFR abolished DNA damage repair and sensitized gastric tumor cells to PARP inhibitor treatment. Thus, our study reveals a potential therapeutic approach for treating gastric cancer with PARP inhibitor and lacking CHFR can serve as a biomarker for predicting the efficacy of PARP inhibitor on the gastric tumor treatment in future.
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Affiliation(s)
- Yuan Li
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 10091, China
| | - Yanyan Shi
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiumin Wang
- College of Life Sciences, Hebei University, Baoding, 071000, Hebei, PR China
| | - Xiaochun Yu
- Department of Cancer Genetics and Epigenetics, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA.
| | - Chen Wu
- College of Life Sciences, Hebei University, Baoding, 071000, Hebei, PR China.
| | - Shigang Ding
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 10091, China.
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Allen CJ, Newhook TE, Vreeland TJ, Das P, Minsky BD, Blum M, Song S, Ajani J, Ikoma N, Mansfield PF, Roy‐Chowdhuri S, Badgwell BD. Yield of peritoneal cytology in staging patients with gastric and gastroesophageal cancer. J Surg Oncol 2019; 120:1350-1357. [DOI: 10.1002/jso.25729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/01/2019] [Indexed: 08/30/2023]
Affiliation(s)
- Casey J. Allen
- Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Timothy E. Newhook
- Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Timothy J. Vreeland
- Department of Surgical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Prajnan Das
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Bruce D. Minsky
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Mariela Blum
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Shumei Song
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Jaffer Ajani
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
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Rawicz-Pruszyński K, Mielko J, Pudło K, Lisiecki R, Skoczylas T, Murawa D, Polkowski WP. Yield of staging laparoscopy in gastric cancer is influenced by Laurén histologic subtype. J Surg Oncol 2019; 120:1148-1153. [PMID: 31544969 DOI: 10.1002/jso.25711] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Staging laparoscopy (SL) with cytologic lavage is a useful staging procedure that allows tailoring the treatment of advanced gastric cancer (GC). The current study aimed to evaluate the total yield of SL in patients with various Laurén histo-types of GC, before planned neoadjuvant chemotherapy and gastrectomy. METHODS After exclusion of distant metastatic disease on imaging modalities, 173 patients with primary advanced gastric adenocarcinoma who underwent SL between August 2016 and September 2018, were eligible for the analysis. Patients sex, age, Lauren histo-type, tumor location, grade, cT, and cN were assessed in bivariate analysis. Multivariable logistic regression analysis was used to identify independent factors associated with peritoneal metastases. RESULTS Peritoneal metastases, ascites, and positive cytology were found in 39 (22.5%), 17 (9.8%) and 38 (22%) patients, respectively. The total yield of the SL in the current study was 36.4%. Multivariable logistic regression analysis revealed that serosal involvement (cT4) and diffuse histo-type were independent predictors of peritoneal metastases (OR, 15; 95% CI, 1.9-119, P = .02 and OR, 2.4; 95% CI, 1.2-4.6, P = .01, respectively). CONCLUSIONS Although cT4 and diffuse tumors show the highest association with peritoneal metastases, SL is a valuable diagnostic procedure in all advanced GC patients.
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Affiliation(s)
| | - Jerzy Mielko
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Kamil Pudło
- Department of General, Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Radosław Lisiecki
- Department of General Surgery and Oncological Surgery, Pleszewskie Medical Center, Pleszew, Poland
| | - Tomasz Skoczylas
- Department of General, Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Dawid Murawa
- Department of Surgery and Oncology, University of Medical Science, Zielona Góra, Poland
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Fukagawa T. Role of staging laparoscopy for gastric cancer patients. Ann Gastroenterol Surg 2019; 3:496-505. [PMID: 31549009 PMCID: PMC6749947 DOI: 10.1002/ags3.12283] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022] Open
Abstract
Staging laparoscopy (SL) is frequently carried out in patients with advanced gastric cancer. However, some clinical questions are being debated and consensus must be obtained. With this aim, a literature search of PubMed/MEDLINE was carried out using the keywords "gastric cancer," "SL," and "diagnostic laparoscopy". Articles published online up to February 2019 were analyzed, focusing on the following questions. (i) What is an adequate indication for SL? (ii) How do you carry out SL? (iii) Does SL provide accurate information about peritoneal dissemination? (iv) Is the yield of SL different by tumor location? (v) Is SL a safe procedure? (vi) Is "repeat SL" needed? (vii) Does SL provide oncological benefit? Results provided the following responses: (i) In Western countries, clinically resectable advanced tumor is an indication for SL. Terms to be introduced for adequate indication include "location," "type 4 (linitis feature)," "large tumor," "equivocal computed tomography (CT] findings," and "lymph node swelling". (ii) Exploration of the entire peritoneal cavity is preferable. (iii) Detection rate of peritoneal disease is 43%-52% in Japanese institutions and 7.8%-40% in other countries. False-negative findings during SL were 0%-17%, and 10%-13% when limited to cytology. (iv) Yield of SL was higher in gastric cancer compared with esophagogastric junctional tumor. (v) SL-related complications were estimated to occur in 0.4%. (vi) Repeat SL is important after treatment. (vii) If the efficacy of neoadjuvant chemotherapy for patients with P0CY1 is established, SL can provide oncological benefit. SL can be carried out safely and effectively. Considering the prevalence of neoadjuvant treatment, the role of SL will become more important.
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Affiliation(s)
- Takeo Fukagawa
- Department of SurgerySchool of MedicineTeikyo UniversityTokyoJapan
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Espinosa JL, Suárez LM, Guevara RE, Mendivelso FO. Utilidad de la laparoscopia de estadificación frente a la tomografía axial computarizada para detectar metástasis peritoneales en el adenocarcinoma gástrico avanzado. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El adenocarcinoma gástrico es una de las neoplasias más frecuentes. La tomografía computarizada abdominal con contraste es el método estándar para la estadificación; tiene una sensibilidad del 30 al 73 % y una especificidad del 83 al 100 %. La laparoscopia detecta hasta el 30 % de los casos de enfermedad metastásica que no se haya observado en los estudios de imágenes. En la Clínica Universitaria Colombia se realiza estadificación rutinaria con tomografía y laparoscopia más lavado peritoneal.
Objetivos. Determinar la utilidad de la laparoscopia para detectar la carcinomatosis peritoneal en los pacientes con adenocarcinoma gástrico avanzado en un centro de referencia.
Materiales y métodos. Se llevó a cabo un estudio descriptivo y retrospectivo, en el cual se analizaron todas las historias clínicas de los pacientes con cáncer gástrico atendidos en la Clínica Universitaria Colombia entre el 2013 y el 2016. Se confrontó el hallazgo de la laparoscopia con el de la tomografía abdominal, buscando falsos negativos para la enfermedad peritoneal.
Resultados. Se incluyeron 94 pacientes con adenocarcinoma gástrico. La localización en el cuerpo gástrico fue la más frecuente (47,9 %). La tomografía reportó estadio T3 en el 56,4 %, N0 en el 55,3 % y M0 en el 97,9 % de los casos. La laparoscopia reportó estadio T3 en el 43,6 %, ganglios comprometidos en el 56,4 % y carcinomatosis peritoneal (M1) en el 11,7 %.
Discusión. Un radiólogo experimentado detecta una gran proporción de las enfermedades peritoneales, pero la laparoscopia detecta hasta 11 % de aquellas que no son evidentes en los exámenes de imágenes. El lavado peritoneal no prolonga el tiempo quirúrgico ni incrementa la morbilidad, lo cual favorece su realización rutinaria. Se puede recomendar la laparoscopia en aquellos pacientes con resultados tomográficos negativos, evitando la cirugía cuando la neoplasia es irresecable. La laparoscopia tiene un impacto positivo en el manejo integral del cáncer gástrico, acorde con la literatura mundial.
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Jiao J, Zhang S. Long non‑coding RNA MEG‑3 suppresses gastric carcinoma cell growth, invasion and migration via EMT regulation. Mol Med Rep 2019; 20:2685-2693. [PMID: 31524253 PMCID: PMC6691256 DOI: 10.3892/mmr.2019.10515] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/29/2018] [Indexed: 12/20/2022] Open
Abstract
Gastric carcinoma is one of the most frequently diagnosed gastrointestinal tumors. Long non-coding RNAs (lncRNAs) are broadly defined as endogenous cellular non-coding RNA molecules. Studies have demonstrated that they may be associated with human cancer progression. In the present study, the role of lncRNA-maternally expressed gene 3 (MEG3) in the progression of gastric carcinoma cells was investigated in vitro and in vivo. It was demonstrated that lncRNA-MEG3 expression was downregulated in gastric carcinoma cells compared with normal gastric cells. lncRNA-MEG3 transfection increased E-cadherin expression and markedly inhibited gastric carcinoma cell growth, migration and invasion. Flow cytometric analysis revealed that lncRNA-MEG3 transfection promoted the apoptosis of gastric carcinoma cells. Western blot analysis demonstrated that lncRNA-MEG3 transfection inhibited the expression of anti-apoptotic proteins B cell lymphoma-2 (Bcl-2) and Bcl-2-like protein 2 and increased the expression of pro-apoptotic proteins caspase-3 and caspase-9 in gastric carcinoma cells. lncRNA-MEG3 transfection upregulated the expression of epithelial marker E-cadherin and inhibited the expression of mesenchymal markers vimentin and fibronectin in gastric carcinoma cells, which suggested that lncRNA-MEG3 inhibited epithelial-mesenchymal transition (EMT), which may subsequently inhibit progression in gastric carcinoma cells. The present study also revealed that lncRNA-MEG3 transfection suppressed tumor growth mainly by decreasing the expression of vascular endothelial growth factor and increasing the expression of Bcl-2 in vivo. In conclusion, these results indicated that lncRNA-MEG3 may regulate EMT-associated signaling pathways and has the potential as a therapeutic target in gastric carcinoma.
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Affiliation(s)
- Junquan Jiao
- Center for Cancer Diagnosis and Treatment, Shangluo Central Hospital, Shangluo, Shaanxi 72600, P.R. China
| | - Shaobo Zhang
- Department of General Surgery, Hong Hui Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710049, P.R. China
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Abstract
PURPOSE OF REVIEW Gastric adenocarcinoma is the fifth most common and the third most lethal cancer worldwide. Surgery is the only chance of cure, but recurrence is common, even with complete resection. RECENT FINDINGS Advances in diagnosis and staging, genomic classification, surgical resection and treatment of peritoneal disease, systemic chemotherapy and chemoradiation, and targeted and immune therapies have led to the current multidisciplinary approach to gastric adenocarcinoma. Treatment of gastric cancer is rapidly evolving in an effort to combat this challenging disease.
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Affiliation(s)
- Fabian M Johnston
- Section of Gastrointestinal Surgical Oncology, Peritoneal Surface Malignancy Program, Division of Surgical Oncology, Johns Hopkins University, 600 N. Wolfe Street/Blalock 606, Baltimore, MD, 21287, USA.
| | - Michael Beckman
- Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street/Blalock 665, Baltimore, MD, 21287, USA
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Koemans WJ, van der Kaaij RT, Boot H, Buffart T, Veenhof AAFA, Hartemink KJ, Grootscholten C, Snaebjornsson P, Retel VP, van Tinteren H, Vanhoutvin S, van der Noort V, Houwink A, Hahn C, Huitema ADR, Lahaye M, Los M, van den Barselaar P, Imhof O, Aalbers A, van Dam GM, van Etten B, Wijnhoven BPL, Luyer MDP, Boerma D, van Sandick JW. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy versus palliative systemic chemotherapy in stomach cancer patients with peritoneal dissemination, the study protocol of a multicentre randomised controlled trial (PERISCOPE II). BMC Cancer 2019; 19:420. [PMID: 31060544 PMCID: PMC6501330 DOI: 10.1186/s12885-019-5640-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/25/2019] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND At present, palliative systemic chemotherapy is the standard treatment in the Netherlands for gastric cancer patients with peritoneal dissemination. In contrast to lymphatic and haematogenous dissemination, peritoneal dissemination may be regarded as locoregional spread of disease. Administering cytotoxic drugs directly into the peritoneal cavity has an advantage over systemic chemotherapy since high concentrations can be delivered directly into the peritoneal cavity with limited systemic toxicity. The combination of a radical gastrectomy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results in patients with gastric cancer in Asia. However, the results obtained in Asian patients cannot be extrapolated to Western patients. The aim of this study is to compare the overall survival between patients with gastric cancer with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with palliative systemic chemotherapy, and those treated with gastrectomy, CRS and HIPEC after neoadjuvant systemic chemotherapy. METHODS In this multicentre randomised controlled two-armed phase III trial, 106 patients will be randomised (1:1) between palliative systemic chemotherapy only (standard treatment) and gastrectomy, CRS and HIPEC (experimental treatment) after 3-4 cycles of systemic chemotherapy.Patients with gastric cancer are eligible for inclusion if (1) the primary cT3-cT4 gastric tumour including regional lymph nodes is considered to be resectable, (2) limited peritoneal dissemination (Peritoneal Cancer Index < 7) and/or tumour positive peritoneal cytology are confirmed by laparoscopy or laparotomy, and (3) systemic chemotherapy was given (prior to inclusion) without disease progression. DISCUSSION The PERISCOPE II study will determine whether gastric cancer patients with limited peritoneal dissemination and/or tumour positive peritoneal cytology treated with systemic chemotherapy, gastrectomy, CRS and HIPEC have a survival benefit over patients treated with palliative systemic chemotherapy only. TRIAL REGISTRATION clinicaltrials.gov NCT03348150 ; registration date November 2017; first enrolment November 2017; expected end date December 2022; trial status: Ongoing.
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Affiliation(s)
- W J Koemans
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands.
| | - R T van der Kaaij
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - H Boot
- Department of Gastro-Intestinal Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - T Buffart
- Department of Gastro-Intestinal Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - A A F A Veenhof
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - K J Hartemink
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - C Grootscholten
- Department of Gastro-Intestinal Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - P Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - V P Retel
- Department of Psychosocial Research and Epidomiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - H van Tinteren
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - S Vanhoutvin
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - V van der Noort
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - A Houwink
- Department of Anaesthesiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - C Hahn
- Department of Anaesthesiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - A D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - M Lahaye
- Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - M Los
- Department of Oncology, Sint Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, The Netherlands
| | - P van den Barselaar
- Clinical perfusion, Heartbeat, Kerkstraat 3A, Eemnes, 3755 CK, The Netherlands
| | - O Imhof
- Clinical perfusion, Heartbeat, Kerkstraat 3A, Eemnes, 3755 CK, The Netherlands
| | - A Aalbers
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
| | - G M van Dam
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - B van Etten
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
| | - D Boerma
- Department of Surgery, Sint Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, The Netherlands
| | - J W van Sandick
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066CX, The Netherlands
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Borggreve AS, Goense L, Brenkman HJF, Mook S, Meijer GJ, Wessels FJ, Verheij M, Jansen EPM, van Hillegersberg R, van Rossum PSN, Ruurda JP. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. Br J Radiol 2019; 92:20181044. [PMID: 30789792 DOI: 10.1259/bjr.20181044] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Accurate preoperative staging of gastric cancer and the assessment of tumor response to neoadjuvant treatment is of importance for treatment and prognosis. Current imaging techniques, mainly endoscopic ultrasonography (EUS), computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), have their limitations. Historically, the role of magnetic resonance imaging (MRI) in gastric cancer has been limited, but with the continuous technical improvements, MRI has become a more potent imaging technique for gastrointestinal malignancies. The accuracy of MRI for T- and N-staging of gastric cancer is similar to EUS and CT, making MRI a suitable alternative to other imaging strategies. There is limited evidence on the performance of MRI for M-staging of gastric cancer specifically, but MRI is widely used for diagnosing liver metastases and shows potential for diagnosing peritoneal seeding. Recent pilot studies showed that treatment response assessment as well as detection of lymph node metastases and systemic disease might benefit from functional MRI (e.g. diffusion weighted imaging and dynamic contrast enhancement). Regarding treatment guidance, additional value of MRI might be expected from its role in better defining clinical target volumes and setup verification with MR-guided radiation treatment.
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Affiliation(s)
- Alicia S Borggreve
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Lucas Goense
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Hylke J F Brenkman
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Stella Mook
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Gert J Meijer
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Frank J Wessels
- 3 Department of Radiology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Marcel Verheij
- 4 Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL) , Amsterdam , Netherlands
| | - Edwin P M Jansen
- 4 Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL) , Amsterdam , Netherlands
| | - Richard van Hillegersberg
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Peter S N van Rossum
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Jelle P Ruurda
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
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47
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Yepuri N, Bahary N, Jain A, Dhir M. Review and Update on the Role of Peritoneal Cytology in the Treatment of Gastric Cancer. J Surg Res 2018; 235:607-614. [PMID: 30691849 DOI: 10.1016/j.jss.2018.10.049] [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: 07/01/2018] [Revised: 08/12/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Positive peritoneal cytology (Cyt+) even in the absence of macroscopic disease is associated with poor prognosis in patients with gastric cancer and deemed as M1 disease. Recent years have seen advancements in the evaluation strategies for peritoneal washings and management of patients with Cyt+. The aim of this review was to describe the newest paradigms in the management of patients with gastric cancer who have Cyt+ without macroscopic peritoneal metastases. METHODS A comprehensive literature review was performed to identify studies on the management of gastric cancer and thereby to summarize relevant information on the accuracy of various diagnostic tests and controversies involved in the treatment of patients with Cyt+. RESULTS Although conventional cytology remains the standard technique for assessment of peritoneal washings, it is limited by low sensitivity. The role of immunohistochemistry and molecular techniques for the assessment of peritoneal washings is evolving. Although systemic chemotherapy remains the standard of care for patients with Cyt+ disease, the role of gastrectomy, intraperitoneal chemotherapy, extensive intraperitoneal saline lavage, and hyperthermic intraperitoneal chemotherapy is being evaluated. CONCLUSIONS Clinical decision-making in patients with Cyt+ remains controversial given the seemingly technical resectable albeit biologically unresectable or aggressive disease that portends an overall poor prognosis. Current management strategies are evolving, and further studies are needed to develop an optimal treatment strategy for these patients.
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Affiliation(s)
- Natesh Yepuri
- Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Nathan Bahary
- Division of Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ajay Jain
- Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Mashaal Dhir
- Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
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Kim H, Moon JY, Burapan S, Han J, Cho SK. Induction of ER Stress-Mediated Apoptosis by the Major Component 5,7,4'-Trimethoxyflavone Isolated from Kaempferia parviflora Tea Infusion. Nutr Cancer 2018; 70:984-996. [PMID: 30273054 DOI: 10.1080/01635581.2018.1491607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Kaempferia parviflora (KP) is a famous medicinal plant from Thailand, and is a rich source of various kinds of methoxyflavones (MFs). Many kinds of food products such as tea, capsule, and liquor are manufactured from the rhizomes of KP. In this study, KP infusions were prepared with different brewing conditions, and the amounts of three major methoxylflavones, 5,7-dimethoxyflavone (DMF), 5,7,4'-trimethoxyflavone (TMF), and 3,5,7,3',4'-pentamethoxyflavone (PMF), were analyzed. The antiproliferative activities of DMF, TMF, and PMF isolated from the brewed tea samples were evaluated. TMF was discovered to be significantly effective at inhibiting proliferation of SNU-16 human gastric cancer cells in a concentration dependent manner. TMF induced apoptosis, as evidenced by increments of sub-G1 phase, DNA fragmentation, annexin-V/PI staining, the Bax/Bcl-xL ratio, proteolytic activation of caspase-3,-7,-8, and degradation of poly (ADP-ribose) polymerase (PARP) protein. Furthermore, it was found that TMF induced apoptosis via ER stress, verified by an increase in the level of C/EBP homologous protein (CHOP), glucose regulated protein 78 (GRP78), inositol-requiring enzyme 1 α (IRE1α), activating transcription factor-4 (ATF-4), and the splice isoform of X-box-binding protein-1 (XBP-1) mRNA.
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Affiliation(s)
- Hyeonji Kim
- a Faculty of Biotechnology, College of Applied Life Sciences , SARI, Jeju National University , Jeju , Republic of Korea
| | - Jeong Yong Moon
- b Subtropical/Tropical Organism Gene Bank, Jeju National University , Jeju , Republic of Korea
| | - Supawadee Burapan
- c Metalloenzyme Research Group and Department of Integrative Plant Science , Chung-Ang University , Anseong , Republic of Korea
| | - Jaehong Han
- c Metalloenzyme Research Group and Department of Integrative Plant Science , Chung-Ang University , Anseong , Republic of Korea
| | - Somi Kim Cho
- a Faculty of Biotechnology, College of Applied Life Sciences , SARI, Jeju National University , Jeju , Republic of Korea.,b Subtropical/Tropical Organism Gene Bank, Jeju National University , Jeju , Republic of Korea
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Thiels CA, Ikoma N, Fournier K, Das P, Blum M, Estrella JS, Minsky BD, Ajani J, Mansfield P, Badgwell BD. Repeat staging laparoscopy for gastric cancer after preoperative therapy. J Surg Oncol 2018; 118:61-67. [PMID: 29878364 DOI: 10.1002/jso.25094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/16/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Staging laparoscopy is recommended before preoperative therapy in patients with locoregional gastric cancer, but yield of repeated diagnostic laparoscopy at the time of resection is unknown. METHODS Retrospective review of a prospective database of patients with gastric adenocarcinoma (1994-2016) who had negative staging laparoscopy followed by preoperative therapy and subsequent attempted resection. Primary outcome was positive exploration (peritoneal or unresectable disease) at the time of resection. Multivariable logistic regression identified factors associated with positive exploration. RESULTS Of the 451 patients with attempted resection, 54 (12.0%) had positive explorations, including 48 with peritoneal disease. Patients with positive explorations were more likely to be female and have poorly differentiated tumors, linitis features, and signet-ring morphology. There was no significant difference by exploration results in age, race, clinical stage, or delayed definitive surgery. Positive explorations were independently associated with poor differentiation (OR 4.6, 95%CI 1.4-15.3; P = 0.01) and linitis (OR 4.2, 95%CI 1.9-9.2; P < 0.001). Positive explorations were seen in 14.0% of patients with poor differentiation, 36.6% of patients with linitis, and 5.8% of patients with neither linitis nor poor differentiation. CONCLUSION Despite negative pretreatment laparoscopy, post-treatment repeat laparoscopy may prevent non-therapeutic laparotomies. At a minimum, we recommend selective repeat laparoscopy for patients with linitis features.
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Affiliation(s)
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keith Fournier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mariela Blum
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeannelyn S Estrella
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruce D Minsky
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaffer Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Mansfield
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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50
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Shimura T, Ebi M, Yamada T, Yamada T, Katano T, Nojiri Y, Iwasaki H, Nomura S, Hayashi N, Mori Y, Kataoka H, Moses MA, Joh T. Urinary kallikrein 10 predicts the incurability of gastric cancer. Oncotarget 2018; 8:29247-29257. [PMID: 28418926 PMCID: PMC5438727 DOI: 10.18632/oncotarget.16453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/22/2017] [Indexed: 01/06/2023] Open
Abstract
The current imaging modalities are not sufficient to identify inoperable tumor factors, including distant metastasis and local invasion. Hence, we conducted this study using urine samples to discover non-invasive biomarkers for the incurability of gastric cancer (GC). Urine samples from 111 GC patients were analyzed in this study. The GC cohort was categorized and analyzed according to disease stage and operability. In the discovery phase, protease protein array analysis identified 3 potential candidate proteins that were elevated in the urine of advanced GC patients compared to early GC patients. Among them, urinary kallikrein 10 (KLK10) was positively associated with tumor stage progression. Moreover, the urinary level of KLK10 (uKLK10) was significantly elevated in the urine of patients with inoperable GC compared to operable GC patients (median, 118 vs. 229; P=0.014). The combination of uKLK10, tumor location and tumor size distinguished operability of GC with an area under the curve of 0.859, 82.4% sensitivity and 86.2% specificity. Disease-free survival (DFS) was significantly shorter in GC patients with high uKLK10 compared to those with low uKLK10 (hazard ratio: 3.30 [95% confidence interval, 1.58-6.90] P<0.001). Immunohistochemical analyses also demonstrated a positive correlation between tumor stage and KLK10 expression in GC tissues (r=0.426, P<0.001). In addition, GC patients with high expression of pathological KLK10 (pKLK10) showed a significantly shorter DFS compared to those with low pKLK10 (hazard ratio: 3.79 [95% confidence interval, 1.27-11.24] P=0.010). uKLK10 is a promising non-invasive biomarker for the inoperability and incurability of GC.
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Affiliation(s)
- Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahide Ebi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | | | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yu Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroyasu Iwasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Satoshi Nomura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshinori Mori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Marsha A Moses
- Vascular Biology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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