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Kamimura G, Aoki M, Umehara T, Harada-Takeda A, Nagata T, Koriyama C, Ueda K. Prognostic Outcome of Pulmonary Resection for Pulmonary Metastases from Gastric Cancer. Ann Thorac Cardiovasc Surg 2024; 30:24-00044. [PMID: 38945854 PMCID: PMC11219219 DOI: 10.5761/atcs.oa.24-00044] [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: 03/07/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024] Open
Abstract
PURPOSE Regardless of the devastating outcomes of pulmonary resection for metastases from gastric cancer, a handful of patients survive long after pulmonary metastasectomy. This study aimed to identify a good candidate for pulmonary resection for metastases from gastric cancer. METHODS Between 2005 and 2023, 564 patients underwent pulmonary metastasectomy in our department, of which 12 patients underwent pulmonary resection for metastases from gastric cancer. Variables evaluated were the number and size of metastatic lesions, surgical procedure, disease-free interval (DFI), and the serum carcinoembryonic antigen at pulmonary metastasectomy. RESULTS The DFI following gastrectomy ≤12.5 months group had a significantly worse overall survival (OS) than the other group (p = 0.005). A comparison between DFI following gastrectomy ≤12.5 months group and DFI following gastrectomy >12.5 months group showed a significant difference in serum carcinoembryonic antigen (CEA) value at pulmonary metastasectomy (p = 0.048). The serum CEA value at pulmonary metastasectomy >5.8 ng/ml group had a significantly worse OS than the other group (p = 0.001). CONCLUSION Pulmonary metastasectomy can be indicated in some patients with metastasis from gastric cancer who have longer DFI from gastrectomy and lower serum CEA at pulmonary metastasectomy.
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Affiliation(s)
- Go Kamimura
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Masaya Aoki
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Tadashi Umehara
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Aya Harada-Takeda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Toshiyuki Nagata
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Kazuhiro Ueda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
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Shigenobu T, Ohtsuka T, Hanawa R, Sakamaki H, Yoshizu A, Tajima A. Prognostic Impact of Visceral Pleural Invasion in Resected Solitary Lung Metastases from Gastric Cancer. Ann Thorac Cardiovasc Surg 2023; 29:279-286. [PMID: 37316253 PMCID: PMC10767656 DOI: 10.5761/atcs.oa.23-00032] [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: 02/22/2023] [Accepted: 05/20/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE Pulmonary resection of metastases from gastric cancer is extremely rare because gastric cancer metastasis to the lungs or thoracic cavity occurs as multiple pulmonary metastases, carcinomatous lymphangitis, or carcinomatous pleurisy. Therefore, the significance of surgery for pulmonary metastasis of gastric cancer remains unclear. This study aimed to investigate the surgical outcomes and prognostic factors for survival after the resection of pulmonary metastases from gastric cancer. METHODS From 2007 to 2019, 13 patients with pulmonary metastasis of gastric cancer underwent metastasectomy. Surgical outcomes were analyzed to determine the prognostic factors for recurrence and overall survival (OS). RESULTS All the patients underwent pulmonary resection for solitary metastases. At the median follow-up time of 45.6 months (range, 4.8-106.8 months), five patients experienced a recurrence of gastric cancer after metastasectomy. The 5-year recurrence-free survival rate was 44.4%, and the 5-year OS rate after pulmonary resection was 45.3%. Univariate analysis revealed that visceral pleural invasion (VPI) was an unfavorable prognostic factor for both recurrence-free and OS. CONCLUSION Pulmonary resection of solitary metastases from gastric cancer may be an effective therapeutic option to improve survival. VPI in gastric cancer metastasis is a negative prognostic factor.
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Affiliation(s)
- Takao Shigenobu
- Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
- Division of Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryutaro Hanawa
- Division of Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Hiroyuki Sakamaki
- Division of Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Akira Yoshizu
- Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Atsushi Tajima
- Division of Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
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An W, Bao L, Wang C, Zheng M, Zhao Y. Analysis of Related Risk Factors and Prognostic Factors of Gastric Cancer with Liver Metastasis: A SEER and External Validation Based Study. Int J Gen Med 2023; 16:5969-5978. [PMID: 38144441 PMCID: PMC10748731 DOI: 10.2147/ijgm.s434952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
Background Gastric cancer (GC) has a poor prognosis, particularly in patients with liver metastasis (LM). This study aims to identify relevant factors associated with the occurrence of LM in GC patients and factors influencing the prognosis of gastric cancer with liver metastasis (GCLM) patients, in addition to developing diagnostic and prognostic nomograms specifically. Patients and Methods Overall, 6184 training data were from the Surveillance, Epidemiology, and End Results (SEER) database from 2011 to 2015. 1527 validation data were from our hospital between January 2018 and December 2022. Logistic regression was used to identify the risk factors associated with the occurrence of LM in GC patients, Cox regression was used to confirm the prognostic factors of GCLM patients. Two nomogram models were established to predict the risk and overall survival (OS) of patients with GCLM. The performance of the two models was evaluated using the area under the curve (AUC), concordance index (C-index), and calibration curves. Results A nomogram included five independent factors from multivariate logistic regression: sex, lymph node removal, chemotherapy, T stage and N stage were constructed to calculate the possibility of LM. Internal and external verifications of AUC were 0.786 and 0.885, respectively. The other nomogram included four independent factors from multivariate Cox regression: surgery at primary site, surgery at other site, chemotherapy, and N stage were constructed to predict OS. C-index for internal and external validations were 0.714 and 0.702, respectively, and the calibration curves demonstrated the robust discriminative ability of the models. Conclusion Based on the SEER database and validation data, we defined effective nomogram models to predict risk and OS in patients with GCLM. They have important value in clinical decision-making and personalized treatment.
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Affiliation(s)
- Wenxiu An
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
| | - Lijie Bao
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
| | - Chenyu Wang
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
| | - Mingxin Zheng
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd, Shenyang City, Liaoning Province, People’s Republic of China
| | - Yan Zhao
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
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Yoshioka S, Takahashi N, Fujisaki M, Takeshita K, Takano Y, Yano F, Toya N, Eto K. Long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases. Surg Case Rep 2023; 9:139. [PMID: 37548808 PMCID: PMC10406778 DOI: 10.1186/s40792-023-01714-8] [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: 01/16/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Trastuzumab-based chemotherapy is a standard treatment regimen for human epithelial growth factor 2 (HER2)-positive gastric cancer. This is a case of a patient who has survived 12 years after being diagnosed with advanced gastric cancer with multiple liver and lung metastases. CASE PRESENTATION A woman in her 70s underwent total gastrectomy, cholecystectomy, and left hepatic lobectomy for gastric cancer with liver metastasis. One month after the surgery, multiple liver metastases appeared. After two courses of S-1 + CDDP chemotherapy, the liver metastases disappeared, and new lung metastases occurred. Because the primary tumor was HER2 positive, S-1 + CDDP + trastuzumab chemotherapy was performed. After one course of chemotherapy, the blood test showed pancytopenia, and CDDP was discontinued. S-1 + trastuzumab chemotherapy was then initiated, and as a result, the lung metastases disappeared. The patient is alive without recurrence 12 years after the surgery. CONCLUSIONS We encountered a case of long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases.
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Affiliation(s)
- Satoshi Yoshioka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Naoto Takahashi
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Muneharu Fujisaki
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8471 Japan
| | - Kenji Takeshita
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Yuta Takano
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Fumiaki Yano
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8471 Japan
| | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567 Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8471 Japan
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Chen X, Bai K, Zhang Y, Xu Y, Huo Y, Wang S, Zou Y, Qi X, Guo R, Ou Q, Liu D, Yin S, Chen S, Bu H. Genomic alterations of cerebrospinal fluid cell-free DNA in leptomeningeal metastases of gastric cancer. J Transl Med 2023; 21:296. [PMID: 37131253 PMCID: PMC10155444 DOI: 10.1186/s12967-023-04077-8] [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: 01/18/2023] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Leptomeningeal metastases (LM) were rare in gastric cancer (GC), and GC patients with LM (GCLM) generally suffer from poor prognosis. Nevertheless, the clinical utility of cerebrospinal fluid (CSF) circulating tumor DNA (ctDNA) was underinvestigated in GCLM. METHODS We retrospectively studied 15 GCLM patients, and all patients had paired primary tumor tissue samples and post-LM CSF samples while 5 patients also had post-LM plasma samples. All samples were analyzed using next-generation sequencing (NGS), and the molecular and clinical features were correlated with clinical outcomes. RESULTS CSF had higher mutation allele frequency (P = 0.015), more somatic mutations (P = 0.032), and more copy-number variations (P < 0.001) than tumor or plasma samples. Multiple genetic alterations and aberrant signal pathways were enriched in post-LM CSF, including CCNE1 amplification and cell cycle-related genes, and CCNE1 amplification was significantly associated with patients' overall survival (P = 0.0062). More potential LM progression-related markers were detected in CSF samples than in tumor samples, including PREX2 mutation (P = 0.014), IGF1R mutation (P = 0.034), AR mutation (P = 0.038), SMARCB1 deletion (P < 0.001), SMAD4 deletion (P = 0.0034), and TGF-beta pathway aberration (P = 0.0038). Additionally, improvement in intracranial pressure (P < 0.001), improvement in CSF cytology (P = 0.0038), and relatively low levels of CSF ctDNA (P = 0.0098) were significantly associated with better PFS. Lastly, we reported a GCLM case whose CSF ctDNA dynamic changes were well correlated with his clinical assessment. CONCLUSIONS CSF ctDNA could more sensitively detect molecular markers and metastasis-related mechanisms than tumor tissues in GCLM patients, and our study sheds light on utilizing CSF ctDNA in prognostic estimation and clinical assessment in GCLM.
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Affiliation(s)
- Xin Chen
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China
- Key Laboratory of Cancer Research, Affiliated Hospital Xingtai People's Hospital of Hebei Medical University, 818 Xiangdu North Road, Xiangdu District, Xingtai, Hebei, 054001, People's Republic of China
- Department of Neurology, Affiliated Hospital Xingtai People's Hospital of Hebei Medical University, Xingtai, Hebei Province, 054001, People's Republic of China
| | - Kaixuan Bai
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Yu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Yang Xu
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, People's Republic of China
| | - Yinghao Huo
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Sha Wang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, People's Republic of China
| | - Yueli Zou
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Xuejiao Qi
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Rongyun Guo
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, People's Republic of China
| | - Qiuxiang Ou
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, People's Republic of China
| | - Dengxiang Liu
- Key Laboratory of Cancer Research, Affiliated Hospital Xingtai People's Hospital of Hebei Medical University, 818 Xiangdu North Road, Xiangdu District, Xingtai, Hebei, 054001, People's Republic of China
| | - Shaohua Yin
- Department of Neurology, Affiliated Hospital Xingtai People's Hospital of Hebei Medical University, Xingtai, Hebei Province, 054001, People's Republic of China
| | - Shubo Chen
- Key Laboratory of Cancer Research, Affiliated Hospital Xingtai People's Hospital of Hebei Medical University, 818 Xiangdu North Road, Xiangdu District, Xingtai, Hebei, 054001, People's Republic of China.
| | - Hui Bu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050000, People's Republic of China.
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei, 050000, People's Republic of China.
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Gu J, Chu X, Huo Y, Liu C, Chen Q, Hu S, Pei Y, Ding P, Pang S, Wang M. Gastric cancer-derived exosomes facilitate pulmonary metastasis by activating ERK-mediated immunosuppressive macrophage polarization. J Cell Biochem 2023; 124:557-572. [PMID: 36842167 DOI: 10.1002/jcb.30390] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Abstract
Gastric cancer (GC) with pulmonary metastasis is one of the deadliest diseases in the world; however, the underlying pathological mechanisms and potential therapeutic targets remain to be elucidated. As exosomes play indispensable roles in the formation of premetastatic niches (PMN) and cancer metastasis. Therefore, investigating the underlying mechanisms of exosome-mediated pulmonary metastasis of GC may shed new light on identifying novel therapeutic targets for GC treatment. GC-derived exosomes were isolated from the conditioned medium of mouse forestomach carcinoma (MFC) cell line. The effects of MFC-derived exosomes on pulmonary macrophage polarization were analyzed by reverse- transcription polymerase chain reaction and flow cytometry. Expression of PD-L1 and other proteins was evaluated by Western blot. Exosomal microRNAs (miRNAs) were analyzed by microarray. GC-derived exosomes (GC-exo) accumulated in high numbers in the lungs and were ingested by macrophages. The extracellular-signal-regulated kinase (ERK) signaling pathway was activated by GC-exo, inducing macrophage immunosuppressive-phenotype differentiation and increased PD-L1 expression. miRNA-sequencing identified 130 enriched miRNAs in GC-exo. Among the enriched miRNAs, miR-92a-3p plays a major role in activating ERK signaling via inhibition of PTEN expression. In addition, inhibiting ERK signaling with PD98059 significantly reduced the expression of PD-L1 in macrophages and, therefore, reversed the immunosuppressive PMN and inhibited the colonization of GC cells in the lungs. This study identified a novel mechanism of GC-exo mediated PD-L1 expression in lung macrophages that facilitates lung PMN formation and GC pulmonary metastasis, which also provided a potential therapeutic target for GC with pulmonary metastasis treatment.
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Affiliation(s)
- Juan Gu
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Xu Chu
- The First Affiliated Hospital of Henan University of Science and Technology, Luo Yang, China
| | - Yujia Huo
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Chaoyi Liu
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Qingge Chen
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Shengnan Hu
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Yanyan Pei
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Pu Ding
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Sen Pang
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
| | - Ming Wang
- Huanghe Science and Technology University, Zheng Zhou, Henan, China
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Restrepo J, Carvajal-Fierro CA, Facundo H, González F, Ramírez AM, Beltran R, Buitrago R, Jimenez AF, Carreño J, Oliveros R. Pleural and pulmonary dissemination patterns from gastric adenocarcinoma among patients with treated primary disease in Latin America. Front Surg 2022; 9:969397. [PMID: 36157435 PMCID: PMC9489939 DOI: 10.3389/fsurg.2022.969397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
PurposeLatin America is one of the regions with the highest incidence of gastric cancer. Even though, there are not reports about the patterns of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intent and the prognosis according to each dissemination pattern.Material and methodsWe conducted a retrospective analysis of patients with gastric adenocarcinoma treated with curative intent at the National Cancer Institute (INC) between 2010 and 2017. Demographic variables, variables associated with the primary disease and variables associated with the presence of pleuro-pulmonary opacities and metastases were collected. A univariate and multivariate logistic regression analysis was performed and survival curves were presented using the Kaplan Meier method and compared using the log-rank test. A Cox regression model was performed for multivariate analysis for overall survival.ResultsThe study included 450 patients, 51.3% were male and the median age was 63 years. Intestinal adenocarcinoma was the most frequent histological subtype, in 261 cases (58.0%). Gastric cancer initial pathological stage was stage I in 23.3% of the patients, stage II in 19.3% and stage III in 53.6%. During a median follow-up of 31.9 months, 37 (8.2%) patients developed pleuro-pulmonary opacities; among those, 14 (3.1%) met the criteria for pleuro-pulmonary metastases: 6 (1.3%) had lymphangitic metastasis, 4 (0.9%) had a mixed pattern of pleural and lung nodules, 3 (0.7%) had pleural metastasis, and only one (0.2%) had hematogenous metastasis. The median OS was 114.5 months for the entire cohort and 38.2 (95%CI, 19.2–57.2) months for patients with pleuro-pulmonary metastases. Patients with pleural metastasis and lymphangitic carcinomatosis had median survival of 24.3 (95%CI, 0.01–51.0) and 26.4 (95%CI, 18.2–34.7) months, respectively.Conclusionsincidence of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intention was low. In our series, lymphangitic carcinomatosis was the main pattern of dissemination; meanwhile, hematogenous metastasis was rare and patients with pleural carcinomatosis had the lowest median survival.
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Affiliation(s)
- Juliana Restrepo
- Surgical Oncology Department, National Cancer Institute, Bogotá, Colombia
| | | | - Helena Facundo
- Gastro-intestinal Surgery Department, National Cancer Institute, Bogotá, Colombia
| | - Felipe González
- Surgical Oncology Department, National Cancer Institute, Bogotá, Colombia
| | - Ana María Ramírez
- Thoracic Surgery Department, National Cancer Institute, Bogotá, Colombia
| | - Rafael Beltran
- Thoracic Surgery Department, National Cancer Institute, Bogotá, Colombia
| | - Ricardo Buitrago
- Thoracic Surgery Department, National Cancer Institute, Bogotá, Colombia
| | | | - José Carreño
- Epidemiology, National Cancer Institute, Bogotá, Colombia
| | - Ricardo Oliveros
- Gastro-intestinal Surgery Department, National Cancer Institute, Bogotá, Colombia
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Construction, Validation, and Visualization of Two Web-Based Nomograms to Predict Overall and Cancer-Specific Survival in Patients with Gastric Cancer and Lung Metastases. JOURNAL OF ONCOLOGY 2021; 2021:5495267. [PMID: 34759968 PMCID: PMC8575630 DOI: 10.1155/2021/5495267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/21/2021] [Indexed: 12/14/2022]
Abstract
Background The lung is one of the most common sites of metastasis in gastric cancer. Our study developed two nomograms to achieve individualized prediction of overall survival (OS) and cancer-specific survival (CSS) in patients with gastric cancer and lung metastasis (GCLM) to better guide follow-up and planning of subsequent treatment. Methods We reviewed data of patients diagnosed with GCLM in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. The endpoints of the study were the OS and CSS. We used the “caret” package to randomly divide patients into training and validation cohorts in a 7 : 3 ratio. Multivariate Cox regression analysis was performed using univariate Cox regression analysis to confirm the independent prognostic factors. Afterward, we built the OS and CSS nomograms with the “rms” package. Subsequently, we evaluated the two nomograms through calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Finally, two web-based nomograms were built on the basis of effective nomograms. Results The OS analysis included 640 patients, and the results of the multivariate Cox regression analysis showed that grade, chemotherapy, and liver metastasis were independent prognostic factors for patients with GCLM. The CSS analysis included 524 patients, and the results of the multivariate Cox regression analysis showed that the independent prognostic factors for patients with GCLM were chemotherapy, liver metastasis, marital status, and tumor site. The ROC curves, calibration curves, and DCA revealed favorable predictive power in the OS and CSS nomograms. We created web-based nomograms for OS (https://zhenghh.shinyapps.io/aclmos/) and CSS (https://zhenghh.shinyapps.io/aslmcss/). Conclusions We created two web-based nomograms to predict OS and CSS in patients with GCLM. Both web-based nomograms had satisfactory accuracy and clinical usefulness and may help clinicians make individualized treatment decisions for patients.
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Chen Y, Yang YC, Tang LY, Ge QM, Shi WQ, Su T, Shu HY, Pan YC, Liang RB, Li QY, Shao Y. Risk Factors and Their Diagnostic Values for Ocular Metastases in Gastric Adenocarcinoma. Cancer Manag Res 2021; 13:5835-5843. [PMID: 34326667 PMCID: PMC8315769 DOI: 10.2147/cmar.s311474] [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: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Gastric adenocarcinoma originates from the glands in the superficial layer or mucosa of the stomach. It is prone to metastases, of which ocular metastasis (OM) is rare, but once it occurs the disease is considered more serious. The aim of this study was to investigate the risk factors for OM in gastric adenocarcinoma. Methods Patients with gastric adenocarcinoma were recruited to this study between June 2003 and July 2019. Demographic data and serological indicators (SI) were compared between patients with and without OM, and binary logistic regression was used to explore whether the relevant SI may be risk factors for OM of gastric adenocarcinoma. Receiver operating characteristic (ROC) curves were used to analyze different SIs for OM in gastric cancer patients. Results Chi-square tests showed significant between-groups difference in gender composition (P < 0.05), but not in age or histological grade (P > 0.05). t-test results showed that low-density lipoprotein (LDL) and carbohydrate antigen-724 (CA724) were significantly higher in patients with than without OM (P < 0.05). Binary logistic regression analysis showed that LDL was an independent risk factor for OM (P < 0.001). ROC curve analysis showed that the areas under the curves (AUC) for LDL and CA724 were 0.903 and 0.913 respectively, with higher AUC for combined LDL and CA724 (0.934; P < 0.001). Conclusion LDL and CA724 have value as predictors for OM in patients with gastric adenocarcinoma, with higher predictive value when these factors are combined.
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Affiliation(s)
- Yue Chen
- Department of Dermatology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangzhou, 518033, People's Republic of China
| | - Yan-Chang Yang
- Department of Anesthesiology, Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Li-Ying Tang
- Department of Ophthalmology, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, 361102, People's Republic of China
| | - Qian-Min Ge
- Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Wen-Qing Shi
- Department of Dermatology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangzhou, 518033, People's Republic of China.,Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Ting Su
- Department of Ophthalmology, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, 361102, People's Republic of China.,Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
| | - Hui-Ye Shu
- Department of Dermatology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangzhou, 518033, People's Republic of China.,Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yi-Cong Pan
- Department of Dermatology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangzhou, 518033, People's Republic of China.,Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Rong-Bin Liang
- Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Qiu-Yu Li
- Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yi Shao
- Department of Geriatric Medicine and Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
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10
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Shioya S, Masuda T, Iwamoto H, Yamaguchi K, Sakamoto S, Horimasu Y, Miyamoto S, Nakashima T, Fujitaka K, Hamada H, Hattori N. Pulmonary lymphangitic carcinomatosis from recurrent gastric cancer 19 years after primary resection: a case report. Clin J Gastroenterol 2021; 14:484-488. [PMID: 33453005 DOI: 10.1007/s12328-020-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Pulmonary lymphangitic carcinomatosis is one rare pattern of pulmonary metastases in advanced cancers. Gastric cancer is one of the most common forms of cancer that causes pulmonary lymphangitic carcinomatosis. However, recurrent gastric cancer presenting as pulmonary lymphangitic carcinomatosis after surgery is extremely rare. Furthermore, recurrence is usually observed within 5 years. We present the first case of pulmonary lymphangitic carcinomatosis in a patient with recurrent gastric cancer, 19 years after resection. In patients with a history of gastric cancer and the presence of interstitial shadow, pulmonary lymphangitic carcinomatosis should be considered in the differential diagnosis even if several years have passed since surgery.
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Affiliation(s)
- Sachiko Shioya
- Department of Respiratory Internal Medicine, Innoshima Ishikai Hospital, 1962 Innoshima-Nakanosho, Onomichi, 722-7221, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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11
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Delays in Diagnosis of Pulmonary Lymphangitic Carcinomatosis due to Benign Presentation. Case Rep Oncol Med 2020; 2020:4150924. [PMID: 33299624 PMCID: PMC7707955 DOI: 10.1155/2020/4150924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/26/2019] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of lymphangitic carcinomatosis is challenging due to the manifestation of nonspecific symptoms and radiographic abnormalities that bear similarity to those of interstitial lung disease. Herein, we report the case of a 53-year-old woman diagnosed with lymphangitic carcinomatosis from metastatic gastric adenocarcinoma, 3 months after her initial presentation.
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12
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Li Y, Xie D, Chen X, Hu T, Lu S, Han Y. Prognostic Value of the Site of Distant Metastasis and Surgical Interventions in Metastatic Gastric Cancer: A Population-Based Study. Technol Cancer Res Treat 2020; 19:1533033820964131. [PMID: 33111644 PMCID: PMC7607730 DOI: 10.1177/1533033820964131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Studies on the prognostic significance of site-specific distant metastasis, multiple-site metastases, and the impact of surgery of the primary tumor and metastatic lesion on survival outcomes of patients with metastatic gastric cancer (GC) remain elusive. Therefore, this study aimed to investigate the prognostic significance of the site of distant metastasis among patients with metastatic GC. Furthermore, the effect of surgery of the primary tumor and metastatic lesion on the prognosis of metastatic GC was also analyzed. METHODS The data of 4,221 eligible patients, who were diagnosed with metastatic GC between 2010 and 2015, were identified from the Surveillance Epidemiology and End Results (SEER) database. Multivariate logistic regression analysis was performed to assess the association between potential prognostic factors, including the site of metastasis and surgery, and survival of patients with metastatic GC. Overall survival (OS) and cause-specific survival (CSS) were determined using the Kaplan-Meier survival curves and differences were assessed using the Log-rank test. RESULTS Out of the total 4,221 GC patients with definite organ metastases, 3312 patients had single-site metastasis while 909 patients had multiple-site metastases. GC patients with single-site metastasis of liver or lung exhibited better CSS and OS compared to those with bone metastasis. Furthermore, GC patients with liver metastasis benefited from surgery of both the primary and metastatic lesions, while those with lung metastasis benefited from surgery of metastasis resection only. Multivariate Cox regression analysis revealed that GC patients with single-site metastasis, well-differentiated tumors, GC patients who underwent surgery of the primary tumor and those who received chemotherapy exhibited favorable prognosis. CONCLUSIONS The site of metastasis was an independent prognostic factor for metastatic GC. Surgery had survival benefits in certain cases of metastatic GC; however, further studies are warranted to clarify these benefits in carefully selected patients.
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Affiliation(s)
- Yinghua Li
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Danna Xie
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaojing Chen
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Teng Hu
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Simin Lu
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yunwei Han
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
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13
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Liang C, Bai X, Qi C, Sun Q, Han X, Lan T, Zhang H, Zheng X, Liang R, Jiao J, Zheng Z, Fang J, Lei P, Wang Y, Möckel D, Metselaar JM, Storm G, Hennink WE, Kiessling F, Wei H, Lammers T, Shi Y, Wei B. Π electron-stabilized polymeric micelles potentiate docetaxel therapy in advanced-stage gastrointestinal cancer. Biomaterials 2020; 266:120432. [PMID: 33069116 DOI: 10.1016/j.biomaterials.2020.120432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/10/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022]
Abstract
Gastrointestinal (GI) cancers are among the most lethal malignancies. The treatment of advanced-stage GI cancer involves standard chemotherapeutic drugs, such as docetaxel, as well as targeted therapeutics and immunomodulatory agents, all of which are only moderately effective. We here show that Π electron-stabilized polymeric micelles based on PEG-b-p(HPMAm-Bz) can be loaded highly efficiently with docetaxel (loading capacity up to 23 wt%) and potentiate chemotherapy responses in multiple advanced-stage GI cancer mouse models. Complete cures and full tumor regression were achieved upon intravenously administering micellar docetaxel in subcutaneous gastric cancer cell line-derived xenografts (CDX), as well as in CDX models with intraperitoneal and lung metastases. Nanoformulated docetaxel also outperformed conventional docetaxel in a patient-derived xenograft (PDX) model, doubling the extent of tumor growth inhibition. Furthermore, micellar docetaxel modulated the tumor immune microenvironment in CDX and PDX tumors, increasing the ratio between M1-and M2-like macrophages, and toxicologically, it was found to be very well-tolerated. These findings demonstrate that Π electron-stabilized polymeric micelles loaded with docetaxel hold significant potential for the treatment of advanced-stage GI cancers.
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Affiliation(s)
- Chenghua Liang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Xiangyang Bai
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Cuiling Qi
- Vascular Biology Research Institute, School of Basic Course, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qingxue Sun
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Xiaoyan Han
- Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Tianyun Lan
- Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Haibo Zhang
- Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Xiaoming Zheng
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Rongpu Liang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Ju Jiao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Zongheng Zheng
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Jiafeng Fang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Purun Lei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yan Wang
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands
| | - Diana Möckel
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Josbert M Metselaar
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands; Department of Biomaterials Science & Technology (BST), University of Twente, 7500 AE, Enschede, the Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany; Fraunhofer MEVIS, Institute for Medical Image Computing, 52074, Aachen, Germany
| | - Hongbo Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands; Department of Biomaterials Science & Technology (BST), University of Twente, 7500 AE, Enschede, the Netherlands.
| | - Yang Shi
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany.
| | - Bo Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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14
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Feng Y, Guo K, Jin H, Xiang Y, Zhang Y, Ruan S. A Predictive Nomogram for Early Mortality in Stage IV Gastric Cancer. Med Sci Monit 2020; 26:e923931. [PMID: 32813682 PMCID: PMC7453749 DOI: 10.12659/msm.923931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The study was intended to establish predictive nomogram models for predicting total early mortality (the probability of surviving less than or equal to 3 months) and cancer-specific early mortality in patients with stage IV gastric cancer. This was the first study to establish prognostic survival in patients with stage IV gastric cancer. Material/Methods Patients from the SEER database were identified using inclusion and exclusion criteria. Their clinical characteristics were statistically analyzed. The Kaplan-Meier method and the log-rank test were used to compare the influences of different factors on survival time. Logistic regression models were conducted to explore the correlative factors of early mortality. A nomogram was established based on factors significant in the logistic regression model and an internal validation was performed. Results Of the 11,036 eligible patients included in the study, 4932 (44.7%) patients resulted in total early death (42.6% died of the cancer and 2.1% died of other reasons). Larger tumor size, poor differentiation, and liver metastasis were positively related to cancer-specific early mortality. Surgery was negatively related to total early mortality and cancer-specific early mortality, while cardia was only negatively associated with total early death. Predictive nomogram models for total early mortality and cancer-specific early mortality have been validated internally. The areas under the receiver operating characteristics curve were 73.5%, and 68.0%, respectively, and the decision curve analysis also proved the value of the models. Conclusions The nomogram models proved to be a suitable tool for predicting the early mortality in stage IV gastric cancer.
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Affiliation(s)
- Yuqian Feng
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Kaibo Guo
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Huimin Jin
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Yuying Xiang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Yiting Zhang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Shanming Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
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15
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Nishiwaki N, Kojima H, Isaka M, Bando E, Terashima M, Ohde Y. Pulmonary resection for metachronous metastatic gastric cancer diagnosed using multi-detector computed tomography: Report of five cases. Int J Surg Case Rep 2020; 73:342-346. [PMID: 32739523 PMCID: PMC7397694 DOI: 10.1016/j.ijscr.2020.07.062] [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: 05/14/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/04/2022] Open
Abstract
The standard treatment for metastatic gastric cancer is systemic chemotherapy. Pulmonary resection for metastatic gastric cancer has been rarely reported on. Five patients with metastatic gastric cancer diagnosed using MDCT underwent surgery. We demonstrated remarkably better survival values compared to previous reports. Pulmonary resection may be treatment option for select patients.
Introduction As pulmonary resection for metastatic gastric cancer has been rarely reported on, the role of metastasectomy remains unclear in such settings. We reviewed the clinicopathological characteristics and surgical outcomes of patients with metachronous pulmonary metastasis from gastric cancer (MPMGC) diagnosed using multi-detector computed tomography (MDCT) who underwent pulmonary resection. Presentation of case From September 2002 to May 2018, five patients underwent pulmonary resection for MPMGC at Shizuoka Cancer Center. All patients received curative resection for initial gastric cancer. Three patients received adjuvant chemotherapy. The median age at pulmonary resection was 70 years. The median disease-free interval between initial gastrectomy and MPMGC diagnosis was 41 months. The first site of recurrence was the lung in all patients. All patients were diagnosed as having primary lung cancer using MDCT before pulmonary resection and fit the surgical indication for primary lung cancer. Lobectomy was performed in three patients, while wedge resection was performed in two. The median overall survival following pulmonary resection was 79 (range, 18–89) months. Two patients experienced recurrence. While one showed recurrence in the mediastinal lymph node, in the other it was observed in the remnant lung; the latter underwent repeated pulmonary resection followed by systemic chemotherapy. Four patients survived for longer than 4 years after pulmonary resection. Conclusions Of the five patients with MPMGC diagnosed using MDCT who underwent pulmonary resection, long-term survival was achieved after pulmonary resection in four. Thus, pulmonary resection may be considered for those diagnosed with lung nodules after surgery for gastric cancer, and who fit the surgical indication for primary lung cancer.
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Affiliation(s)
- Noriyuki Nishiwaki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Hideaki Kojima
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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16
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Abe Y, Suzuki M, Tsuji K, Sato M, Kimura H, Kimura H, Nagaoka K, Takakuwa E, Matsuno Y, Konno S. Lung metastasis from gastric cancer presenting as diffuse ground-glass opacities. Respir Med Case Rep 2020; 30:101104. [PMID: 32489852 PMCID: PMC7260585 DOI: 10.1016/j.rmcr.2020.101104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Abstract
Most metastatic lung tumors display well-defined, round, multiple nodular shadows, whereas the presence of diffuse ground-glass opacities on chest computed tomography generally suggests non-malignant conditions. Here, we report an unusual case of pulmonary metastasis from gastric cancer in which diffuse ground-glass opacities were observed in all lung segments. A 59-year-old man with a 3-month history of worsening chest pain and shortness of breath was referred to the pulmonary clinic. Chest computed tomography revealed low attenuation areas, suggesting emphysema, along with diffuse ground-glass opacities and interlobular septal thickening in both lungs. A transbronchial lung biopsy specimen revealed signet-ring cell carcinoma infiltrating the alveolar septa. Immunohistochemical staining of the cancer cells was positive for CDX-2, cytokeratin 7, and cytokeratin 20, and negative for surfactant apoprotein-A, TTF-1, and Napsin A. Gastrointestinal endoscopy revealed an ulcerative tumor in the stomach, and a biopsy from the tumor demonstrated malignant cells with similar morphology and immunophenotypes as those in the lungs. The final diagnosis was diffuse lung metastasis from gastric cancer. Our case shows that although multiple, well-defined nodules are typically considered to be the classic presentation of pulmonary metastasis, clinicians should also be aware of the possibility of pulmonary metastasis presenting as diffuse ground-glass opacities.
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Affiliation(s)
- Yuki Abe
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Tsuji
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mineyoshi Sato
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokazu Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Nagaoka
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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17
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Huang Y, Eltelbany M, Chow RD, Sood A. Peritoneal carcinomatosis, unilateral malignant pleural effusion with bilateral hydronephrosis post-radical gastrectomy in a signet-ring gastric cancer patient: a case report. J Community Hosp Intern Med Perspect 2020; 10:140-144. [PMID: 32850050 PMCID: PMC7425629 DOI: 10.1080/20009666.2020.1742511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gastric cancer is the fifth most common cancer in the world and the third leading cause of cancer-related deaths. Signet-ring cell type is the most malicious subtype. We report a case of advanced stage gastric adenocarcinoma case post-radical gastrectomy who presented with nausea, vomiting, and diarrhea. Though there were no signs of bowel obstruction on abdominal CT and PET imagine studies, and the cytology of body fluid was initially negative, the patient had unilateral malignant pleural effusion, a moderate amount of ascites and bilateral hydronephrosis. After laparoscopic surgery, the patient was diagnosed with local cancer relapse causing jejunojejunal anastomosis obstruction and peritoneal carcinomatosis causing hydronephrosis. We urge broadening the indication of EGD in the evaluation of advanced stage gastric carcinoma to include mechanic bowel obstruction.
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Affiliation(s)
- Yuting Huang
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Moemen Eltelbany
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - R Dobbin Chow
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Aseem Sood
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
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18
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Zhang Y, Lin Y, Duan J, Xu K, Mao M, Wang X. A Population-Based Analysis of Distant Metastasis in Stage IV Gastric Cancer. Med Sci Monit 2020; 26:e923867. [PMID: 32409630 PMCID: PMC7245058 DOI: 10.12659/msm.923867] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distant metastasis (DM) is a crucial problem in management of patients with gastric cancer. Identification of the risk factors for development of DM and the prognostic factors for patients with DM is essential in development of individualized treatment of patients at the advanced stage with specific metastasis. MATERIAL AND METHODS Records of patients with gastric cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival duration of patients with specific DM was estimated, and the prognostic factors were investigated using the Cox proportional hazard regression model. The logistic regression model was used to reveal the inherent risk factors for development of DM. RESULTS Eventually, 32.6% (11,918 out of 36,588) of gastric cancer patients were diagnosed with DM between 2010 and 2015, among whom 5,361, 1,778, 1,495, and 231 patients were diagnosed with liver, lung, bone, and brain metastasis, respectively. The median overall survival for patients with DM was 5.0 (95% CI: 4.8-5.2) months, with a 5-year survival rate of 3.9%. Primary tumor site, histology types, tumor grade, T stage, N stage, surgery, chemotherapy, and the number of metastases were associated with worse survival. Younger age and higher tumor grade were positively associated with the development of DM. CONCLUSIONS Initial DM was found in 32.6% of patients with gastric cancer. Homogenous and heterogenous predictive factors were identified for patients with a specific metastatic site, which can be used in targeted screening and individualized treatment.
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Affiliation(s)
- Yiran Zhang
- International Medical Center, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Yile Lin
- Clinical Medical College of Tianjin Medical University, Tianjin, China (mainland)
| | - Jincai Duan
- Clinical Medical College of Tianjin Medical University, Tianjin, China (mainland)
| | - Ke Xu
- Clinical Medical College of Tianjin Medical University, Tianjin, China (mainland)
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing, China (mainland)
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, China (mainland)
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19
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Peng W, Ma T, Xu H, Wu Z, Wu C, Sun G. Survival benefits of palliative gastrectomy in stage IV gastric cancer: a propensity score matched analysis. J Gastrointest Oncol 2020; 11:376-385. [PMID: 32399278 DOI: 10.21037/jgo.2020.01.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background This study aimed to investigate the effect of palliative gastrectomy on survival in stage IV gastric cancer. Methods Patients diagnosed with stage IV gastric cancer between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were estimated by the Kaplan-Meier method before and after propensity score matching (PSM). Univariate and multivariate Cox analyses were performed to evaluate risk factors for survival in patients who underwent palliative gastrectomy. Results We examined 6,529 patients with stage IV gastric cancer, of which 625 underwent palliative gastrectomy. Using a 1:2 PSM, the 625 patients were matched with 1,250 patients from the no gastrectomy group. The overall survival was higher in the gastrectomy group before [hazard ratio (HR) =0.57, 95% confidence interval (CI): 0.53-0.62, P<0.0001] and after PSM (HR =0.51, 95% CI: 0.46-0.57, P<0.0001). Multivariate Cox analysis confirmed the survival benefits of palliative gastrectomy and chemotherapy. Older age, over-lapping lesions, non-adenocarcinomas, higher tumor grade, and lung metastasis significantly increased the risk of mortality. In the gastrectomy group, patients aged ≥80 years, diagnosed with grades 3/4 non-adenocarcinomas, or with lung metastasis showed poorer prognosis. However, chemotherapy could improve the survival of these patients. Conclusions Palliative gastrectomy provides survival benefits to stage IV gastric cancer patients. However, age, tumor grade, tumor histology, and lung metastasis status should be considered while making a decision regarding gastrectomy. Chemotherapy should also be recommended for these patients.
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Affiliation(s)
- Wanren Peng
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Tai Ma
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Hui Xu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Anhui Institute for Cancer Prevention and Control, Hefei 230022, China
| | - Zhijun Wu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Maanshan People' Hospital, Maanshan 243000, China
| | - Changhao Wu
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Guoping Sun
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.,Anhui Institute for Cancer Prevention and Control, Hefei 230022, China
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20
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Nostedt J, Gibson-Brokop L, Ghosh S, Seidler M, McCall M, Schiller D. Evaluating the utility of computed tomography of the chest for gastric cancer staging. Can J Surg 2020; 63:E57-E61. [PMID: 32031765 DOI: 10.1503/cjs.000319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background International guidelines recommend routine computed tomography (CT) of the chest for gastric cancer staging. In Asian countries, where the incidence of pulmonary metastases is less than 1%, some guidelines recommend chest CT only for gastroesophageal junction cancers. If the incidence of pulmonary metastases is also low in Canada, routine chest CT may not be beneficial. Methods We performed a retrospective review of patients in northern Alberta with newly diagnosed gastric cancer from January 2010 to July 2016. The primary aim of the study was to determine the incidence of pulmonary metastases at the time of diagnosis in this population. A secondary aim was to identify potential predictors of pulmonary metastases. We reviewed CT reports for pulmonary metastases. Imaging data also included liver metastases, abdominal lymphadenopathy (> 1 cm), ascites and omental or peritoneal nodules. Other data recorded were age, sex, primary tumour location, histologic type and tumour grade. Results Four hundred and sixty-two patients (311 men, 151 women) were included in the analysis. Pulmonary metastases were identified in 25 patients (5.4%) overall and in 11 of 299 patients (3.7%) whose primary cancer was not in the cardia. On univariate analysis the presence of liver metastases (odds ratio [OR] 7.72, 95% confidence interval [CI] 3.24–18.37, p < 0.001) and abdominal lymphadenopathy (OR 3.30, 95% CI 1.29–8.48, p = 0.01) was associated with an increased risk of pulmonary metastases. Liver metastases retained statistical significance on multivariate analysis (OR 6.17, 95% CI 2.53–15.03, p < 0.001). Conclusion The incidence of pulmonary metastases at the time of gastric cancer diagnosis is higher in northern Alberta than previously reported in Asian studies. Abdominal lymphadenopathy and liver metastases confer an elevated risk of pulmonary metastases.
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Affiliation(s)
- Jordan Nostedt
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler)
| | - Lindsay Gibson-Brokop
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler)
| | - Sunita Ghosh
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler)
| | - Michael Seidler
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler)
| | - Michael McCall
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler)
| | - Daniel Schiller
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler)
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21
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Oguri Y, Okui M, Yamamichi T, Asakawa A, Harada M, Horio H. The impact of pulmonary metastasectomy from gastric cancer. Mol Clin Oncol 2019; 11:401-404. [PMID: 31497298 PMCID: PMC6719255 DOI: 10.3892/mco.2019.1910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/22/2019] [Indexed: 11/06/2022] Open
Abstract
Gastric cancer remains the most commonly-occurring cancer and the third most frequent cause of cancer-associated mortality in Japan. Solitary pulmonary metastasis of gastric cancer is rare and the outcome of pulmonary metastasectomy is still unclear. Herein we report the impact of pulmonary resection in patients with metastasis from gastric cancer. The present study retrospectively reviewed the preoperative data and clinical courses of 10 patients who underwent pulmonary resection for metastasis from gastric cancer at our institution between July 1986 and December 2017. The data on the outcomes, including morbidity, mortality and survival, were obtained from the patient records. All patients were followed-up from the time of pulmonary resection until mortality or referral to another hospital. The statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for the R software program (The R Foundation for Statistical Computing, Vienna, Austria). The study population included 7 male patients and 3 female patients. A total of 5 patients underwent total gastrectomy, and 5 underwent distal gastrectomy. The median disease-free interval after initial gastric resection was 34.5 months. Five patients received adjuvant chemotherapy, of the 10 thoracotomies, 5 were lobectomy, 3 were wedge resection and 2 were segmentectomy. The median overall survival following pulmonary metastasectomy was 59 months and the 5-year survival rate was 40.5%. Taken together, the results of the present study suggest that pulmonary resection may be an effective therapeutic option for metastatic gastric cancer when a patient has a solitary metastatic lesion.
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Affiliation(s)
- Yohei Oguri
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Masayuki Okui
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Takashi Yamamichi
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Ayaka Asakawa
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Masahiko Harada
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Hirotoshi Horio
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
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22
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Roviello G, Corona SP, Multari AG, Petrioli R, Rosellini P, Aieta M. Poor outcome for patients with gastric cancer and lung metastases treated with ramucirumab and paclitaxel. Anticancer Drugs 2019; 30:e0789. [PMID: 31305296 DOI: 10.1097/cad.0000000000000789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this report is to investigate the activity of ramucirumab in combination with paclitaxel in patients with metastatic gastric cancer (GC) and lung metastases. We retrospectively reviewed clinical data from patients with GC treated in second line with ramucirumab and paclitaxel according to the presence or not of lung metastases. Thirty-one patients were eligible. Five (16.1%) patients had lung metastases. The median progression-free survival was 156 days in patients without lung metastases compared with 54 days in patients with lung metastases. The median survival also showed a trend in favour of patients without lung metastases. Despite the small number of patients and the retrospective nature of the data, our analysis showed relatively poor efficacy of ramucirumab plus paclitaxel as a second-line treatment in patients with lung metastases from GC. Further studies are required to evaluate novel treatments in this subset of patients.
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Affiliation(s)
- Giandomenico Roviello
- Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Division of Medical Oncology, Rionero
| | - Silvia P Corona
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Moorabbin Campus, Bentleigh East, Victoria, Australia
| | - Andrea G Multari
- Unit of Medical Oncology, Department of Oncology, Ospedale San Donato, Arezzo
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Pietro Rosellini
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Michele Aieta
- Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Division of Medical Oncology, Rionero
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23
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Sun Z, Liu H, Yu J, Huang W, Han Z, Lin T, Chen H, Zhao M, Hu Y, Jiang Y, Li G. Frequency and Prognosis of Pulmonary Metastases in Newly Diagnosed Gastric Cancer. Front Oncol 2019; 9:671. [PMID: 31417862 PMCID: PMC6683847 DOI: 10.3389/fonc.2019.00671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: The purpose of this study was to analyze the frequency and prognosis of pulmonary metastases in newly diagnosed gastric cancer using population-based data from SEER. Methods: Patients with gastric cancer and pulmonary metastases (GCPM) at the time of diagnosis in advanced gastric cancer were identified using the Surveillance, Epidemiology and End Result (SEER) database of the National Cancer Institute from 2010 to 2014. Multivariable logistic regression was performed to identify predictors of the presence of GCPM at diagnosis. Receiver operator characteristics analysis was performed to significant predictors on multivariable logistic regression and was then assessed with Delong's test. Multivariable Cox regression was developed to identify factors associated with all-cause mortality and gastric cancer-specific mortality. Survival curves were obtained according to the Kaplan-Meier method and compared using the log-rank test. Results: We identified 1,104 patients with gastric cancer and pulmonary metastases at the time of diagnosis, representing 6.02% of the entire cohort and 15.19% of the subset with metastatic disease to any distant site. Among the entire cohort, multivariable logistic regression identified six factors (younger, upper 1/3 of stomach, intestinal-type, T4 staging, N1 staging, and presence of more extrapulmonary metastases to liver, bone, and brain) as positive predictors of the presence of pulmonary metastases at diagnosis. The value of AUC for the multivariable logistic regression model was 0.775. Median survival among the entire cohort with GCPM was 3.0 months (interquartile range: 1.0-9.0 mo). Multivariable Cox model in SEER cohort confirmed five factors (diagnosis at previous period, black race, adverse pathology grade, absence of chemotherapy, and presence of more extrapulmonary metastases to liver, bone, and brain) as negative predictors for overall survival. Conclusions: The findings of this study provided population-based estimates of the frequency and prognosis for GCPM at time of diagnosis. The multivariable logistic regression model had an acceptable performance to predict the presence of PM. These findings may provide preventive guidelines for the screening and treatment of PM in GC patients. Patients with high risk factors should be paid more attention before and after diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yuming Jiang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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24
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Chen AH, Chan WH, Lee YH, Tseng JH, Yeh TS, Chiu CT, Chen JS, Chen CM. Routine chest CT for staging of gastric cancer. Br J Surg 2019; 106:1197-1203. [PMID: 31210362 PMCID: PMC6771689 DOI: 10.1002/bjs.11186] [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: 11/11/2018] [Revised: 01/18/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022]
Abstract
Background International guidelines on clinical staging of gastric cancer recommend the use of chest CT for the detection of pulmonary metastases. This study assessed the clinical value of routine chest CT in the staging of gastric cancer. Methods This retrospective study included patients identified from the gastric cancer registry of Chang Gung Memorial Hospital, Linkou, Taiwan. All patients who underwent clinical staging between 2008 and 2014 were included. The pattern, site and number of metastases at initial presentation and after surgery with curative intent were evaluated. Pulmonary metastases were defined as multiple small round pulmonary nodules with a random distribution or of variable size. Results Some 1669 patients were included, of whom 478 (28·6 per cent) had metastatic disease at clinical presentation. The majority of metastases were to the peritoneum (75·7 per cent of patients) or liver (30·5 per cent), and only 27 patients (5·6 per cent) had pulmonary metastases at presentation, none of which were isolated to the lung. Of these 27 patients, 11 had primary lesions located at the cardia/fundus. In 19 patients the lung metastases were also detected on the staging chest X‐ray. After surgery there were 196 cancer recurrences. Some 15 patients (7·6 per cent) had lung metastasis and this was not the only site of metastases in any patient. The prevalence of lung metastasis at presentation of the disease and after surgery was 1·6 and 1·5 per cent respectively. Conclusion This study does not support the routine use of chest CT for staging of gastric cancer as isolated pulmonary metastasis in the absence of other metastatic sites could not be detected.
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Affiliation(s)
- A-H Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - W-H Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Y-H Lee
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - J-H Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - T-S Yeh
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - C-T Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - J-S Chen
- Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - C-M Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
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25
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Jing JC, Feng Z, Chen ZH, Ji BN, Hong J, Tang N, Yu JL, Wang SY. KDM4B promotes gastric cancer metastasis by regulating miR-125b-mediated activation of Wnt signaling. J Cell Biochem 2019; 120:7897-7906. [PMID: 30485532 DOI: 10.1002/jcb.28065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/22/2018] [Indexed: 01/24/2023]
Abstract
Emerging evidence has demonstrated that the aberrant expression of histone-modifying enzymes such as histone demethylases contributes to gastric carcinogenesis and progression. The role of KDM4B in cancer progression has been gradually revealed. However, the underlying mechanisms regulating gastric cancer metastasis of KDM4B remain unclear. In the present study we determined KDM4B expression in gastric cancer and its biologic function in vitro and in vivo. We found that KDM4B expression was significantly increased in most gastric cancer tissues compared with the adjacent normal tissues. Upregulated expression of KDM4B in human gastric cancer was correlated with poor prognosis. In vitro, KDM4B overexpression in AGS cells promoted cell invasion, whereas knockdown of KDM4B inhibited cell invasion. Furthermore, KDM4B overexpression also promoted tumor metastasis in vivo. Mechanistically, KDM4B upregulated miR-125b expression and activated Wnt signaling pathway. More important, miR-125b partially mediated KDM4B-induced activation of Wnt signaling. Finally, we demonstrated that KDM4B promoted gastric cancer cell invasion in vitro and cancer metastasis in vivo, at least in part, by upregulating miR-125b expression. These data provided novel insights on the role of KDM4B-driven gastric cancer metastasis and indicated that KDM4B may be served as a potential target for gastric cancer.
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Affiliation(s)
- Jia-Chen Jing
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Zhen Feng
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Zhong-Hua Chen
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Bei-Na Ji
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Jing Hong
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Nan Tang
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Jin Ling Yu
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
| | - Shao-Ying Wang
- Department of Gastroenterology, Xu Hui District Center Hospital, Shanghai, China
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Abstract
The therapeutic approach to patients with oligometastatic gastric cancer and esophageal cancer is currently undergoing a shift towards a more aggressive therapy including surgical resection. In the current German S3 guidelines surgical treatment of metastatic disease is not recommended; however, nowadays interdisciplinary tumor boards have to evaluate such patients increasingly more often. On an individual basis a radical surgical resection of the primary tumor and the metastases is considered and performed in patients who respond well to multimodal chemotherapy concepts. In this review article the currently available data from the literature are discussed and a foundation for individually extended surgical approaches is presented. Together with the currently available results of the FLOT 3 study and the mostly retrospective studies, it seems to be possible to identify patients who would profit from such an aggressive treatment. In the future randomized prospective studies, such as the RENAISSANCE/FLOT 5 study and the GASTRIPEC study will have to evaluate whether an aggressive surgical therapy within multimodal therapy concepts of metastatic gastric and esophageal carcinomas is warranted.
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Affiliation(s)
- T Schmidt
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
| | - S P Mönig
- Department of Surgery, Upper-GI-Surgery, Geneva University Hospitals, Geneva, Schweiz
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27
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Qiu MZ, Shi SM, Chen ZH, Yu HE, Sheng H, Jin Y, Wang DS, Wang FH, Li YH, Xie D, Zhou ZW, Yang DJ, Xu RH. Frequency and clinicopathological features of metastasis to liver, lung, bone, and brain from gastric cancer: A SEER-based study. Cancer Med 2018; 7:3662-3672. [PMID: 29984918 PMCID: PMC6089142 DOI: 10.1002/cam4.1661] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/05/2018] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
The hematogenous metastatic pattern of gastric cancer (GC) was not fully explored. Here we analyzed the frequency and clinicopathological features of metastasis to liver, lung, bone, and brain from GC patients. Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 2010 to 2014. All of statistical analyses were performed using the Intercooled Stata 13.0 (Stata Corporation, College Station, TX). All statistical tests were two‐sided. Totally, there were 19 022 eligible patients for analysis. At the time of diagnosis, there were 7792 patients at stage IV, including 3218 (41.30%) patients with liver metastasis, 1126 (14.45%) with lung metastasis, 966 (12.40%) with bone metastasis and 151 (1.94%) with brain metastasis. GC patients with lung or liver metastasis have a higher risk of bone and brain metastasis than those without lung nor liver metastasis. Intestinal subtype had significantly higher rate of liver and lung metastasis, while diffuse type was more likely to have bone metastasis. Proximal stomach had significantly higher risk to develop metastasis than distal stomach. African‐Americans had the highest risk of liver metastasis and Caucasian had the highest prone to develop lung and brain metastasis. The median survival for patients with liver, lung, bone, and brain metastasis was 4 months, 3 months, 4 months and 3 months, respectively. It is important to evaluate the status of bone and brain metastasis in GC patients with lung or liver metastasis. Knowledge of metastatic patterns is helpful for clinicians to design personalized pretreatment imaging evaluation for GC patients.
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Affiliation(s)
- Miao-Zhen Qiu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Si-Mei Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Nursing, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhan-Hong Chen
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hong-En Yu
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hui Sheng
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ying Jin
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - De-Shen Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Feng-Hua Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yu-Hong Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dan Xie
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhi-Wei Zhou
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Da-Jun Yang
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Rui-Hua Xu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
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29
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Kojima H, Isaka M, Takahashi S, Machida N, Funai K, Ohde Y. Long-term survival after pulmonary resections for multiple metastases from gastric cancer: A case report. Int J Surg Case Rep 2018; 45:87-90. [PMID: 29597098 PMCID: PMC6000898 DOI: 10.1016/j.ijscr.2018.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 11/24/2022] Open
Abstract
We report a case of long-term survival after pulmonary resections for multiple metastases from gastric cancer. The prognosis of pulmonary resection for metastatic gastric cancer is poor even though solitary metastasis. Recently, however, cases of long-term survival have been reported. By contrast, long-term survival after pulmonary resections for multiple pulmonary metastases from gastric cancer is extremely rare. Our case suggests that pulmonary metastasectomy could be a therapeutic option even in patients involving multiple pulmonary metastases.
Introduction The prognosis of pulmonary resection for metastatic gastric cancer is poor even though solitary metastasis. Long-term survival after pulmonary resections for multiple pulmonary metastases from gastric cancer is extremely rare. Case presentation The patient was 67-year old man who underwent a distal gastrectomy for early gastric cancer. Wedge resections of the right upper and lower lobes and right lower lobectomy were performed for metastases from gastric cancer at 29 months and 55 months after the gastrectomy, respectively. As of 96 months after the first pulmonary metastasectomy, this patient continues to be recurrence-free. Discussion Multiple pulmonary metastases after gastrectomy are not considered candidates for surgery. Although systemic chemotherapy is the standard therapy for metastatic gastric cancer, the prognosis is extremely poor. In this case with favorable prognostic factors, such as long disease-free intervals or absence of extrapulmonary metastasis, pulmonary metastasectomy could be a therapeutic option in patients despite the presence of multiple pulmonary metastases. Conclusions Our case suggests that even in cases involving multiple pulmonary metastases, pulmonary metastasectomy might be an effective therapeutic option that can improve survival.
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Affiliation(s)
- Hideaki Kojima
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
| | - Shoji Takahashi
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
| | - Nozomu Machida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi, Hamamatsu, Shizuoka 431-3192, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
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Yamada M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, Yamaguchi J, Nagino M. Pulmonary Metastasis After Resection of Cholangiocarcinoma: Incidence, Resectability, and Survival. World J Surg 2018; 41:1550-1557. [PMID: 28105527 DOI: 10.1007/s00268-017-3877-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are few reports on pulmonary metastasis from cholangiocarcinoma; therefore, its incidence, resectability, and survival are unclear. METHODS Patients who underwent surgical resection for cholangiocarcinoma, including intrahepatic, perihilar, and distal cholangiocarcinoma were retrospectively reviewed, and this study focused on patients with pulmonary metastasis. RESULTS Between January 2003 and December 2014, 681 patients underwent surgical resection for cholangiocarcinoma. Of these, 407 patients experienced disease recurrence, including 46 (11.3%) who developed pulmonary metastasis. Of these 46 patients, 9 underwent resection for pulmonary metastasis; no resection was performed in the remaining 37 patients. R0 resection was achieved in all patients, and no complications related to pulmonary metastasectomy were observed. The median time to recurrence was significantly longer in the 9 patients who underwent surgery than in the 37 patients without surgery (2.5 vs 1.0 years, p < 0.010). Survival after surgery for primary cancer and survival after recurrence were significantly better in the former group than in the latter group (after primary cancer: 66.7 vs 0% at 5 years, p < 0.001; after recurrence: 40.0 vs 8.7% at 3 years, p = 0.003). Multivariate analysis identified the time to recurrence and resection for pulmonary metastasis as independent prognostic factors for survival after recurrence. CONCLUSION Resection for pulmonary metastasis originating from cholangiocarcinoma can be safely performed and confers survival benefits for select patients, especially those with a longer time to recurrence after initial surgery.
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Affiliation(s)
- Mihoko Yamada
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sugawara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Gleason JB, Dolan J, Hadeh A. Lymphangitic Pulmonary Metastasis: A Rare Finding in Gastric Carcinoma. J Clin Diagn Res 2017; 11:OJ01. [PMID: 28658839 DOI: 10.7860/jcdr/2017/25809.9798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
Affiliation(s)
- James Benjamin Gleason
- Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, 2950; Cleveland Clinic, Boulevard, Weston, FL 33331, USA
| | - Justin Dolan
- Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, 2950; Cleveland Clinic, Boulevard, Weston, FL 33331, USA
| | - Anas Hadeh
- Attending Physician, Department of Pulmonary and Critical Care Medicine, Cleveland ClinicFlorida, 2950; Cleveland Clinic, Boulevard, Weston, FL 33331, USA
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Iijima Y, Akiyama H, Atari M, Fukuhara M, Nakajima Y, Kinosita H, Uramoto H. Pulmonary Resection for Metastatic Gastric Cancer. Ann Thorac Cardiovasc Surg 2016. [PMID: 27118522 DOI: 10.5761/atcs.oa.16-00049,] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with some malignancies. On the other hand, the role of pulmonary metastasectomy for gastric cancer is still unknown. Metastasectomy is rarely indicated in cases of pulmonary metastasis from gastric cancer, because in most cases, the metastasis occurs in the form of lymphangitic carcinomatosis and the lesions are numerous. The purpose of this study was to determine the surgical outcomes and prognostic factors for survival after pulmonary metastasectomy. METHODS From 1985 to 2012, 10 patients underwent pulmonary metastasectomy for gastric cancer at Saitama Cancer Center, Japan. The overall survival rate was examined by the Kaplan-Meier method and univariate analysis was carried out to identify prognostic factors. RESULTS The overall 3-year survival rate was 30.0 %. The median follow-up period was 26.8 months (range, 6.5-96.6) after the pulmonary metastasectomy. Univariate analysis revealed an advanced pathological stage of the gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy as unfavorable prognostic factors. CONCLUSION Pulmonary metastasectomy should be considered in selected patients with lung metastasis from gastric cancer. An advanced pathological stage of gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy are unfavorable prognostic factors.
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Affiliation(s)
- Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
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Iijima Y, Akiyama H, Atari M, Fukuhara M, Nakajima Y, Kinosita H, Uramoto H. Pulmonary Resection for Metastatic Gastric Cancer. Ann Thorac Cardiovasc Surg 2016; 22:230-6. [PMID: 27118522 DOI: 10.5761/atcs.oa.16-00049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with some malignancies. On the other hand, the role of pulmonary metastasectomy for gastric cancer is still unknown. Metastasectomy is rarely indicated in cases of pulmonary metastasis from gastric cancer, because in most cases, the metastasis occurs in the form of lymphangitic carcinomatosis and the lesions are numerous. The purpose of this study was to determine the surgical outcomes and prognostic factors for survival after pulmonary metastasectomy. METHODS From 1985 to 2012, 10 patients underwent pulmonary metastasectomy for gastric cancer at Saitama Cancer Center, Japan. The overall survival rate was examined by the Kaplan-Meier method and univariate analysis was carried out to identify prognostic factors. RESULTS The overall 3-year survival rate was 30.0 %. The median follow-up period was 26.8 months (range, 6.5-96.6) after the pulmonary metastasectomy. Univariate analysis revealed an advanced pathological stage of the gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy as unfavorable prognostic factors. CONCLUSION Pulmonary metastasectomy should be considered in selected patients with lung metastasis from gastric cancer. An advanced pathological stage of gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy are unfavorable prognostic factors.
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Affiliation(s)
- Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
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Kwee RM, Kwee TC. Modern imaging techniques for preoperative detection of distant metastases in gastric cancer. World J Gastroenterol 2015; 21:10502-10509. [PMID: 26457011 PMCID: PMC4588073 DOI: 10.3748/wjg.v21.i37.10502] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/20/2015] [Accepted: 08/25/2015] [Indexed: 02/06/2023] Open
Abstract
A substantial portion of patients with newly diagnosed gastric cancer has distant metastases (M1 disease). These patients have a very poor prognosis and it is generally accepted that they should be treated with noncurative intent. Because it dramatically changes prognosis and treatment plans, it is very important to diagnose distant metastases. In this article, the definition, pathways, incidence and sites of distant metastases in gastric cancer are described. Subsequently, the current performance of imaging in detecting distant metastases in newly diagnosed gastric cancer is outlined and future prospects are discussed.
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Orlandi E, Mordenti P, Zangrandi A, Cavanna L. Intrapleural Trastuzumab Therapy for Malignant Pleural Effusion from HER2 Overexpression in Metastatic Gastric Cancer. Chemotherapy 2015; 60:321-4. [PMID: 26279275 DOI: 10.1159/000437136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant pleural effusion (MPE) is an extremely common problem affecting cancer patients with advanced disease. The current therapy for MPE is local treatment, such as thoracentesis, chemical pleurodesis, intracavitary administration of anticancer drugs and systemic therapy. However, the management of MPE is still unsatisfactory. CASE We report a case of MPE secondary to human epidermal growth factor receptor 2 (HER2)-positive gastric cancer that was successfully treated with intrapleural trastuzumab. A 52-year-old male with metastatic HER2-positive gastric cancer received chemotherapy (FOLFOX4 regimen) plus trastuzumab; after 11 courses of chemotherapy, he developed right MPE refractory to systemic treatment and pleurodesis. A pleural biopsy performed during thoracoscopy showed pleural metastasis from HER2-positive gastric cancer. The patient received 2 courses of intrapleuric trastuzumab. After the second course, the MPE disappeared, and he continued systemic therapy with trastuzumab and docetaxel. CONCLUSION The safety was good, no local or systemic complications occurred, and the dyspnea secondary to MPE improved and subsequently disappeared. To our knowledge, this case is the first report on intrapleuric trastuzumab use to treat refractory MPE secondary to metastasis from HER2-positive gastric cancer. The treatment was well-tolerated and efficacious.
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Affiliation(s)
- Elena Orlandi
- Department of Oncology-Hematology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
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Bao C, Conde J, Curtin J, Artzi N, Tian F, Cui D. Bioresponsive antisense DNA gold nanobeacons as a hybrid in vivo theranostics platform for the inhibition of cancer cells and metastasis. Sci Rep 2015; 5:12297. [PMID: 26189409 PMCID: PMC4507177 DOI: 10.1038/srep12297] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/23/2015] [Indexed: 12/26/2022] Open
Abstract
Gold nanobeacons can be used as a powerful tool for cancer theranostics. Here, we proposed a nanomaterial platform based on gold nanobeacons to detect, target and inhibit the expression of a mutant Kras gene in an in vivo murine gastric cancer model. The conjugation of fluorescently-labeled antisense DNA hairpin oligonucleotides to the surface of gold nanoparticles enables using their localized surface plasmon resonance properties to directly track the delivery to the primary gastric tumor and to lung metastatic sites. The fluorescently labeled nanobeacons reports on the interaction with the target as the fluorescent Cy3 signal is quenched by the gold nanoparticle and only emit light following conjugation to the Kras target owing to reorganization and opening of the nanobeacons, thus increasing the distance between the dye and the quencher. The systemic administration of the anti-Kras nanobeacons resulted in approximately 60% tumor size reduction and a 90% reduction in tumor vascularization. More important, the inhibition of the Kras gene expression in gastric tumors prevents the occurrence of metastasis to lung (80% reduction), increasing mice survival in more than 85%. Our developed platform can be easily adjusted to hybridize with any specific target and provide facile diagnosis and treatment for neoplastic diseases.
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Affiliation(s)
- Chenchen Bao
- Institute of Nano Biomedicine and Engineering, Key Lab. of Thin Film and Microfabrication Technology of Ministry of Education, Department of instrument science and engineering, School of Electronic Information and Electrical Engineering, National Center for Translational Medicine, Shanghai Jiao Tong University, P.R.China
| | - João Conde
- 1] Massachusetts Institute of Technology, Institute for Medical Engineering and Science, Harvard-MIT Division for Health Sciences and Technology, Cambridge, Massachusetts, USA [2] School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - James Curtin
- School of Food Science and Environmental Health, College of Sciences and Health, Dublin Institute of Technology, Cathal Brugha Street, Dublin, Ireland
| | - Natalie Artzi
- 1] Massachusetts Institute of Technology, Institute for Medical Engineering and Science, Harvard-MIT Division for Health Sciences and Technology, Cambridge, Massachusetts, USA [2] Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Furong Tian
- Focas Research Institute, Dublin Institute of Technology, Camden Row, Dublin, Ireland
| | - Daxiang Cui
- Institute of Nano Biomedicine and Engineering, Key Lab. of Thin Film and Microfabrication Technology of Ministry of Education, Department of instrument science and engineering, School of Electronic Information and Electrical Engineering, National Center for Translational Medicine, Shanghai Jiao Tong University, P.R.China
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Ekinci AŞ, Bal O, Ozatlı T, Türker I, Eşbah O, Demirci A, Budakoğlu B, Arslan UY, Eraslan E, Oksüzoğlu B. Gastric carcinoma with bone marrow metastasis: a case series. J Gastric Cancer 2014; 14:54-7. [PMID: 24765538 PMCID: PMC3996250 DOI: 10.5230/jgc.2014.14.1.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 01/13/2023] Open
Abstract
Gastric cancer is a major cause of cancer-related mortality. At the time of diagnosis, majority of the patients usually have unresectable or metastatic disease. The most common sites of metastases are the liver and the peritoneum, but in the advanced stages, there may be metastases to any region of the body. Bone marrow is an important metastatic site for solid tumors, and the prognosis in such cases is poor. In gastric cancer cases, bone marrow metastasis is usually observed in younger patients and in those with poorly differentiated tumors. Prognosis is worsened owing to the poor histomorphology as well as the occurrence of pancytopenia. The effect of standard chemotherapy is unknown, as survival is limited to a few weeks. This report aimed to evaluate 5 gastric cancer patients with bone marrow metastases to emphasize the importance of this condition.
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Affiliation(s)
- Ahmet Şiyar Ekinci
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Oznur Bal
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Tahsin Ozatlı
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Türker
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Onur Eşbah
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ayşe Demirci
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Burçin Budakoğlu
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ulkü Yalçıntaş Arslan
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Emrah Eraslan
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Berna Oksüzoğlu
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
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A nomogram predicting pulmonary metastasis of hepatocellular carcinoma following partial hepatectomy. Br J Cancer 2014; 110:1110-7. [PMID: 24481404 PMCID: PMC3950869 DOI: 10.1038/bjc.2014.19] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/29/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary metastasis (PM) following curative hepatectomy for hepatocellular carcinoma (HCC) is indicative of a poor prognosis. This study aimed to develop a nomogram to identify patients at high risks of PM. METHODS A primary cohort of patients who underwent curative hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital from 2002 to 2010 was prospectively studied. A nomogram predicting PM was constructed based on independent risk factors of PM. The predictive performance was evaluated by the concordance index (c-index), calibration curve and decision curve analysis (DCA). During the study period, a validation cohort was included at the First Affiliated Hospital of Fujian Medical University. RESULTS Postoperative PMs were detected in 106 out of 620 and 45 out of 218 patients, respectively, in two cohorts. Factors included in the nomogram were microvascular invasion, serum alpha-fetoprotein, tumour size, tumour number, encapsulation and intratumoral CD34 staining. The nomogram had a c-index of 0.75 and 0.82 for the two cohorts for predicting PM, respectively. The calibration curves fitted well. In the two cohorts, the DCA demonstrated positive net benefits by the nomogram, within the threshold probabilities of PM >10%. CONCLUSION The nomogram was accurate in predicting PM following curative hepatectomy for HCC.
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Yoshida Y, Imakiire T, Yoneda S, Obuchi T, Inada K, Iwasaki A. Ten cases of resected solitary pulmonary metastases arising from gastric cancer. Asian Cardiovasc Thorac Ann 2013; 22:578-82. [PMID: 24867033 DOI: 10.1177/0218492313513777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because carcinomatous lymphangitis and carcinomatous pleuritis are the usual forms of metastasis associated with gastric cancer, resection of solitary pulmonary metastases arising from gastric cancer is rarely performed. To clarify the characteristics of pulmonary metastases from gastric cancer, we investigated patients who underwent resection of metastatic solitary lung tumors arising from gastric cancer. METHODS Between October 2003 and October 2012, 10 patients underwent pulmonary metastasectomy for metastatic gastric cancer at our institution. We retrospectively evaluated features of the primary gastric cancer and the clinicopathological features of the pulmonary metastases in these cases. RESULTS 70% of the patients had stage II disease. Lymphatic invasion was observed in all cases of primary gastric cancer. The method of pulmonary resection was partial resection in 5 cases, segmentectomy in 1, and lobectomy in 4. On histopathological examination, immunohistochemical staining was negative for thyroid transcription factor-1 and napsin A in all cases. Patients who underwent resection of pulmonary metastases arising from gastric cancer had a good prognosis: the 4-year survival rate was 75%. CONCLUSIONS Carefully chosen patients have a good opportunity to obtain benefits from resection of pulmonary metastases arising from gastric cancer.
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Affiliation(s)
- Yasuhiro Yoshida
- Department of Thoracic, Endocrine and Pediatric Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takayuki Imakiire
- Department of Thoracic Surgery, Imakiire General Hospital, Kagoshima, Japan
| | - Satoshi Yoneda
- Department of Thoracic Surgery, Imakiire General Hospital, Kagoshima, Japan
| | - Toshiro Obuchi
- Department of Thoracic Surgery, St. Mary's Hospital, Kurume, Japan
| | - Kazuo Inada
- Department of Surgery, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of Thoracic, Endocrine and Pediatric Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Shiono S, Sato T, Horio H, Chida M, Matsuguma H, Ozeki Y, Nakajima J, Okumura S. Outcomes and prognostic factors of survival after pulmonary resection for metastatic gastric cancer. Eur J Cardiothorac Surg 2012; 43:e13-6. [DOI: 10.1093/ejcts/ezs574] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Toru Sato
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hirotoshi Horio
- Department of General Thoracic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | | | - Yuichi Ozeki
- Department of Surgery II, National Defense Medical College, Saitama, Japan
| | - Jun Nakajima
- Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
| | - Sakae Okumura
- Department of Chest Surgery, Cancer Institute Hospital, Tokyo, Japan
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