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Wang Y, Ding G, Chu C, Cheng XD, Qin JJ. Genomic biology and therapeutic strategies of liver metastasis from gastric cancer. Crit Rev Oncol Hematol 2024; 202:104470. [PMID: 39111457 DOI: 10.1016/j.critrevonc.2024.104470] [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: 12/15/2023] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
The liver is a frequent site of metastasis in advanced gastric cancer (GC). Despite significant advancements in diagnostic and therapeutic techniques, the overall survival rate for patients afflicted with gastric cancer liver metastasis (GCLM) remains dismally low. Precision oncology has made significant progress in identifying therapeutic targets and enhancing our understanding of metastasis mechanisms through genome sequencing and molecular characterization. Therefore, it is crucial to have a comprehensive understanding of the various molecular processes involved in GCLM and the fundamental principles of systemic therapy to develop new treatment approaches. This paper aims to review recent findings on the diagnosis, potential biomarkers, and therapies targeting the multiple molecular processes of GCLM, with the goal of improving treatment strategies for patients with GCLM.
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Affiliation(s)
- Yichao Wang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 313200, China; Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Guangyu Ding
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Chu Chu
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 313200, China
| | - Xiang-Dong Cheng
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China; Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Hangzhou 310022, China.
| | - Jiang-Jiang Qin
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China; Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Hangzhou 310022, China; Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China.
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Nakazawa N, Sohda M, Hosoi N, Watanabe T, Kumakura Y, Yamashita T, Tanaka N, Saito K, Kimura A, Kasuga K, Nakazato K, Yoshinari D, Shimizu H, Ubukata Y, Hosaka H, Sano A, Sakai M, Ogawa H, Shirabe K, Saeki H. Conversion Surgery After Chemotherapy Plus Nivolumab as the First-Line Treatment for Unresectable Advanced or Recurrent Gastric Cancer and a Biomarker Study Using the Gustave Roussy Immune Score: A Multicenter Study. Ann Surg Oncol 2024:10.1245/s10434-024-16161-4. [PMID: 39225857 DOI: 10.1245/s10434-024-16161-4] [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: 06/03/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND There are few reports on conversion surgery (CS) after chemotherapy plus nivolumab as a first-line treatment in patients with unresectable advanced or recurrent gastric cancer (GC). This multicenter study was conducted to analyze real-world data on CS after chemotherapy plus nivolumab as a first-line treatment and to identify predictive biomarkers. METHODS This multicenter study included 104 patients who received chemotherapy plus nivolumab as primary treatment for unresectable advanced recurrent GC from 12 institutes. We investigated and analyzed patient characteristics and blood test data in the presence or absence of CS, the relationship between the Gustave Roussy Immune Score (GRIm-s) and CS, and the characteristics of CS cases. RESULTS CS was performed in 12 patients (11.5%). Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was significantly better in patients who underwent CS (p < 0.0001). There were no CS cases with high-risk GRIm-s (0%), however there were 22 non-CS cases (23.9%). No high-risk GRIm-s cases were converted to CS. Minimally invasive surgery was performed in 50.0% of the cases, with R0 resection in all cases and only one case of urinary retention (Grade II) as a postoperative complication, indicating a good postoperative short-term outcome. There were two cases of postoperative recurrence (16.7%), both of which were grade 1b. CONCLUSIONS The short-term postoperative results of CS after chemotherapy plus nivolumab as the first-line treatment for GC were acceptable in this study. There were no high-risk GRIm-s cases among those who underwent CS, suggesting that the GRIm-s may be a predictor of CS.
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Affiliation(s)
- Nobuhiro Nakazawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan.
| | - Makoto Sohda
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Nobuhiro Hosoi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Takayoshi Watanabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Yuji Kumakura
- Department of Surgery, Tonechuo Hospital, Numata, Gunma, Japan
| | - Toshiki Yamashita
- Department of Surgery, Subaru Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Naritaka Tanaka
- Department of Surgery, Japanese Red Cross Haramachi Hospital, Agatsumagun, Gunma, Japan
| | - Kana Saito
- Department of Surgery, Japan Community Healthcare Organization Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Akiharu Kimura
- Department of Surgery, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
| | - Kengo Kasuga
- Department of Gastroenterology, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Kenji Nakazato
- Department of Surgery, Fujioka General Hospital, Fujioka, Gunma, Japan
| | - Daisuke Yoshinari
- Department of Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Hisashi Shimizu
- Department of Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yasunari Ubukata
- Department of Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Hisashi Hosaka
- Department of Gastroenterology, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | - Akihiko Sano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
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Toji Y, Takeuchi S, Ebihara Y, Kurashima Y, Harada K, Hayashi M, Abe H, Wada H, Yorinaga S, Shichinohe T, Tomaru U, Komatsu Y, Hirano S. Perioperative chemotherapy with nivolumab for HER2-negative locally advanced gastric cancer: a case series. Surg Case Rep 2024; 10:200. [PMID: 39192090 DOI: 10.1186/s40792-024-02001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 08/15/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Nivolumab with chemotherapy has been transformative for metastatic gastric cancer (GC). The potential of this regimen for local tumor control could be utilized for perioperative chemotherapy in locally advanced GC with bulky tumors or lymph node metastasis involving other organs. CASE PRESENTATION Five patients with HER2-negative advanced GC were treated with nivolumab and oxaliplatin-based chemotherapy. All patients presented with clinical stage III or IVA GC with tumors in contact with either the pancreas or liver. Following chemotherapy, all tumors demonstrated shrinkage, allowing successful radical gastrectomies including four minimally invasive approach without postoperative complications. Four patients avoided combined resection of other organs. CONCLUSIONS Perioperative chemotherapy with nivolumab was effective for local disease control in this case series. This regimen could be a promising treatment approach for locally advanced GC; however, its survival benefits should be evaluated in clinical trials.
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Affiliation(s)
- Yuta Toji
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shintaro Takeuchi
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kazuaki Harada
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Mariko Hayashi
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hirotake Abe
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideyuki Wada
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoko Yorinaga
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Surgical Pathology, Hokkaido University Hospital, West-5, North-14, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Utano Tomaru
- Department of Surgical Pathology, Hokkaido University Hospital, West-5, North-14, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yoshito Komatsu
- Department of Cancer Center, Hokkaido University Hospital, West-5, North-14, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Division of Surgery, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Hall LA, Loader D, Gouveia S, Burak M, Halle-Smith J, Labib P, Alarabiyat M, Marudanayagam R, Dasari BV, Roberts KJ, Raza SS, Papamichail M, Bartlett DC, Sutcliffe RP, Chatzizacharias NA. Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy. World J Gastrointest Surg 2024; 16:2689-2701. [PMID: 39220089 PMCID: PMC11362928 DOI: 10.4240/wjgs.v16.i8.2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/28/2024] [Accepted: 06/27/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse. AIM To synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement. METHODS A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT. All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database. Baseline characteristics, NAT type, progression to surgery and oncological outcomes were collected. RESULTS Twelve studies were included. The definition of "unresectable" locally advanced dCCA was heterogenous. Four studies reported outcomes for 9 patients who received NAT for dCCA with extensive vascular involvement. R0 resection rate ranged between 0 and 100% but without survival benefit in most cases. Remaining studies considered either NAT in resectable dCCA or inclusive with extrahepatic CCA. The presented case series includes 9 patients (median age 67, IQR 56-74 years, male:female 5:4) referred for NAT for borderline resectable or locally advanced disease. Three patients progressed to surgery and 2 were resected. One patient died at 14 months with evidence of recurrence at 6 months and the other died at 51 months following recurrence 6 months post-operatively. CONCLUSION Evidence for benefit of NAT is limited. Consensus on criteria for uniform definition of resectability for dCCA is required. We propose using the established National-Comprehensive-Cancer-Network® criteria for pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Lewis A Hall
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Duncan Loader
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Santiago Gouveia
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Marta Burak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - James Halle-Smith
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Peter Labib
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Moath Alarabiyat
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Ravi Marudanayagam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Bobby V Dasari
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Keith J Roberts
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Syed S Raza
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Michail Papamichail
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - David C Bartlett
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
| | - Nikolaos A Chatzizacharias
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
- Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
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Kitai T, Yamanaka K. Conversion surgery for gastric cancer with PM. J Surg Oncol 2024. [PMID: 39155703 DOI: 10.1002/jso.27794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024]
Abstract
It remains unclear whether the application of surgery to gastric cancer with peritoneal carcinomatosis prolongs survival. Twenty studies on conversion surgery were reviewed. Key points were the response to chemotherapy, complete resection, and a low tumor burden at the time of surgery. A bidirectional approach has been developed to increase the response rate. There are two different strategies in surgery. The outcomes of ongoing trials may clarify controversial issues.
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Affiliation(s)
- Toshiyuki Kitai
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenya Yamanaka
- Department of Surgery, Shiga General Hospital, Moriyama, Japan
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Okamoto T, Takeda T, Sasaki T, Inoue Y, Mie T, Hirai T, Ishitsuka T, Yamada M, Nakagawa H, Furukawa T, Kasuga A, Ozaka M, Takahashi Y, Sasahira N. Liver Oligometastasis in Biliary Tract Cancer and Impact on Survival Outcomes. J Gastrointest Cancer 2024:10.1007/s12029-024-01098-4. [PMID: 39145915 DOI: 10.1007/s12029-024-01098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Outcomes of unresectable biliary tract cancer (BTC) with varying extents of liver involvement remain unclear. We evaluated characteristics and outcomes of BTC patients with liver metastases who underwent chemotherapy. METHODS We retrospectively reviewed consecutive BTC patients with synchronous or metachronous intrahepatic metastases who started first-line chemotherapy at our institution between January 2016 and December 2021. RESULTS Ninety-six patients were included, of which 57 only had liver metastases and 39 had multiorgan involvement. The liver only group had longer median overall survival (OS) (11.8 vs. 7.4 months, P = 0.006) and median progression-free survival (PFS) (4.1 vs. 2.7 months, P = 0.035) than the multiorgan group. Patients with oligometastases (defined as no more than three liver metastases) achieved longer OS than those with polymetastases (four or more liver metastases) in the entire cohort. Within the liver only group, there were no significant differences in OS or PFS between the oligometastasis and polymetastasis groups. Patients who underwent subsequent surgery had significantly longer median OS than those who did not (44.4 vs. 7.7 months, P < 0.001). Age ≥ 75 years, liver-only metastasis, modified Glasgow prognostic score ≥ 1 carcinoembryonic antigen ≥ 5 μg/L, and subsequent surgery were independent predictors of OS. Liver oligometastasis was only a significant predictor of longer OS in univariate Cox analysis. CONCLUSIONS Outcomes in BTC patients with metastases limited to the liver, particularly those with oligometastasis, were more favorable than those with multiorgan metastases. Selected cases, generally with liver oligometastases, may achieve prolonged OS through subsequent surgery.
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Affiliation(s)
- Takeshi Okamoto
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan.
| | - Tsuyoshi Takeda
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Yosuke Inoue
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takafumi Mie
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Tatsuki Hirai
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Takahiro Ishitsuka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Manabu Yamada
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Hiroki Nakagawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Takaaki Furukawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Akiyoshi Kasuga
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
| | - Yu Takahashi
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake Koto-Ku, Tokyo, 135-8550, Japan
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Pereira MA, Ramos MFKP, Charruf AZ, Dias AR, Ribeiro U. Risk Scoring System to Predict Mortality in Gastric Cancer with Peritoneal Carcinomatosis. Med Sci (Basel) 2024; 12:30. [PMID: 38921684 PMCID: PMC11205632 DOI: 10.3390/medsci12020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Gastric cancer (GC) with peritoneal carcinomatosis (PC) has a particularly unfavorable prognosis. This limited survival raises doubts about which factors confer an extremely worse outcome and which patients could benefit from more aggressive treatments, in an attempt to improve survival and better control the disease. This study aimed to evaluate the survival outcomes of patients with PC due to GC and develop a prognostic score to predict 6-month mortality. We performed an analysis of clinical stage IV GC with PC. Scores were assigned to risk factors and calculated for each patient from nine variables. Among 326 IVB GC, 211 (64.7%) had PC and were included. After calculating the score, 136 (64.5%) GCs were classified as a low-risk group and 75 (35.5%) as a high-risk group. Median OS was 7.9 and 1.9 months for low- and high-risk patients (p < 0.001). In the high-risk group, 77.3% of the patients died in <6 mo (p < 0.001). Palliative surgery and chemotherapy were associated with better survival, and the prognostic groups maintained statistical significance even when the same type of treatment was performed. In conclusion, the scoring system developed with variables related to patient performance status and clinical data was able to distinguish GC with PC with a high risk of 6-month mortality. Accordingly, verifying and validating our findings in a large cohort of patients is necessary to confirm and guarantee the external validation of the results.
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Affiliation(s)
- Marina Alessandra Pereira
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01249-000, Brazil; (M.F.K.P.R.); (A.Z.C.); (A.R.D.)
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, São Paulo 01246-000, Brazil
| | - Marcus Fernando Kodama Pertille Ramos
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01249-000, Brazil; (M.F.K.P.R.); (A.Z.C.); (A.R.D.)
| | - Amir Zeide Charruf
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01249-000, Brazil; (M.F.K.P.R.); (A.Z.C.); (A.R.D.)
| | - André Roncon Dias
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01249-000, Brazil; (M.F.K.P.R.); (A.Z.C.); (A.R.D.)
| | - Ulysses Ribeiro
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01249-000, Brazil; (M.F.K.P.R.); (A.Z.C.); (A.R.D.)
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8
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Maratta MG, Vitale A, Basso M, Vivolo R, Di Monte E, Biondi A, Di Giorgio A, Rosa F, Tondolo V, Agnes A, Tortora G, Strippoli A, Pozzo C. Benefit of a multimodal approach combining chemotherapy and surgery in oligometastatic gastric cancer: experience from a tertiary referral center. Front Oncol 2024; 14:1343596. [PMID: 38912067 PMCID: PMC11190071 DOI: 10.3389/fonc.2024.1343596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Gastric cancer (GC) is the fourth leading cause of cancer-related death worldwide with limited therapeutic options. The aim of this study was to analyze the value of adding surgery to the first-line treatment in patients with oligometastatic GC (OGC). Methods This retrospective study included patients with OGC who underwent induction chemotherapy followed by surgery of both primary tumor and synchronous metastasis between April 2012 and April 2022. Endpoints were overall survival (OS) and relapse-free survival (RFS) analyzed by the Kaplan-Meier method. Prognostic factors were assessed with the Cox model. Results Data from 39 patients were collected. All cases were referred to our multidisciplinary tumor board (MTB) to evaluate the feasibility of radical surgery. After a median follow-up of 33.6 months (mo.), median OS was 26.6 mo. (95% CI 23.8-29.4) and median RFS was 10.6 mo. (95% CI 6.3-14.8). Pathologic response according to the Mandard criteria (TRG 1-3, not reached versus 20.5 mo. for TRG 4-5; HR 0.23, p=0.019), PS ECOG ≤ 1 (26.7 mo. for PS ≤ 1 versus 11.2 mo. for PS >1; HR 0.3, p=0.022) and a low metastatic burden (26.7 mo. for single site versus 12.9 mo. for ≥2 sites; HR 0.34, p=0.039) were related to good prognosis. No major intraoperative complications nor surgery-related deaths occurred in our series. Discussion A sequential strategy of preoperative chemotherapy and radical surgical excision of both primary tumor and metastases was demonstrated to significantly improve OS and RFS. Multidisciplinary evaluation is mandatory to identify patients who could benefit from this strategy.
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Affiliation(s)
- Maria Grazia Maratta
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Vitale
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Basso
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raffaella Vivolo
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Di Monte
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Biondi
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Di Giorgio
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fausto Rosa
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Tondolo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annamaria Agnes
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Strippoli
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Pozzo
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Kawai J, Yasufuku I, Fukada M, Asai R, Sato Y, Tajima YJ, Saigo C, Kiyama S, Makiyama A, Tanaka Y, Okumura N, Murase K, Miyazaki T, Matsuhashi N. Successful R0 resection after chemotherapy, including nivolumab, for gastric cancer with liver metastases: three case reports. Surg Case Rep 2024; 10:138. [PMID: 38837046 PMCID: PMC11153382 DOI: 10.1186/s40792-024-01929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Advances in chemotherapy have increased clinical experience with conversion surgery for inoperable advanced gastric cancer. This report describes three patients with unresectable gastric cancer accompanied by multiple liver metastases. In all three patients, nivolumab resolved the liver metastases and subsequent conversion surgery achieved a pathological complete response. CASE PRESENTATION In Case 1, a 68-year-old man with clinical Stage IVB gastric cancer and multiple liver metastases initiated first-line therapy with SOX plus nivolumab. The patient completed 13 cycles; however, only nivolumab was continued for 3 cycles because of adverse events. Distal gastrectomy and partial hepatic resection were performed because of a significant reduction in the size of the liver metastases as observed on magnetic resonance imaging (MRI). In Case 2, a 72-year-old man with clinical Stage IVB gastric cancer and multiple liver metastases initiated first-line therapy with SOX. Because of the subsequent emergence of new liver metastases, the patient transitioned to ramucirumab plus paclitaxel as second-line therapy. Third-line therapy with nivolumab was initiated because of side effects. MRI revealed necrosis within the liver metastasis, and the patient underwent proximal gastrectomy and partial hepatectomy. In Case 3, a 51-year-old woman with clinical Stage IVB gastric cancer accompanied by multiple metastases of the liver and para-aortic lymph nodes began first-line therapy with SOX plus nivolumab. The patient completed 10 cycles; however, only nivolumab was continued for 5 cycles because of adverse events. Computed tomography showed a significant decrease in the size of the para-aortic lymph nodes, while MRI indicated the presence of a singular liver metastasis. Distal gastrectomy and partial hepatic resection were subsequently performed. In all three cases, MRI revealed the presence of liver metastases; however, pathological examination showed no viable tumor cells. CONCLUSIONS We herein present three cases in which chemotherapy, including nivolumab, elicited a response in patients with multiple unresectable liver metastases, ultimately culminating in R0 resection through conversion surgery. Although MRI showed liver metastases, pathological analysis revealed no cancer, underscoring the beneficial impact of chemotherapy.
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Affiliation(s)
- Junpei Kawai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Ryuichi Asai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yu Jesse Tajima
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Chiemi Saigo
- Department of Pathology, Gifu University Hospital, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Akitaka Makiyama
- Cancer Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University Hospital, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
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10
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Yu P, Ding G, Huang X, Wang C, Fang J, Huang L, Ye Z, Xu Q, Wu X, Yan J, Ou Q, Du Y, Cheng X. Genomic and immune microenvironment features influencing chemoimmunotherapy response in gastric cancer with peritoneal metastasis: a retrospective cohort study. Int J Surg 2024; 110:3504-3517. [PMID: 38502852 PMCID: PMC11175815 DOI: 10.1097/js9.0000000000001281] [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: 11/14/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Patients with peritoneal metastasis (PM) from gastric cancer (GC) exhibit poor prognosis. Chemoimmunotherapy offers promising clinical benefits; however, its efficacy and predictive biomarkers in a conversion therapy setting remain unclear. The authors aimed to retrospectively evaluate chemoimmunotherapy efficacy in a conversion therapy setting for GC patients with PM and establish a prediction model for assessing clinical benefits. MATERIALS AND METHODS A retrospective evaluation of clinical outcomes encompassed 55 GC patients with PM who underwent chemoimmunotherapy in a conversion therapy setting. Baseline PM specimens were collected for genomic and transcriptomic profiling. Clinicopathological factors, gene signatures, and tumor immune microenvironment were evaluated to identify predictive markers and develop a prediction model. RESULTS Chemoimmunotherapy achieved a 41.8% objective response rate and 72.4% R0 resection rate in GC patients with PM. Patients with conversion surgery showed better overall survival (OS) than those without the surgery (median OS: not reached vs 7.82 m, P <0.0001). Responders to chemoimmunotherapy showed higher ERBB2 and ERBB3 mutation frequencies, CTLA4 and HLA-DQB1 expression, and CD8+ T cell infiltration, but lower CDH1 mutation and naïve CD4+ T cell infiltration, compared to nonresponders. A prediction model was established integrating CDH1 and ERBB3 mutations, HLA-DQB1 expression, and naïve CD4+ T cell infiltration (AUC=0.918), which were further tested using an independent external cohort (AUC=0.785). CONCLUSION This exploratory study comprehensively evaluated clinicopathological, genomic, and immune features and developed a novel prediction model, providing a rational basis for the selection of GC patients with PM for chemoimmunotherapy-involved conversion therapy.
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Affiliation(s)
- Pengfei Yu
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Guangyu Ding
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Xingmao Huang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Chenxuan Wang
- Medical department, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People’s Republic of China
| | - Jingquan Fang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Ling Huang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Zeyao Ye
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Qi Xu
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang
| | - Xiaoying Wu
- Medical department, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People’s Republic of China
| | - Junrong Yan
- Medical department, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People’s Republic of China
| | - Qiuxiang Ou
- Medical department, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People’s Republic of China
| | - Yian Du
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
| | - Xiangdong Cheng
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences
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11
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Sakoh T, Eto K, Iwagami S, Yoshida N, Kosumi K, Iwatsuki M, Baba Y, Miyamoto Y, Yoshii D, Baba H. Conversion surgery for stage IV gastric cancer with multiple liver metastases with a complete pathological response to S-1 plus oxaliplatin therapy. Clin J Gastroenterol 2024; 17:419-424. [PMID: 38466470 DOI: 10.1007/s12328-024-01933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024]
Abstract
Although patients with stage IV gastric cancer who respond well to systemic chemotherapy can be treated with gastrectomy, the prognosis of patients with multiple liver metastases is poor. We herein describe a patient with stage IV gastric cancer with multiple liver metastases who underwent conversion surgery after systemic treatment with S-1 plus oxaliplatin. The patient was a 62-year-old man. Upper gastrointestinal endoscopy revealed a 30-mm type 2 tumor in the greater curvature of the stomach at the anterior wall, and biopsy revealed a poorly differentiated adenocarcinoma. Imaging showed three suspected liver metastases in liver segment S8. The patient was judged to have gastric cancer, cStage IV (cT3N1M1(H)), and systemic chemotherapy was administered. He was treated with a total of six courses of chemotherapy. After re-evaluation, the primary tumor had shrunk significantly, and liver metastases could not be detected. Confirming no signs of seeding by laparoscopy, robot-assisted pylorus-preserving gastrectomy with D2 dissection and laparoscopic partial hepatic (S8) resection were performed. The patient was diagnosed with a complete pathological response. Conversion surgery is an option for stage IV gastric cancer when distant metastases are controlled with chemotherapy and when R0 resection is possible.
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Affiliation(s)
- Teruki Sakoh
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Keisuke Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Daiki Yoshii
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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12
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Tanioka N, Kuwahara M, Sakai T, Nokubo Y, Shimizu S, Hiroi M, Akimori T. Minimally Invasive Conversion Surgery for Unresectable Gastric Cancer with Splenic Metastasis and Splenic Vein Tumor Thrombus: A Case Report. Curr Oncol 2024; 31:2662-2669. [PMID: 38785482 PMCID: PMC11119725 DOI: 10.3390/curroncol31050201] [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: 04/15/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
While the importance of conversion surgery has increased with the development of systemic chemotherapy for gastric cancer (GC), reports of conversion surgery for patients with GC with distant metastasis and tumor thrombus are extremely scarce, and a definitive surgical strategy has yet to be established. Herein, we report a 67-year-old man with left abdominal pain referred to our hospital following a diagnosis of unresectable GC. Esophagogastroduodenoscopy and contrast-enhanced abdominal computed tomography (CT) revealed advanced GC with splenic metastasis. A splenic vein tumor thrombus (SVTT) and a continuous thrombus to the main trunk of the portal vein were detected. The patient was treated with anticoagulation therapy and systemic chemotherapy comprising S-1 and oxaliplatin. One year following chemotherapy initiation, a CT scan revealed progressive disease (PD); therefore, the chemotherapy regimen was switched to ramucirumab with paclitaxel. After 10 courses of chemotherapy resulting in primary tumor and SVTT shrinkage, the patient underwent laparoscopic total gastrectomy (LTG) and distal pancreaticosplenectomy (DPS). He was discharged without complications and remained alive 6 months postoperatively without recurrence. In summary, the wait-and-see approach was effective in a patient with GC with splenic metastasis and SVTT, ultimately leading to an R0 resection performed via LTG and DPS.
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Affiliation(s)
- Nobuhisa Tanioka
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Michio Kuwahara
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Takashi Sakai
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Yuzuko Nokubo
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Shigeto Shimizu
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
| | - Makoto Hiroi
- Department of Pathology, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan;
| | - Toyokazu Akimori
- Department of Surgery, Hata Kenmin Hospital, 3-1 Yoshina, Yamanacho, Sukumo-City 788-0785, Kochi, Japan; (M.K.); (T.S.); (Y.N.); (S.S.); (T.A.)
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13
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Takeno A, Motoori M, Kishi K, Omori T, Hirao M, Masuzawa T, Fujitani K, Yamamato K, Kurokawa Y, Doki Y. Prognostic factors of conversion surgery for stage IV gastric cancer: A multi-institutional retrospective analysis. Ann Gastroenterol Surg 2024; 8:431-442. [PMID: 38707233 PMCID: PMC11066490 DOI: 10.1002/ags3.12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 05/07/2024] Open
Abstract
Background Conversion surgery (CS) is a highly anticipated strategy for stage IV advanced gastric cancer (AGC) with a good response to chemotherapy. However, prognostic factors limiting R0 resection remain unclear. In this multi-institutional study, we investigated the clinical outcomes of CS for stage IV AGC and the prognostic factors of CS-limiting R0 resection and analyzed them according to metastatic patterns. Methods Clinical data on 210 patients who underwent CS for stage IV AGC at six institutions between 2007 and 2017 were retrospectively retrieved. The patient background, preoperative treatment, operative outcomes, and survival times were recorded. Prognostic factors for overall and recurrence-free survival were investigated using univariate and multivariate analyses for patients who underwent R0 resection. Results R0 resection was achieved in 146 (70%) patients. The median survival time was 32 months, and the 3-year survival rate was 45%. Patients who achieved R0 resection had significantly longer survival than those with R1/2 resection (median survival time: 41.5 months vs. 20.7 months). Multivariate analysis identified pathological N positivity for overall and relapse-free survival and pathological T4 for relapse-free survival as significant independent poor prognostic factors of R0 resected patients. There was no significant difference in survival among the peritoneum, liver, and lymph node groups regarding the initial metastatic sites. Conclusions CS with R0 resection for patients with stage IV AGC can lead to longer survival. Patients with pathological T4 and pathological N positivity were eligible for intensive adjuvant therapy after CS with R0 resection.
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Affiliation(s)
- Atsushi Takeno
- Department of Surgery, National Hospital OrganizationOsaka National HospitalOsakaJapan
| | | | - Kentaro Kishi
- Department of SurgeryOsaka Police HospitalOsakaJapan
| | - Takeshi Omori
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Motohiro Hirao
- Department of Surgery, National Hospital OrganizationOsaka National HospitalOsakaJapan
| | - Toru Masuzawa
- Department of SurgeryKansai Rosai HospitalAmagasakiHyogoJapan
| | | | - Kazuyoshi Yamamato
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
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14
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Sugimura K, Tanaka K, Sugase T, Momose K, Kanemura T, Yamashita K, Makino T, Shiraishi O, Motoori M, Yamasaki M, Miyata H, Fujitani K, Yasuda T, Yano M, Eguchi H, Doki Y. Clinical Impact of Conversion Surgery After Induction Therapy for Esophageal Cancer with Synchronous Distant Metastasis: A Multi-institutional Retrospective Study. Ann Surg Oncol 2024; 31:3437-3447. [PMID: 38300405 DOI: 10.1245/s10434-024-14960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The standard treatment for advanced esophageal cancer with synchronous distant metastasis is systemic chemotherapy or immunotherapy. Conversion surgery is not established for esophageal cancer with synchronous distant metastasis. This study aimed to investigate the clinical impact of conversion surgery for esophageal cancer with synchronous distant metastasis after induction therapy. METHODS This multi-institutional retrospective study enrolled 66 patients with advanced esophageal cancer, including synchronous distant metastasis, who underwent induction chemotherapy or chemoradiotherapy followed by conversion surgery between 2005 and 2021. Short- and long-term outcomes were investigated. RESULTS Distant lymph node (LN) metastasis occurred in 51 patients (77%). Distant organ metastasis occurred in 15 (23%) patients. There were 41 patients with metastatic para-aortic LNs, and 10 patients with other metastatic LNs. Organs with distant metastasis included the lung in seven patients, liver in seven patients, and liver and lung in one patient. For 61 patients (92%), R0 resection was achieved. The postoperative complication rate was 47%. The in-hospital mortality rate was 1%, and the 3- and 5-year overall survival (OS) rates for all the patients were 32.4% and 24.4%, respectively. The OS rates were similar between the patients with distant LN metastasis and the patients with distant organ metastasis (3-year OS: 34.9% vs. 26.7%; P = 0.435). Multivariate analysis showed that pathologic nodal status is independently associated with a poor prognosis (hazard ratio, 2.43; P = 0.005). CONCLUSIONS Conversion surgery after chemotherapy or chemoradiotherapy for esophageal cancer with synchronous distant metastasis is feasible and promising. It might be effective for improving the long-term prognosis for patients with controlled nodal status.
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Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.
| | - Koji Tanaka
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takahito Sugase
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kota Momose
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takashi Kanemura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kotaro Yamashita
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tomoki Makino
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka Sayama, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Makoto Yamasaki
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka Sayama, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidetoshi Eguchi
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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15
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Enomoto T, Mikami S, Otsubo T, Tsuda T, Chosokabe M. Ten-Year Follow-Up After Chemotherapy and Conversion Surgery for Human Epidermal Growth Factor Receptor 2-Positive Stage IV Esophagogastric Junction Cancer With a Pathological Complete Response: A Case Report. Cureus 2024; 16:e60178. [PMID: 38868263 PMCID: PMC11167507 DOI: 10.7759/cureus.60178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Recent reports have focused on the usefulness of conversion surgery, in which chemotherapy is given to patients with unresectable advanced gastric cancer (GC), and radical surgery is subsequently performed if resection becomes possible; however, no consensus has been reached regarding the usefulness of this strategy. We report on a 74-year-old man who was diagnosed with esophagogastric junction cancer (T3N3M1 (LYM): stage IV). Chemotherapy was chosen and seven courses of S1 + cisplatin (SP) + trastuzumab (HCN) and two courses of S1 + HCN were administered. Approximately 10 months after the start of chemotherapy, the tumor had almost disappeared and we therefore decided to perform conversion surgery. Pathologic examination of the specimen and dissected lymph nodes showed no cancer. Postoperatively, the patient underwent chemotherapy until the second postoperative year, and no metastasis or recurrence was observed for nine years after surgery. Conversion surgery after chemotherapy resulted in recurrence-free survival in this case; however, further studies are needed to elucidate the effect of surgery after chemotherapy for patients with stage IV GC, as chemotherapy continues to evolve.
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Affiliation(s)
- Takeharu Enomoto
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Shinya Mikami
- Department of Gastrointestinal and General Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Takashi Tsuda
- Department of Oncology, Center for Hepato-Biliary-Pancreatic and Digestive Disease, Shonan Fujisawa Tokushukai Hospital, Fujisawa, JPN
| | - Motohiro Chosokabe
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, JPN
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16
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Katsumata K, Morimoto Y, Aoyama J, Yamada T, Katsuki Y, Nishiyama R, Egawa T. Conversion surgery for gastric remnant cancer with liver metastasis after nivolumab combination chemotherapy achieving pathological complete response: a case report and literature review. Surg Case Rep 2024; 10:107. [PMID: 38691201 PMCID: PMC11063010 DOI: 10.1186/s40792-024-01905-x] [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: 02/08/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Nivolumab combination chemotherapy has recently emerged as a potential first-line treatment for patients with unresectable or metastatic gastric cancer (GC). Further research has indicated that R0 resection by conversion surgery could be an effective treatment strategy to improve overall survival. However, there have been limited reports on the successful application of conversion surgery following combination chemotherapy achieving pathological complete response (pCR) in cases of advanced gastric remnant cancer with liver metastasis. Here, we present a case of long-term survival in a patient who underwent this treatment. CASE PRESENTATION A 54-year-old man was initially referred to our department for treatment of stage III (cT3N1M0) gastric cancer where he underwent laparoscopic distal gastrectomy and D2 lymph node dissection. After a year of uneventful follow-up, the patient was diagnosed with a tumor in the gastric remnant combined with liver metastasis, resulting in a diagnosis of stage IV (cT3N0M1) gastric remnant cancer. Subsequently, the patient was treated with four cycles of TS-1, Oxaliplatin, and Nivolumab as the first-line regimen. Remarkably, both the remnant tumor and liver metastasis exhibited significant shrinkage, and no new lesions were found. Given this response, conversion surgery was performed to achieve complete resection of the remnant gastric cancer and liver metastasis, followed by laparoscopic remnant gastrectomy and partial hepatectomy. Pathological examination revealed the absence of residual carcinoma cells and lymph node metastases. Postoperatively, the patient was treated with adjuvant chemotherapy with S-1 for 1 year, and survived without recurrence for 18 months after conversion surgery. CONCLUSIONS Nivolumab combination chemotherapy shows promise as a clinically beneficial treatment approach for gastric remnant cancer with liver metastasis, particularly when pCR can be achieved following conversion surgery.
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Affiliation(s)
- Kaori Katsumata
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Yosuke Morimoto
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan.
| | - Junya Aoyama
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Toru Yamada
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Yusuke Katsuki
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Ryo Nishiyama
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Tomohisa Egawa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-Ku, Yokohama, Kanagawa, 230-0012, Japan
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Morito A, Eto K, Iwatsuki M, Toihata T, Kosumi K, Iwagami S, Baba Y, Miyamoto Y, Yoshida N, Baba H. Clinical impact of very early recurrence after conversion surgery for stage IV gastric cancer. Ann Gastroenterol Surg 2024; 8:214-220. [PMID: 38455498 PMCID: PMC10914691 DOI: 10.1002/ags3.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 03/09/2024] Open
Abstract
Background The development and improved response to chemotherapy has resulted in a survival benefit of conversion surgery (CS) for advanced gastric cancer (GC). However, this benefit is limited in some cases, such as in those with very early recurrence (VER). This study investigated the relationship between outcome and clinicopathological characteristics after CS for stage IV GC, and the risk factors for VER after CS. Methods We retrospectively studied 184 patients with stage IV GC who initially underwent chemotherapy, including 36 patients who underwent CS between May 2007 and January 2022. We evaluated the long-term outcome after CS for stage IV GC and the clinicopathological characteristics of the patients who underwent CS. Results Median survival times (MSTs) in the chemotherapy alone and CS groups were 13.4 and 36.5 months, respectively (p < 0.0001). Of the 27 patients who underwent R0 resection, 22 remained free of early recurrence and five experienced VER. MSTs in the VER and free of early recurrence groups were 15.2 and 44.1 months, respectively (p < 0.0001). Significantly more patients had liver metastasis before initial treatment in the VER group than in the FER group (p = 0.016). There were more patients with preoperative PNI <40 in the VER group (p = 0.046). Conclusion CS is an effective treatment for stage IV GC, but VER is associated with poor prognosis. We need to carefully consider the indications for CS, especially for patients with poor nutritional status and liver metastases.
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Affiliation(s)
- Atsushi Morito
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Tasuku Toihata
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Keisuke Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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18
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Zhang Z, Liao Y, Zhao P, Chen X, Liu Y, Wu J, Zuo H. Hypoxia-based critical gene biomarkers as prognostic reporters for gastric adenocarcinoma. ENVIRONMENTAL TOXICOLOGY 2024; 39:1811-1821. [PMID: 38073300 DOI: 10.1002/tox.24064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Gastric cancer is the most common malignant tumour of the digestive system, yet there is a lack of reported prognostic biomarkers for STAD patients. METHODS Transcriptomic expression data of STAD from GEO database, single cell sequencing data from OMIX gastric cancer database. Conservative molecular typing of gastric cancer was constructed using non-negative matrix factorization (NMF). The abundance of 28 immune cells in the tumour samples was assessed using ssGSEA. The R package "oncoPredict" was used to predict chemotherapy response. TIDE website for immunotherapy response prediction. Finally, single cell analysis was performed to clarify the specific type annotation of STAD cells and to analysis their spatial expression. RESULTS Hypoxia-score demonstrated excellent prognostic discrimination in TCGA gastric cancer samples. Among multiple deconvolution-based algorithms for immune infiltration, Hypoxia-score presented a general immunosuppressive efficacy across multiple datasets, as evidenced by a broad negative correlation with immune cell infiltration. By the likelihood that each group may have specific drug sensitivity to multiple chemotherapeutic and targeted agents. Results showed that high-risk scoring patients were more sensitive to Staurosporine, Sabutoclax, and AZD8055, while low-risk patients were more sensitive to Bortezomib, Dactinomycin, Docetaxel, Daporinad, Sepantronium, and bromide. In the immunotherapy cohort, the Hypoxia-score presented the ability to discriminate for immunotherapy efficacy. The distribution of Hypoxia-score in single-cell descending space was calculated using AddModuleScore and was found to be distributed across the various cell types annotated in the single-cell analysis. It is suggested that various cells in the tumour microenvironment are involved in hypoxia gene set processes to varying degrees. CONCLUSION The Hypoxia-score proves to be a valuable tool for assessing the prognosis of gastric cancer patients and guiding drug treatments, providing significant guidance for clinical diagnosis and treatment in the context of gastric cancer.
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Affiliation(s)
- Zhiya Zhang
- Department of Oncology, The Second People's Hospital of Meishan City, Meishan, Sichuan, China
| | - Yin Liao
- Department of Oncology, The Second People's Hospital of Meishan City, Meishan, Sichuan, China
| | - Peiyou Zhao
- Department of Oncology, The Second People's Hospital of Meishan City, Meishan, Sichuan, China
| | - Xinwei Chen
- Department of Oncology, The Second People's Hospital of Meishan City, Meishan, Sichuan, China
| | - Yunfei Liu
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ji Wu
- Second School of Clinical Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hongbin Zuo
- Department of General surgery, Wuhan Jiangxia Hospital of TCM (Traditional Chinese Medicine), Wuhan, Hubei, China
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19
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Yasufuku I, Tsuchiya H, Fujibayashi S, Okumura N, Sengoku Y, Fukada M, Asai R, Sato Y, Tajima JY, Kiyama S, Kato T, Tanaka Y, Murase K, Matsuhashi N. Oligometastasis of Gastric Cancer: A Review. Cancers (Basel) 2024; 16:673. [PMID: 38339424 PMCID: PMC10854838 DOI: 10.3390/cancers16030673] [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: 12/26/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
The concept of oligometastasis is not yet fully established in the field of gastric cancer. However, metastatic lesions that are localized, technically resectable at diagnosis, present a certain response to preoperative chemotherapy, and present favorable survival outcomes with local treatments, sometimes in combination with chemotherapy, are recognized as oligometastasis in the field of gastric cancer. Oligometastasis is noted in European Society for Medical Oncology guidelines and Japanese gastric cancer treatment guidelines, and local treatment is mentioned as one of the pivotal treatment options for oligometastasis. Solitary liver metastasis or a small number of liver metastases; retroperitoneal lymph node metastasis, especially localized para-aortic lymph node metastasis; localized peritoneal dissemination; and Krukenberg tumor are representative types of oligometastasis in gastric cancer. The AIO-FLOT3 trial prospectively evaluated the efficacy of multimodal treatments for gastric cancer with oligometastasis, including surgical resection of primary and metastatic lesions combined with chemotherapy, confirming favorable survival outcomes. Two phase 3 studies are ongoing to investigate the efficacy of surgical resection combined with perioperative chemotherapy compared with palliative chemotherapy. Thus far, the evidence suggests that multimodal treatment for oligometastasis of gastric cancer is promising.
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Affiliation(s)
- Itaru Yasufuku
- Department of Clinical Anatomy Development Studies, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan;
| | - Hiroshi Tsuchiya
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Seito Fujibayashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Naoki Okumura
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Yuki Sengoku
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Masahiro Fukada
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Ryuichi Asai
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Yuta Sato
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Jesse Yu Tajima
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Shigeru Kiyama
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Takazumi Kato
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Yoshihiro Tanaka
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Katsutoshi Murase
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
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20
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Hojo Y, Ishida Y, Tomita T, Kurahashi Y, Nakamura T, Kitayama Y, Nakao E, Kohno S, Murakami M, Takeuchi J, Takagawa T, Hirota S, Shinohara H. Treatment strategy for successful conversion surgery in clinical stage IVB gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107314. [PMID: 38101115 DOI: 10.1016/j.ejso.2023.107314] [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: 09/02/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Recent advances in chemotherapy have resulted in successful conversion surgery (CS) for clinical stage (cStage) IVB gastric cancer (GC). This study aimed to evaluate the success rate of CS in clinical practice and determine optimal treatment strategies. METHODS Totally, 166 patients with cStage IVB gastric and gastroesophageal junction adenocarcinoma, who underwent chemotherapy at Hyogo Medical University Hospital between January 2017 and June 2022, were included. CS was performed after confirming tumor to be M0 based on imaging and/or staging laparoscopy, except for resectable liver metastases. Preoperative chemotherapy was continued for at least 6 months provided that adverse events were manageable. RESULTS Of 125 eligible patients, 23 were treated with CS, achieving a conversion rate of 18.4% and an R0 resection rate of 91.3%. The median duration of preoperative chemotherapy was 8.5 months; the median number of cycles was eight. The highest conversion rate was observed in patients receiving first-line treatment (14.4%), followed by those receiving second and third lines (5.8% and 2.3%, respectively). The median survival time in patients who received CS was significantly longer than that in patients who continued chemotherapy alone (56.7 versus 16 months, respectively, P < 0.0001). There was no significant difference in the 3-year overall survival between the patients who achieved CS after first-line treatment (63.2%, n = 18) and those who achieved CS after second- or third-line treatment (66.7%, n = 5). CONCLUSION Consistent chemotherapy strategies could lead to successful CS and improved prognosis in a greater number of patients with cStage IVB GC, regardless of line of treatment.
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Affiliation(s)
- Yudai Hojo
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ishida
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yasunori Kurahashi
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tatsuro Nakamura
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshitaka Kitayama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Eiichiro Nakao
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shugo Kohno
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Motoki Murakami
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tetsuya Takagawa
- Center for Clinical Research and Education, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Noma T, Nishi M, Takasu C, Wada Y, Yoshikawa K, Tokunaga T, Nakao T, Kashihara H, Yoshimoto T, Miyakami Y, Atsumi K, Uehara H, Shimada M. Conversion surgery after successful response to chemotherapy (S-1 + oxaliplatin + nivolumab) in a patient with stage IV gastric cancer with peritoneal metastasis (P1, CY1): a case report. Int Cancer Conf J 2024; 13:11-16. [PMID: 38187176 PMCID: PMC10764698 DOI: 10.1007/s13691-023-00628-4] [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: 05/17/2023] [Accepted: 08/01/2023] [Indexed: 01/09/2024] Open
Abstract
We here present a case report of a patient with Stage IV gastric cancer with peritoneal metastasis (P1, CY1) who underwent conversion surgery after a successful response to chemotherapy (S-1 + oxaliplatin + nivolumab). The patient was a woman in her 60 s. Her chief complaint was epigastric pain. Upper gastrointestinal endoscopy showed Type 4 advanced carcinoma on the lesser curvature of the gastric body. Biopsy showed Group 5 (poorly differentiated adenocarcinoma) and HER2 was negative. Staging laparoscopy revealed seeding in the round ligament of the liver (P1) and adenocarcinoma cells in ascites (CY1). Ten courses of chemotherapy (S-1 + oxaliplatin + nivolumab) were administered, after which contrast-enhanced computed tomography showed that the primary tumor had shrunk and seeding was no longer detectable. Upper gastrointestinal endoscopy revealed scar-like changes. A second staging laparoscopy revealed that ascites cytology was negative and a biopsy of the round ligament of the liver showed no malignant cells (P0, CY0). Conversion surgery comprising laparoscopic total gastrectomy with D2 lymph node dissection and resection of the round ligament of the liver was performed. The postoperative course was uneventful. Histopathological examination of the resected specimen revealed no tumor cells in the gastric mesentery or the round ligament of the liver. The pathological diagnosis was gastric cancer [M, U, L, Less, Ant, Post, type4, T3(SS), N0, M0 (H0, P0, CY0), ypStage IIA]. Adjuvant chemotherapy (S-1) was commenced. The patient is still alive 7 months later with no evidence of recurrence.
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Affiliation(s)
- Takayuki Noma
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Masaaki Nishi
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Chie Takasu
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Yuma Wada
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Kozo Yoshikawa
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Takuya Tokunaga
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Toshihiro Nakao
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Hideya Kashihara
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Yuko Miyakami
- Division of Pathology, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Kengo Atsumi
- Division of Pathology, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Hisanori Uehara
- Division of Pathology, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
| | - Mitsuo Shimada
- Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1 Kuramoto Town, Tokushima City, Tokushima 770-8503 Japan
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22
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Bencivenga M, Ministrini S, Morgagni P, Mura G, Marrelli D, Milandri C, Mazzei MA, Berselli M, Monti M, Graziosi L, Reddavid R, Rosa F, Solaini L, Donini A, Fumagalli Romario U, Roviello F, de Manzoni G, Tiberio GAM. Oligometastatic Gastric Cancer: Clinical Data from the Meta-Gastro Prospective Register of the Italian Research Group on Gastric Cancer. Cancers (Basel) 2023; 16:170. [PMID: 38201597 PMCID: PMC10778436 DOI: 10.3390/cancers16010170] [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: 11/18/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Interest in the field of metastatic gastric cancer has grown in recent years, and the identification of oligometastatic patients plays a critical role as it consents to their inclusion in multimodal treatment strategies, which include systemic therapy but also surgery with curative intent. To collect sound clinical data on this subject, The Italian Research Group on Gastric Cancer developed a prospective multicentric observational register of metastatic gastric cancer patients called META-GASTRO. METHODS Data on 383 patients in Meta-Gastro were mined to help our understanding of oligometastatic, according to its double definition: quantitative/anatomical and dynamic. RESULTS the quantitative/anatomical definition applies to single-site metastases independently from the metastatic site (p < 0.001) to peritoneal metastases with PCI ≤ 12 (p = 0.009), to 1 or 2 hepatic metastases (p = 0.024) and nodal metastases in station 16 (p = 0.002). The dynamic definition applies to a percentage of cases variable according to the metastatic site: 8%, 13.5 and 23.8% for hepatic, lymphatic and peritoneal sites, respectively. In all cases, the OS of patients benefitting from conversion therapy was similar to those of cases deemed operable at diagnosis and operated after neoadjuvant chemotherapy. CONCLUSIONS META-GASTRO supports the two-fold definition of oligometastatic gastric cancer: the quantitative/anatomical one, which accounts for 30% of our population, and the dynamic one, observed in 16% of our cases.
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Affiliation(s)
- Maria Bencivenga
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, 37125 Verona, Italy; (M.B.); (G.d.M.)
| | - Silvia Ministrini
- Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25100 Brescia, Italy;
| | - Paolo Morgagni
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy; (P.M.); (L.S.)
| | - Gianni Mura
- Department of Surgery, San Donato Hospital, 52100 Arezzo, Italy;
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.M.); (F.R.)
| | - Carlo Milandri
- Department of Oncology, San Donato Hospital, 52100 Arezzo, Italy;
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, University of Siena, 53100 Siena, Italy;
| | - Mattia Berselli
- General Surgical Unit I, Department of Surgery, ASST Settelaghi-Varese, 21100 Varese, Italy;
| | - Manlio Monti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Luigina Graziosi
- Chirurgia Generale e d’Urgenza, Azienda Ospedaliera di Perugia, 06121 Perugia, Italy; (L.G.); (A.D.)
| | - Rossella Reddavid
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, Orbassano, 10043 Torino, Italy;
| | - Fausto Rosa
- Department of Digestive Surgery, A. Gemelli Hospital, Catholic University, 00168 Roma, Italy;
| | - Leonardo Solaini
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy; (P.M.); (L.S.)
| | - Annibale Donini
- Chirurgia Generale e d’Urgenza, Azienda Ospedaliera di Perugia, 06121 Perugia, Italy; (L.G.); (A.D.)
| | | | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.M.); (F.R.)
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, 37125 Verona, Italy; (M.B.); (G.d.M.)
| | - Guido Alberto Massimo Tiberio
- Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25100 Brescia, Italy;
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Kobiałka S, Sędłak K, Pelc Z, Mlak R, Endo Y, Bogacz P, Kurylcio A, Polkowski WP, Pawlik TM, Rawicz-Pruszyński K. Hyperthermic Intraperitoneal Chemotherapy (HIPEC), Oncological Outcomes and Long-Term Survival among Patients with Gastric Cancer and Limited Peritoneal Disease Progression after Neoadjuvant Chemotherapy. J Clin Med 2023; 13:161. [PMID: 38202168 PMCID: PMC10779559 DOI: 10.3390/jcm13010161] [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: 11/30/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The role of surgery in stage IV gastric cancer with peritoneal metastasis (PM) remains unclear. The objective of the current single-center study was to define the impact of gastrectomy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on outcomes among Central European GC patients with limited peritoneal disease progression after neoadjuvant chemotherapy (NAC). METHODS Patients with histologically confirmed GC who underwent curative-intent multimodal treatment between 2013 and 2023 were included. Patients without adenocarcinoma, who did not undergo gastrectomy, had early (cT1) or metastatic GC at the time of initial diagnosis, who underwent multivisceral resection, incomplete cytoreduction or palliative care, died before planned curative-intent treatment, or had incomplete clinical or pathological missing information were excluded. RESULTS A total of 74 patients who underwent curative-intent treatment for GC with PM were included in the final analytic cohort. Patients who underwent gastrectomy with CRS+HIPEC were less likely to achieve TOO (CRS+HIPEC: 28% vs. CRS: 57.1%, p = 0.033) compared with individuals after CRS alone. Specifically, patients who underwent gastrectomy with CRS+HIPEC had a higher likelihood of postoperative complications (CRS+HIPEC: 48% vs. CRS: 20.4%, p = 0.018) and longer hospital LOS (median, CRS+HIPEC: 12 vs. CRS: 10, p = 0.019). While administration of HIPEC did not impact long-term survival (median OS, CRS+HIPEC: 16 months vs. CRS: 12 months, p = 0.55), postoperative complications (median OS, CCI < 30:16 months vs. CCI > 30:5 months, p = 0.024) and ICU stay (median OS, no ICU stay: 16 months vs. ICU stay: 5 months, p = 0.008) were associated with worsened long-term survival among GC patients with PM. CONCLUSIONS Data from the current study demonstrated a lack of survival benefit among advanced GC patients with PM undergoing gastrectomy with CRS+HIPEC when compared with individuals after gastrectomy with CRS alone. Administration of perioperative chemotherapy and achievement of TO failed to withstand the peritoneal disease progression during NAC.
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Affiliation(s)
- Sebastian Kobiałka
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, 20-080 Lublin, Poland;
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
| | - Paweł Bogacz
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
| | - Andrzej Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
| | - Wojciech P. Polkowski
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland; (S.K.); (K.S.); (Z.P.); (A.K.); (W.P.P.)
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
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Liang H, Yan X, Li Z, Chen X, Qiu Y, Li F, Wang M, Huang Z, Huang K, Xie Q, Zhang H, Zhong R, Zhao Z, Zou Y, Yu J, Hu Y, Liu H, Li G, Zhao L. Clinical outcomes of conversion surgery following immune checkpoint inhibitors and chemotherapy in stage IV gastric cancer. Int J Surg 2023; 109:4162-4172. [PMID: 37720943 PMCID: PMC10720795 DOI: 10.1097/js9.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The clinical benefit of conversion surgery following immunochemotherapy in patients with stage IV gastric cancer (GC) remains uncertain. This study aims to clarify the clinical outcomes of conversion surgery for such patients. METHODS This retrospective cohort study enroled consecutive patients with stage IV GC treated with a combination of immune checkpoint inhibitors and chemotherapy and/or anti-human epidermal growth factor receptor-2 targeted therapy as first-line therapy. Cumulative survival curves were estimated using Kaplan-Meier method. Logistic regression and Cox regression analyses were conducted to identify factors associated with conversion surgery and survival, respectively. RESULTS Among the 136 patients included in the study. The disease control rate was 72.1% (98/136), with objective response rate in 58.8% (80/136) and complete response rate in 5.9% (8/136). Among 98 patients with disease control, 56 patients underwent palliative immunochemotherapy with median progression-free survival (PFS) and overall survival at 9.2 and 16.2 months, respectively; the remaining 42 patients underwent conversion surgery, yielding an unreached median PFS over a 19.0-month median follow-up, accompanied by 1-year overall survival and PFS rates of 96.6% and 89.1%, respectively. The R0 resection rate reached 90.5% (38/42). 7 out of 42 patients achieved pathological complete response, of whom three patients demonstrated human epidermal growth factor receptor-2 positivity. No serious complications leading to death were observed during the perioperative period. Multivariate analysis indicated that programmed death ligand 1 combined positive score greater than or equal to 5 (odds ratio, 0.22; 95% CI, 0.08-0.57; P =0.002) favored successful conversion surgery, while signet ring cell carcinoma (hazard ratio, 6.29; 95% CI, 1.56-25.36; P =0.010) was the poor prognostic factor associated with survival in patients who underwent conversion surgery. CONCLUSIONS Conversion surgery holds the potential for significant survival benefits in stage IV GC patients who have achieved a favourable clinical response to immunochemotherapy. Individuals with signet ring cell carcinoma may experience increased post-conversion surgery recurrence.
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Affiliation(s)
- Huayuan Liang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Xiao Yan
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Zhiwei Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Xinhua Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Yaopeng Qiu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Fengping Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Minghao Wang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Zhicheng Huang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Kaihua Huang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Qing Xie
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Huimin Zhang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Rou Zhong
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
| | - Zhuoyang Zhao
- Department of Pathology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuan Zou
- Department of Pathology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiang Yu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
- Multidisciplinary Team of Gastric Tumor , Nanfang Hospital, Southern Medical University
| | - Yanfeng Hu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
- Multidisciplinary Team of Gastric Tumor , Nanfang Hospital, Southern Medical University
| | - Hao Liu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
- Multidisciplinary Team of Gastric Tumor , Nanfang Hospital, Southern Medical University
| | - Guoxin Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
- Multidisciplinary Team of Gastric Tumor , Nanfang Hospital, Southern Medical University
| | - Liying Zhao
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University
- Multidisciplinary Team of Gastric Tumor , Nanfang Hospital, Southern Medical University
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Dai W, Chen Y, Xue Y, Wan M, Mao C, Zhang K. Progress in the Treatment of Peritoneal Metastatic Cancer and the Application of Therapeutic Nanoagents. ACS APPLIED BIO MATERIALS 2023; 6:4518-4548. [PMID: 37916787 DOI: 10.1021/acsabm.3c00662] [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] [Indexed: 11/03/2023]
Abstract
Peritoneal metastatic cancer is a cancer caused by the direct growth of cancer cells from the primary site through the bloodstream, lymph, or peritoneum, which is a difficult part of current clinical treatment. In the abdominal cavity of patients with metastatic peritoneal cancer, there are usually nodules of various sizes and malignant ascites. Among them, nodules of different sizes can obstruct intestinal movement and form intestinal obstruction, while malignant ascites can cause abdominal distension and discomfort, and even cause patients to have difficulty in breathing. The pathology and physiology of peritoneal metastatic cancer are complex and not fully understood. The main hypothesis is "seed" and "soil"; i.e., cells from the primary tumor are shed and implanted in the peritoneal cavity (peritoneal metastasis). In the last two decades, the main treatment modalities used clinically are cytoreductive surgery (CRS), systemic chemotherapy, intraperitoneal chemotherapy, and combined treatment, all of which help to improve patient survival and quality of life (QOL). However, the small-molecule chemotherapeutic drugs used clinically still have problems such as rapid drug metabolism and systemic toxicity. With the rapid development of nanotechnology in recent years, therapeutic nanoagents for the treatment of peritoneal metastatic cancer have been gradually developed, which has improved the therapeutic effect and reduced the systemic toxicity of small-molecule chemotherapeutic drugs to a certain extent. In addition, nanomaterials have been developed not only as therapeutic agents but also as imaging agents to guide peritoneal tumor CRS. In this review, we describe the etiology and pathological features of peritoneal metastatic cancer, discuss in detail the clinical treatments that have been used for peritoneal metastatic cancer, and analyze the advantages and disadvantages of the different clinical treatments and the QOL of the treated patients, followed by a discussion focusing on the progress, obstacles, and challenges in the use of therapeutic nanoagents in peritoneal metastatic cancer. Finally, therapeutic nanoagents and therapeutic tools that may be used in the future for the treatment of peritoneal metastatic cancer are prospected.
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Affiliation(s)
- Wenjun Dai
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Yidan Chen
- Department of Radiation Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Yunxin Xue
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Mimi Wan
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Chun Mao
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Ke Zhang
- Department of Radiation Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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Nakamura I, Hatano E, Baba H, Kamei K, Wada H, Shimizu J, Kanai M, Yoshimura K, Nagano H, Ioka T. Impact of conversion surgery after chemotherapy in patients with initially unresectable and recurrent biliary tract cancer. Ann Gastroenterol Surg 2023; 7:1009-1020. [PMID: 37927929 PMCID: PMC10623972 DOI: 10.1002/ags3.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Gemcitabine, cisplatin, and S-1 chemotherapy was superior to gemcitabine and cisplatin chemotherapy for progression-free survival and overall survival for unresectable and recurrent biliary tract cancer in a randomized phase III trial (KHBO1401). This study aimed to evaluate the outcome of conversion surgery after chemotherapy in biliary tract cancer patients (ancillary study, KHBO1401-3C). Methods A total of 246 patients were enrolled in KHBO1401. We compared progression-free and overall survivals between the conversion surgery and non-conversion surgery groups. Results Eight patients (3.3%) underwent conversion surgery with chemotherapy, seven of whom were diagnosed with unresectable disease and one with recurrence. Six and two patients received gemcitabine, cisplatin, and S-1 chemotherapy as well as gemcitabine and cisplatin chemotherapy, respectively. Three patients in the conversion surgery group who received gemcitabine, cisplatin, and S-1 chemotherapy showed no disease progression and survived without postoperative chemotherapy. Preoperative carbohydrate antigen 19-9 (CA19-9) level was a prognostic factor for conversion surgery. After correcting for immortal time bias, 1-year progression-free survival rates in the conversion surgery and non-conversion surgery groups were 50.0% and 19.0%, respectively (hazard ratio 0.343, 95% confidence interval 0.286-0.843, p = 0.0092). One-year overall survival rates in the conversion surgery and non-conversion surgery groups were 87.5% and 56.0%, respectively (hazard ratio 0.222, 95% confidence interval 0.226-0.877, p = 0.0197). Conclusions Conversion surgery might be an option for the treatment of unresectable and recurrent biliary tract cancer in patients with normal preoperative CA19-9 level.
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Affiliation(s)
- Ikuo Nakamura
- Department of Gastroenterological SurgeryHyogo Medical UniversityHyogoJapan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Keiko Kamei
- Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan
| | - Hiroshi Wada
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Junzo Shimizu
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Masashi Kanai
- Department of Clinical Oncology and Pharmacogenomics, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Kenichi Yoshimura
- Center for Integrated Medical ResearchHiroshima UniversityHiroshimaJapan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Graduate School of MedicineYamaguchi UniversityYamaguchiJapan
| | - Tatsuya Ioka
- Oncology CenterYamaguchi University HospitalUbeJapan
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27
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Tokunaga M, Kurokawa Y, Fukagawa T, Muro K, Shitara K, Kodera Y, Terashima M. Neoadjuvant chemotherapy for locally advanced gastric cancer in Japan: Consensus meeting at the 77th general meeting of the Japanese Society of Gastroenterological Surgery. Ann Gastroenterol Surg 2023; 7:856-862. [PMID: 37927916 PMCID: PMC10623975 DOI: 10.1002/ags3.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 07/04/2023] [Indexed: 11/07/2023] Open
Abstract
Treatment strategy for locally advanced gastric cancer differs worldwide. Neoadjuvant chemotherapy (NAC) is considered one of the promising treatment options for locally advanced gastric cancer, even in Japan, and clinical trials have been conducted or are ongoing. A consensus meeting was organized at the 77th general meeting of the Japanese Society of Gastroenterological Surgery in 2022, in which the current status and future prospects of NAC for locally advanced gastric cancer were discussed. Participants at the meeting looked forward to the results of the JCOG1509 trial, providing solid evidence regarding NAC. The optimal indications and regimens for NAC were also debated. Patients with cStage III gastric cancer are the main targets of NAC in Japan, and a doublet regimen of S-1 and oxaliplatin was preferred by the participants. However, the feasibility of a triplet regimen with S-1, oxaliplatin, and docetaxel, and that with 5-FU, leucovorin, oxaliplatin, and docetaxel has been demonstrated, and these could become treatment options in Japan. Other points of discussion include perioperative chemotherapy to avoid peritoneal recurrence and for patients with dMMR/MSI-high tumors. The panel regarded NAC as a promising treatment option, and NAC will become the standard treatment for cStage III gastric cancer in Japan if an ongoing clinical trial successfully demonstrates its efficacy.
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Affiliation(s)
- Masanori Tokunaga
- Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Takeo Fukagawa
- Department of Surgery, School of MedicineTeikyo UniversityTokyoJapan
| | - Kei Muro
- Department of Clinical OncologyAichi Cancer Center HospitalNagoyaJapan
| | - Kohei Shitara
- Department of Gastrointestinal Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Yasuhiro Kodera
- Department of Gastroenterological SurgeryNagoya University Graduate School of MedicineNagoyaJapan
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Wang C, Zhang X, Liu Y, Lin S, Yang C, Chen B, Li W. Efficacy and long-term prognosis of gastrojejunostomy for malignant gastric outlet obstruction: A systematic review and Bayesian network meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106967. [PMID: 37385941 DOI: 10.1016/j.ejso.2023.06.019] [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: 02/13/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Gastrojejunostomy (GJ) is becoming a standard surgical treatment for ameliorating malignant gastric outlet obstruction (MGOO). However, data on the long-term outcomes of MGOO treatment are lacking. This network meta-analysis aimed to compare overall survival (OS) rates and subsequent anticancer treatment outcomes of GJwith other therapies in MGOO. METHODS We searched four electronic databases, including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from inception to August 1, 2022. Studies reporting OS associated with GJ versus other treatments for MGOO were selected. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome assessed was OS, whereas the secondary outcome was subsequent anticancer treatment. We performed a Bayesian network meta-analysis to produce hazard ratios (HR) and odds ratios (OR) with 95% credible intervals (CrIs). RESULTS We identified 24 retrospective studies that included 2473 patients. The studies assessed the outcomes of six treatments to alleviate MGOO. Results showed that GJ (hazard ratio: 0.83, 95% CrI: 0.78-0.88) was the most effective treatment for patients with MGOO, with the greatest surface under the cumulative ranking curve (SUCRA) values (79.9%) versus non-resection, palliative chemotherapy (13.9%) in terms of OS. Similarly, GJ (SUCRA: 46.5%) improved subsequent anticancer treatment requirements, ranking second only to jejunostomy/gastrostomy (JT/GT) (SUCRA: 95.9%). CONCLUSIONS Our study demonstrates that GJ improves OS and follow-up treatments versus other non-resection treatments in patients with MGOO. These findings may serve for selecting appropriate therapy for MGOO.
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Affiliation(s)
- Chuandong Wang
- Department of Thyroid and Breast Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, 361006, China; Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Xiaojuan Zhang
- Department of Radiology, Xiamen Humanity Hospital Fujian Medical University, Xiamen, 361006, China
| | - Yi Liu
- Endoscopic Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China; Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100021, China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China; Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China; Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Bing Chen
- Department of Thyroid and Breast Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, 361006, China.
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China; Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China.
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Nakanishi K, Tanaka C, Kanda M, Miyata K, Furukawa K, Maeda O, Shimizu D, Sugita S, Kakushima N, Furune S, Kawashima H, Ando Y, Ebata T, Kodera Y. Low Expectancy of Conversion Surgery with R0 Resection in Patients with CEA > 5.0 ng/mL at the Initial RECIST Evaluation for Metastatic Gastric Cancer. Cancers (Basel) 2023; 15:5197. [PMID: 37958371 PMCID: PMC10650046 DOI: 10.3390/cancers15215197] [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: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
This retrospective study examined early the predictive factors for successful conversion surgery (CS) with R0 resection in patients with metastatic gastric cancer (MGC) who underwent systemic chemotherapy. This study included 204 patients diagnosed with metastatic gastric adenocarcinoma, who received chemotherapy between 2009 and 2019. Of these patients, 31 (15%) underwent CS with R0 resection. The incidence of CS with R0 resection was not affected by the volume of metastatic lesions or the presence of peritoneal metastasis. The overall survival time of the CS with R0 resection group was significantly longer than that of the non-CS group (hazard ratio, 0.12; 95% confidence interval, 0.07-0.23; p < 0.0001), with a 5 year overall survival rate of 50.2%. Multivariate analysis of 150 patients, excluding those with disease progression until the initial Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, showed that carcinoembryonic antigen > 5.0 ng/mL at the initial RECIST evaluation was an independent, significant, and unfavorable predictor of CS with R0 resection (odds ratio, 0.21; p = 0.0108), whereas systemic chemotherapy with trastuzumab for HER2-positive cancer was a favorable factor (odds ratio, 4.20; p = 0.0119). Monitoring serum carcinoembryonic antigen levels during chemotherapy may be a useful predictor of the CS implementation in patients with MGC.
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Affiliation(s)
- Koki Nakanishi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Osamu Maeda
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Dai Shimizu
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Shizuki Sugita
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Satoshi Furune
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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30
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Rosa F, Laterza V, Schena CA, Tondolo V, Strippoli A, Covino M, Pacini G, Quero G, Fiorillo C, DE Sio D, Tortora G, Alfieri S. Surgery for locally advanced gastric cancer in the era of neoadjuvant therapies: something new? Minerva Surg 2023; 78:481-489. [PMID: 37283508 DOI: 10.23736/s2724-5691.23.09884-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Locally advanced gastric cancer (LAGC) represents a therapeutic challenge, particularly as it often involves adjacent organs. The necessity of neoadjuvant treatments for LAGC patients is still controversial. The aim of this study was to analyze the factors affecting prognosis and survival in patients with LAGC with particular regard to the effect of neoadjuvant therapies. METHODS Between January 2005 and December 2018, the medical records of 113 patients with LAGC who underwent curative resection were retrospectively reviewed. Patient characteristics, related complications, long-term survival, and prognostic factors were analyzed at uni- and multivariate analyses. RESULTS Postoperative mortality and morbidity rates of patients undergoing neo-adjuvant therapies were 2.3% and 43.2%, respectively. Whereas in patients undergoing upfront surgery were 4.6% and 26.1%, respectively. R0 resection was achieved 79.5% and in 73.9% of patients undergoing neoadjuvant therapy and upfront surgery, respectively (P<0.001). Multivariate analysis revealed that neoadjuvant therapy, completeness of resection (R0), number of lymph nodes retrieved, N status and the adoption of hyperthermic intraperitoneal chemotherapy were independent prognostic factors associated with longer survival. Five-year overall survival for NAC group and upfront surgery group was 46% and 32%, respectively (P=0.04). Five-year disease-free survival for NAC group and upfront surgery group was 38% and 25%, respectively (P=0.02). CONCLUSIONS Patients with LAGC undergoing surgery plus neoadjuvant therapy had a better OS and DFS with respect to patients treated with surgery alone.
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Affiliation(s)
- Fausto Rosa
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
- Sacred Heart Catholic University, Rome, Italy -
| | - Vito Laterza
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carlo A Schena
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Vincenzo Tondolo
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonia Strippoli
- Department of Medical Oncology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Marcello Covino
- Sacred Heart Catholic University, Rome, Italy
- Department Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giovanni Pacini
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giuseppe Quero
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Claudio Fiorillo
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Davide DE Sio
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giampaolo Tortora
- Department of Medical Oncology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Sergio Alfieri
- Department of Digestive Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
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Nakashima T, Arigami T, Uenosono Y, Matsushita D, Shimonosono M, Tsuruda Y, Sasaki K, Baba K, Kurahara H, Ohtsuka T. Clinical significance of intraperitoneal paclitaxel combined with systemic chemotherapy for gastric cancer with peritoneal metastasis. Int J Clin Oncol 2023; 28:1371-1377. [PMID: 37432613 DOI: 10.1007/s10147-023-02384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Despite investigations of intraperitoneal paclitaxel as a personalized treatment for peritoneal metastasis of gastric cancer, few studies have evaluated its prognostic impact on conversion surgery for unresectable gastric cancer with peritoneal metastasis. Our study aimed to close this gap in knowledge. METHODS We retrospectively enrolled 128 patients who underwent chemotherapy for peritoneal metastasis from gastric cancer and assigned them into intraperitoneal (IP) (n = 36) and non-IP (n = 92) groups, based on the use of intraperitoneal paclitaxel plus systemic chemotherapy. RESULTS Disease control rates were 94% and 69% in the IP and non-IP groups, respectively, with the former having a significantly higher tumor response rate than the latter (p < 0.01). The median survival times in the IP and non-IP groups were 665 and 359 days, respectively, with the former having significantly better prognosis than the latter (p = 0.02). Fifteen (42%) and sixteen (17%) patients underwent conversion surgery after chemotherapy in the IP and non-IP groups, respectively, with the former having a significantly higher conversion surgery induction rate than the latter (p < 0.01). Although the prognosis of the conversion surgery group was significantly better than that of the non-conversion surgery group (p < 0.01), there was no significant difference in prognosis between patients in the IP and non-IP groups who underwent conversion surgery (p = 0.22). Multivariate analysis identified performance status and conversion surgery as independent prognostic factors (all p < 0.01). CONCLUSION Our study demonstrated that the IP chemotherapy was one of important factors for conversion surgery induction, while it was not a risk factor for prognosis.
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Affiliation(s)
- Taiki Nakashima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Takaaki Arigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan.
| | - Yoshikazu Uenosono
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Daisuke Matsushita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Masataka Shimonosono
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Yusuke Tsuruda
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Ken Sasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Kenji Baba
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, KAGOSHIMA, Japan
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左 芦, 王 炼, 杨 子, 李 骏, 王 文, 李 静, 王 月, 宋 雪, 张 小, 耿 志. [High expression of CAMSAP2 promotes invasion and metastasis of gastric cancer cells by upregulating TGF-β signaling]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:1460-1468. [PMID: 37814859 PMCID: PMC10563100 DOI: 10.12122/j.issn.1673-4254.2023.09.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the expression of calmodulin-regulated spectrin-associated protein 2 (CAMSAP2) in gastric cancer and its effect on gastric cancer cell invasion and metastasis. METHODS The association of CAMSAP2 expression levels with progression and prognosis of gastric cancer was analyzed using public cancer data and in 106 patients receiving radical gastrectomy in our hospital from October, 2013 to October, 2017. The biological functions of CAMSAP2 were predicted using bioinformatics analysis. Gastric cancer MGC803 cells with CAMSAP2 overexpression and knockdown were observed for epithelial-mesenchymal transition (EMT), migration and invasion. A nude mouse model bearing orthotopic gastric cancer cell xenografts was established for verifying the results and exploring the underlying molecular mechanism. RESULTS Gastric cancer tissues expressed high levels of CAMSAP2, which were positively correlated with CEA and CA19-9 (P<0.001). Cox regression analysis showed that CAMSAP2 expression level was an independent risk factor affecting the 5-year survival rate of gastric cancer patients (HR=2.969, 95% CI: 1.031-8.548). Enrichment analysis suggested that CAMSAP2 was involved in epithelialmesenchymal transition (EMT) and TGF-β signaling. In gastric cancer cells, CAMSAP2 overexpression significantly increased the expressions of vimentin and N-cadherin, inhibited the expression of E-cadherin, and enhanced cell migration and invasion (P<0.05); CAMSAP2 knockdown produced the opposite effects in the cells (P<0.05). In the tumor- bearing mice, xenografts overexpressing CAMSAP2 showed enhanced metastasis (P<0.05), increased vimentin and N-cadherin expressions and lowered E-cadherin expression (P<0.05), and the xenografts with CAMSAP2 knockdown showed the opposite changes (P<0.05). Both the in vivo and in vitro experiments showed that CAMSAP2 overexpression increased and CAMSAP2 knockdown lowered the levels of TGF-β and p-Smad2/3 in the gastric cancer cells (P<0.05). CONCLUSION The high expression of CAMSAP2 contributes to disease progression and poor prognosis of gastric cancer possibly by upregulating TGF-β signaling to promote EMT.
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Affiliation(s)
- 芦根 左
- 蚌埠医学院第一附属医院胃肠外科,安徽 蚌埠 233004Department of Gastrointestinal Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- 炎症相关性疾病基础与转化研究安徽省重点实验室,安徽 蚌埠 233030Anhui Province Key Laboratory of Basic and Translational Research of Inflammation-related Diseases, Bengbu 233030, China
| | - 炼 王
- 蚌埠医学院第一附属医院胃肠外科,安徽 蚌埠 233004Department of Gastrointestinal Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- 蚌埠医学院临床医学院,安徽 蚌埠 233030College of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
| | - 子 杨
- 蚌埠医学院第一附属医院胃肠外科,安徽 蚌埠 233004Department of Gastrointestinal Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- 蚌埠医学院临床医学院,安徽 蚌埠 233030College of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
| | - 骏杰 李
- 蚌埠医学院临床医学院,安徽 蚌埠 233030College of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
- 组织移植安徽省重点实验室,安徽 蚌埠 233030Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu 233030, China
| | - 文锋 王
- 蚌埠医学院临床医学院,安徽 蚌埠 233030College of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China
- 组织移植安徽省重点实验室,安徽 蚌埠 233030Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu 233030, China
| | - 静 李
- 蚌埠医学院第一附属医院检验科,安徽 蚌埠 233004Clinical Laboratory, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 月月 王
- 蚌埠医学院第一附属医院检验科,安徽 蚌埠 233004Clinical Laboratory, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 雪 宋
- 蚌埠医学院第一附属医院中心实验室,安徽 蚌埠 233004Central Laboratory, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 小凤 张
- 蚌埠医学院第一附属医院中心实验室,安徽 蚌埠 233004Central Laboratory, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 志军 耿
- 蚌埠医学院第一附属医院中心实验室,安徽 蚌埠 233004Central Laboratory, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
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Lianos GD, Bali CD, Vlachos K, Drosou P, Rausei S, Mitsis M, Schizas D. Complete mesogastric excision for gastric cancer: is it the future of gastric cancer surgery? Per Med 2023; 20:461-466. [PMID: 37811582 DOI: 10.2217/pme-2023-0028] [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] [Indexed: 10/10/2023]
Abstract
Gastric cancer remains undoubtedly one of the most common and deadly cancers worldwide. The global incidence shows wide geographic variation with a high prevalence in Asia. Besides that, there are evident differences in epidemiology, histopathology, tumor location, diagnosis and treatment strategy between east and west countries. Gastric cancer represents an aggressive disease, with many factors influencing its development and also recurrence after surgical resection. New knowledge of disease spread and new routes of metastases are now emerging and the 'novel' concept of complete mesogastric excision for gastric cancer is under consideration and debate. This article aims to analyze and highlight this new concept after a careful literature review, offering also a view toward the future.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | | | - Panagiota Drosou
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Stefano Rausei
- Department of Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, Cittiglio, 21033, Italy
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, 11527, Greece
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Zhang Z, Wang X, Li H, Sun H, Chen J, Lin H. Case Report: Camrelizumab combined with gemcitabine and oxaliplatin in the treatment of advanced intrahepatic cholangiocarcinoma: a case report and literature review. Front Immunol 2023; 14:1230261. [PMID: 37671157 PMCID: PMC10475830 DOI: 10.3389/fimmu.2023.1230261] [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: 05/28/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is one of the most common invasive malignant tumors, with a 5-year survival rate of less than 5%. Currently, radical surgical resection is the preferred treatment for ICC. However, most patients are only diagnosed at an advanced stage and are therefore not eligible for surgery. Herein, we present a case of advanced ICC in which radical surgery was not possible due to tumor invasion of the second porta hepatis and right hepatic artery. Six treatment cycles with a gemcitabine and oxaliplatin (GEMOX) regimen combined with camrelizumab immunotherapy achieved a partial response and successful tumor conversion, as tumor invasion of the second porta hepatis and right hepatic artery was no longer evident. The patient subsequently underwent successful radical surgical resection, including hepatectomy, caudate lobe resection, and cholecystectomy combined with lymph node dissection. Cases of patients with advanced ICC undergoing surgical resection after combined immunotherapy and chemotherapy are rare. The GEMOX regimen combined with camrelizumab demonstrated favorable antitumor efficacy and safety, suggesting that it might be a potential feasible and safe conversion therapy strategy for patients with advanced ICC.
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Affiliation(s)
- Zhongyan Zhang
- Department of Hepatobiliary Surgery, Weifang People’s Hospital, Weifang, China
| | - Xin Wang
- Department of Hepatobiliary Surgery, Weifang People’s Hospital, Weifang, China
| | - Hehe Li
- Department of Geriatrics, Weifang People’s Hospital, Weifang, China
| | - Huimin Sun
- Department of Pathology, Weifang People’s Hospital, Weifang, China
| | - Jianhong Chen
- Department of Hepatobiliary Surgery, Weifang People’s Hospital, Weifang, China
| | - Hongfeng Lin
- Department of Hepatobiliary Surgery, Weifang People’s Hospital, Weifang, China
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Obayashi M, Otsuka S, Ashida R, Ohgi K, Yamada M, Kawakami T, Uesaka K, Sugiura T. Conversion surgery for advanced jejunal adenocarcinoma with multiple peritoneal metastases: a case report. Surg Case Rep 2023; 9:145. [PMID: 37589759 PMCID: PMC10435430 DOI: 10.1186/s40792-023-01716-6] [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: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Small bowel cancer (SBC) is a rare malignancy that is often diagnosed at an advanced stage. Palliative chemotherapy is the standard treatment for patients with metastatic SBC. The relevant literature on conversion surgery in patients who have responded favorably to chemotherapy is limited. CASE PRESENTATION A 64-year-old man was diagnosed with jejunal carcinoma with multiple peritoneal metastases. After implanting an expandable metallic stent at the primary site, the patient underwent 6 months of FOLFOX therapy, resulting in a clinical complete response. Chemotherapy was continued, and four years after the initiation of therapy, the patient showed no evidence of disease progression. Nevertheless, anemia of continuous minor hemorrhages from the stent site and general malaise of chemotherapy got progressively worse during treatment. After confirming negative ascites cytology and the absence of peritoneal metastasis via staging laparoscopy, the patient underwent partial jejunectomy. Pathologically, no residual tumor was detected in the resected specimen. The postoperative course was uneventful, and the patient remained free of recurrence for 30 months after surgery without chemotherapy. CONCLUSION Although infrequent, conversion surgery may be a valid therapeutic option for selected cases of SBC with peritoneal metastasis.
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Affiliation(s)
- Miku Obayashi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Takeshi Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
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Chen X, Wang S, Chen Y, Xin H, Zhang S, Wu D, Xue Y, Zha M, Li H, Li K, Gu Z, Wei W, Ping Y. Non-invasive activation of intratumoural gene editing for improved adoptive T-cell therapy in solid tumours. NATURE NANOTECHNOLOGY 2023; 18:933-944. [PMID: 37188968 DOI: 10.1038/s41565-023-01378-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/14/2023] [Indexed: 05/17/2023]
Abstract
Adoptive T-cell therapy against solid tumours is limited by the apoptosis resistance mechanisms of tumour cells and by the extracellular, immunosuppressive tumour microenvironment. Here we report a temperature-sensitive genome-editing nanodevice that can deliver a Cas9 editor with an external trigger which can be used to edit the genome of tumour cells to reduce resistance to apoptosis and modulate the tumour microenvironment via a mild heating trigger. After local or systemic delivery of Cas9, mild heating is induced by non-invasive near-infrared (NIR) light or focused ultrasound (FUS) to activate Cas9, which initiates simultaneous genome editing of HSP70 (HSPA1A) and BAG3 in tumour cells. This disrupts the apoptotic resistance machinery of the tumour cells against adoptive T cells. At the same time, an NIR- or FUS-induced mild thermal effect reshapes the extracellular tumour microenvironment by disrupting the physical barriers and immune suppression. This facilitates the infiltration of adoptive T cells and enhances their therapeutic activity. Mild thermal Cas9 delivery is demonstrated in different murine tumour models which mimic a range of clinical indications, including a tumour model based on humanized patient-derived xenografts. As a result, the non-invasive thermal delivery of Cas9 significantly enhances the therapeutic efficacies of tumour-infiltrating lymphocytes and chimeric antigen receptor T and shows potential for clinical application.
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Affiliation(s)
- Xiaohong Chen
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China
- School of Chemical Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Yuxuan Chen
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Huhu Xin
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Shuaishuai Zhang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Di Wu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yanan Xue
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Menglei Zha
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Hongjun Li
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Kai Li
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Zhen Gu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Wei Wei
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China.
- School of Chemical Engineering, University of Chinese Academy of Sciences, Beijing, China.
| | - Yuan Ping
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China.
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Fang J, Huang X, Chen X, Xu Q, Chai T, Huang L, Chen H, Chen H, Ye Z, Du Y, Yu P. Efficacy of chemotherapy combined with surgical resection for gastric cancer with synchronous ovarian metastasis: A propensity score matching analysis. Cancer Med 2023; 12:17126-17138. [PMID: 37519112 PMCID: PMC10501252 DOI: 10.1002/cam4.6362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Ovarian metastasis from gastric cancer (GC) is characterized by aggressive biological behavior and poor outcome. Currently, there is no standard treatment mode for such patients. Thus, we evaluated the efficacy of conversion therapy in patients with synchronous ovarian metastasis from GC in this study. METHODS About 219 GC patients with ovarian metastasis in 2011-2020 were enrolled. Two groups were established based on the different treatment: the conversion therapy group (chemotherapy combined with surgical resection, CS group) and the non-conversion therapy group (NCS group). Propensity score matching (PSM) was used to analyze the efficacy of different treatment modes on the prognosis of these patients. RESULTS Ninety-two patients were included according to PSM results, with 46 patients each in CS and NCS groups. The median overall survival (OS) in the CS group was notably better than that in the NCS group (p < 0.001). Twenty-six patients (56.52%) in the CS group achieved R0 resection, and they had a better prognosis (p = 0.003). Compared with patients who underwent simultaneous gastrectomy and ovarian metastasectomy (CSb group), those who underwent ovarian metastasectomy before systemic chemotherapy (CSa group) had a higher R0 resection rate (p = 0.016) and longer survival time (p = 0.002). A total of 38 patients (41.30%) across both groups received hyperthermic intraperitoneal chemotherapy (HIPEC), and these patients had a better survival (p = 0.043). CONCLUSION The conversion therapy is safe and effective for patients with synchronous ovarian metastasis from GC and can improve their prognosis. However, our results need to be confirmed by more randomized controlled clinical studies.
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Affiliation(s)
- Jingquan Fang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
- Zhejiang Chinese Medical UniversityHangzhouChina
| | - Xingmao Huang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
- Wenzhou Medical UniversityWenzhouChina
| | - Xiangliu Chen
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Qi Xu
- Department of Medical oncology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Tengjiao Chai
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Ling Huang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Han Chen
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Hang Chen
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Zeyao Ye
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Yian Du
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Pengfei Yu
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
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Shinkai M, Imano M, Kohda M, Nakanishi T, Hiraki Y, Hagi T, Kato H, Shiraishi O, Yasuda A, Tsubaki M, Nishida S, Yasuda T. Efficacy of palliative surgery for gastric cancer patients with peritoneal metastasis who still have residual peritoneal dissemination after chemotherapy. Langenbecks Arch Surg 2023; 408:291. [PMID: 37523006 DOI: 10.1007/s00423-023-03028-7] [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: 06/06/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Gastric cancer patients with peritoneal metastasis (PM) are generally treated with systemic chemotherapy. When PM has disappeared because of chemotherapy, radical gastrectomy (so-called conversion surgery) is usually performed. We have previously reported the efficacy of conversion surgery, but there are no reports examining the efficacy of palliative gastrectomy for patients with residual PM after chemotherapy. The purpose of this study was to investigate the efficacy of palliative surgery for gastric cancer patients with PM who still have residual peritoneal dissemination after chemotherapy. METHODS Twenty-five gastric cancer patients with PM confirmed by laparoscopy and who had received chemotherapy but who still had residual PM were included in this study. Among the 25 patients, palliative surgery was performed in 20 patients (PS group) and chemotherapy was continued in 5 patients (CTx group), and their therapeutic outcomes were compared. RESULTS In the PS group, total and distal gastrectomies were performed. Clavien-Dindo grade I postoperative complications occurred in two patients (10%). There were no treatment-related deaths. Postoperative chemotherapy was performed all cases. In the PS group, the median survival time (MST) reached 22.5 months, with 1- and 2-year overall survival (OS) rates of 95% and 45%, respectively, whereas in the CTx group, the MST was 15.8 months, and the 1- and 2-year OS rates were 60% and 0%, respectively. The PS group had significantly longer OS than the CTx group (P=0.044). CONCLUSIONS Palliative surgery is safe and may prolong survival in gastric cancer patients with residual PM after chemotherapy.
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Affiliation(s)
- Masayuki Shinkai
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Motohiro Imano
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Masashi Kohda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Tomoya Nakanishi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yoko Hiraki
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takaomi Hagi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroaki Kato
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Osamu Shiraishi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Atsushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masanobu Tsubaki
- Division of Pharmacotherapy, Faculty of Pharmacy, Kindai University, Higashiosaka, Japan
| | - Shozo Nishida
- Division of Pharmacotherapy, Faculty of Pharmacy, Kindai University, Higashiosaka, Japan
| | - Takushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
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Liang C, Liang Y, Ou B, Yuan L, Yuan S. Clinicopathological and prognostic features of Borrmann type IV gastric cancer versus other Borrmann types: A unique role of signet ring cell carcinoma. Saudi J Gastroenterol 2023; 29:240-250. [PMID: 37470667 PMCID: PMC10445496 DOI: 10.4103/sjg.sjg_469_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
Background Evidence specifically comparing the clinicopathology of Borrmann type IV (B-IV) gastric cancer with that of other Borrmann types is insufficient. Methods A total of 3130 patients with advanced gastric cancer who underwent gastrectomy from January 2001 to September 2017 were enrolled in the analysis. Logistic regression and survival analysis methodology were used to investigate factors associated with peritoneal metastasis and overall survival (OS). Results Of the total cohort, 264 (8.43%) patients were B-IV type, 1752 (55.97%) were small-size other Borrmann types, and 1114 (35.59%) were large-size other Borrmann types. Signet ring cell carcinoma (SRC) was more common in B-IV types than in other Borrmann types (33.71% vs 11.42% vs 12.66%, P < 0.001). In B-IV gastric cancers, SRC was significantly associated with peritoneal metastasis (HR = 1.898, 95% CI = 1.112 ~ 3.241, P = 0.019) and poorer OS (HR = 1.492, 95% CI = 1.088 ~ 2.045, P = 0.013) in multivariable analysis. Furthermore, stratified analysis revealed that SRC had worse survival than adenocarcinoma in the B-IV subgroups, with locally advanced stages (stages II ~ III) or negative surgical margins (all P < 0.05). In contrast, SRC failed to be significantly associated with peritoneal metastasis and poor OS in other Borrmann types (all P > 0.05). Conclusion SRC was more common in B-IV gastric cancer than in other Borrmann types. It was significantly associated with peritoneal metastasis and poorer OS in the B-IV type but not in other Borrmann types. As a unique prognostic factor for B-IV gastric cancer, SRC might help evaluate risk stratification and optimize treatment for this entity, especially for patients with locally advanced stages or R0 resection.
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Affiliation(s)
- Chengcai Liang
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yao Liang
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Biyi Ou
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lei Yuan
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shuqiang Yuan
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Sammartino P, De Manzoni G, Marano L, Marrelli D, Biacchi D, Sommariva A, Scaringi S, Federici O, Guaglio M, Angrisani M, Cardi M, Fassari A, Casella F, Graziosi L, Roviello F. Gastric Cancer (GC) with Peritoneal Metastases (PMs): An Overview of Italian PSM Oncoteam Evidence and Study Purposes. Cancers (Basel) 2023; 15:3137. [PMID: 37370747 DOI: 10.3390/cancers15123137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Gastric cancer (GC) continues to be one of the leading types of malignancies worldwide, despite an ongoing decrease in incidence. It is the fifth most frequent type of cancer in the world and the fourth leading cause of cancer death. Peritoneal metastases (PMs) occur in 20-30% of cases during the natural history of the disease. Systemic chemotherapy (SC) is undoubtedly the standard of care for patients with GC and PMs. However, with the development of highly effective regimens (SC combined with intraperitoneal chemotherapy), significant tumor shrinkage has been observed in many patients with synchronous GC and PMs, allowing some to undergo curative resection "conversion surgery" with long-term survival. In recent years, there has been growing interest in intraperitoneal chemotherapy for PMs, because the reduced drug clearance associated with the peritoneal/plasma barrier allows for direct and prolonged drug exposure with less systemic toxicity. These procedures, along with other methods used for peritoneal surface malignancies (PSMs), can be used in GCs with PMs as neoadjuvant chemotherapy or adjuvant treatments after radical surgery or as palliative treatments delivered either laparoscopically or-more recently-as pressurized intraperitoneal aerosol chemotherapy. The great heterogeneity of patients with stage IV gastric cancer did not allow us to carry out a systemic review; therefore, we limited ourselves to providing readers with an overview to clarify the indications and outcomes of integrated treatments for GCs with PMs by analyzing reports from the international clinical literature and the specific experiences of our oncoteam.
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Affiliation(s)
- Paolo Sammartino
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | | | - Luigi Marano
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
| | - Daniele Biacchi
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Antonio Sommariva
- Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto, Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Stefano Scaringi
- AOU Careggi, IBD Unit-Chirurgia dell'Apparato Digerente, 50100 Firenze, Italy
| | - Orietta Federici
- Peritoneal Tumors Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Marcello Guaglio
- Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale Tumori IRCCS Milano, 20133 Milano, Italy
| | - Marco Angrisani
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Maurizio Cardi
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Alessia Fassari
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Francesco Casella
- Upper GI Surgery Division, University of Verona, 37129 Verona, Italy
| | - Luigina Graziosi
- General and Emergency Surgery Department, Santa Maria Della Misericordia Hospital, University of Perugia, 06125 Perugia, Italy
| | - Franco Roviello
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
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Ye R, Wang C, Hu B, Guan G. Safety and efficacy of laparoscopic digestive tract nutrition reconstruction combined with conversion therapy for patients with unresectable and obstructive gastric cancer. Front Oncol 2023; 13:1175580. [PMID: 37361593 PMCID: PMC10285493 DOI: 10.3389/fonc.2023.1175580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background To explore the safety, efficacy, and survival benefits of laparoscopic digestive tract nutrition reconstruction (LDTNR) combined with conversion therapy in patients with unresectable gastric cancer with obstruction. Methods The clinical data of patients with unresectable gastric cancer with obstruction who was treated in Fujian Provincial Hospital from January 2016 to December 2019, were analyzed. LDTNR was performed according to the type and degree of obstruction. All patients received the epirubicin + oxaliplatin + capecitabine regimen as conversion therapy. Results Thirty-seven patients with unresectable obstructive gastric cancer underwent LDTNR, while thirty-three patients received chemotherapy only. In LDTNR group patients, the proportion of nutritional risks gradually decreased, the rate of severe malnutrition decreased, the proportion of neutrophil-lymphocyte ratio (NLR) <2.5 increased, the proportion of prognosis nutrition index (PNI) ≥45 increased, and the Spitzer QOL Index significantly increased at day 7 and 1 month postoperatively (P<0.05). One patient (6.3%) developed grade III anastomotic leakage and was discharged after the endoscopic intervention. The median chemotherapy cycle of patients in LDTNR group was 6 cycles (2-10 cycles), higher than that in Non-LDTNR group (P<0.001). Among those who received LDTNR therapy, 2 patients had a complete response, 17 had a partial response, 8 had stable disease, and 10 had progressive disease, which was significantly better than the response rate in Non-LDTNR group(P<0.001). The 1-year cumulative survival rates of the patients with or without LDTNR were 59.5% and 9.1%. The 3-year cumulative survival rate with or without LDTNR was 29.7% and 0%, respectively (P<0.001). Conclusions LDTNR can improve the inflammatory and immune status, increase compliance with chemotherapy, and have potential benefits in improving the safety and effectiveness of and survival after conversion treatment.
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Affiliation(s)
- Rong Ye
- Department of Colorectal Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Bo Hu
- Department of Gastrointestinal Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China
| | - Guoxian Guan
- Department of Colorectal Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Abdominal Surgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Jun C, Yamauchi S, Yube Y, Egawa H, Yoshimoto Y, Kubota A, Tsuda K, Kaji S, Orita H, Oka S, Mine S, Fukunaga T. Pathological complete response with nivolumab for recurrence of liver metastasis after gastrectomy of gastric cancer. Surg Case Rep 2023; 9:86. [PMID: 37204618 DOI: 10.1186/s40792-023-01668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Advanced gastric cancer has an unfavorable prognosis and poor curability. Immune checkpoint inhibitors, such as nivolumab, have recently emerged as a potential solution for this aggressive disease. However, there is a lack of established evidence on the clinical efficacy of these agents, particularly in the perioperative period for advanced gastric cancer patients who are unresectable, recurrent, or preoperative. Despite the limited data available, there have been rare cases of dramatic therapeutic effects. In this study, we present a successful case of nivolumab treatment along with surgery. CASE PRESENTATION A 69-year-old female presented with pericardial discomfort and was diagnosed with advanced gastric cancer following upper gastrointestinal endoscopy. Laparoscopic distal gastrectomy with D2 lymph node dissection was performed, resulting in a final pathological diagnosis of Stage IIIA. The patient received postoperative adjuvant chemotherapy with oral S-1 therapy, but was found to have multiple liver metastases at 8 months postsurgery. Weekly paclitaxel and ramucirumab therapy was initiated, but the patient experienced adverse side effects, leading to the discontinuation of treatment. Nivolumab monotherapy was then administered for 18 cycles, resulting in a partial therapeutic response and PET-CT revealed a complete metabolic response. However, the patient developed a Grade 3 pemphigoid as an immune-related adverse event, leading to the cessation of nivolumab. The patient underwent laparoscopic partial hepatectomy. Postoperative pathology showed no residual tumor cells, indicating a complete response. At present, 25 months after surgery, the patient was alive without recurrence. CONCLUSION In this report, we present a case of gastric cancer with liver metastatic recurrence, in which a complete pathological response was achieved with nivolumab treatment. Although determining whether surgical intervention is necessary following successful drug treatment can be challenging, PET-CT imaging may be useful in decision-making regarding surgical treatment.
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Affiliation(s)
- Chen Jun
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
- Department of Surgery, Koshigaya Municipal Hospital, 10-32 Higasikoshigaya, Koshigaya, Saitama, 343-8577, Japan
| | - Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hiroki Egawa
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Akira Kubota
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kenki Tsuda
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hajime Orita
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Shinichi Oka
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
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Li Z, Zheng H, Zhao Z, Chen G, Wang Z, Amin B, Zhang N. Identification of optimal primary tumor resection candidates for metastatic gastric cancer: Nomograms based on propensity score matching. Cancer Med 2023. [PMID: 37096953 DOI: 10.1002/cam4.5983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/28/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND This study sought to develop and validate nomograms for screening patients with metastatic gastric cancer (mGC) who are candidates for primary tumor resection (PTR) and evaluating the prognosis of mGC patients after PTR. METHODS From 2010 to 2016, we screened mGC patients with complete data from the Surveillance, Epidemiology, and End Results (SEER) database. Depending on whether or not PTR was performed, we categorized patients into surgery and non-surgery groups. A 1:1 propensity score matching (PSM) analysis was used to balance the characteristics of the two groups. The endpoints were overall survival (OS) and cancer-specific survival (CSS). Two predictive nomograms were developed using logistic regression to assess the likelihood of benefit. Two additional prognostic nomograms were developed to assess prognosis in mGC patients after PTR by Cox regression. Finally, nomograms were evaluated using a variety of methodologies. RESULTS Our study included 3594 mGC patients who met the criteria. PTR was associated with improved OS and CSS time (median OS time after PSM: 15 vs. 7 months, P < 0.05; median CSS time after PSM: 17 vs. 7 months, P < 0.05). The OS-related predictive nomogram, including age, histologic type, grade, T stage, and chemotherapy, was developed. Moreover, the CSS-related predictive nomogram, including age, histologic type, grade, and chemotherapy, was developed. Sex, histologic type, grade, T stage, N stage, and chemotherapy were found to be correlated with OS. Furthermore, the CSS correlated with histologic type, grade, T stage, N stage, and chemotherapy. Both predictive and prognostic nomograms were found to be valuable and reliable after different types of validation. CONCLUSION Predictive nomograms were developed and validated for identifying the optimal PTR mGC candidates. Prognostic nomograms were developed and validated for assessing the prognosis of mGC patients after PTR.
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Affiliation(s)
- Zhehong Li
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Honghong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ziming Zhao
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guanyang Chen
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Buhe Amin
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Zhao K, Na Y, Xu HM. Advances in translational therapy for locally advanced gastric cancer. World J Clin Cases 2023; 11:2405-2411. [PMID: 37123309 PMCID: PMC10130985 DOI: 10.12998/wjcc.v11.i11.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/02/2023] [Accepted: 03/17/2023] [Indexed: 04/06/2023] Open
Abstract
Translational therapy refers to a combination of chemotherapy, radiotherapy, targeted therapy, and immunotherapy for patients with advanced gastric cancer who are initially unable to undergo R0 resection. This treatment can achieve partial or complete remission of the unresectable tumors to meet the criteria for R0 resection, thus enabling the patients to prolong their survival time and improve their quality of life. In gastric cancer, translational therapy has been tried and improved. At present, there are a large number of patients with locally advanced gastric cancer in China, and the selection of suitable patients for translational therapy to prolong objective survival and improve survival quality is one of the hot spots in the field of gastric cancer research.
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Affiliation(s)
- Kai Zhao
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Ying Na
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Hui-Min Xu
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
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Deng YY, Jiang DY, Zhu PF, Lu H, Liu Q, Zhang X, Pan SY, Chen ZL, Yang L. Apatinib combined with SOX regimen for conversion therapy in advanced gastric cancer patients: a retrospective cohort study. World J Surg Oncol 2023; 21:129. [PMID: 37041581 PMCID: PMC10088230 DOI: 10.1186/s12957-023-02973-3] [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: 10/20/2022] [Accepted: 02/27/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Recently, many studies have shown that the progress of conversion therapy can provide surgical opportunities for patients with advanced gastric cancer (GC) and bring survival benefits. However, the results of the current study show that the regimen used in conversion therapy is still controversial. Apatinib, as the standard third-line treatment for GC, has an inconclusive status in conversion therapy. METHODS This study retrospectively analyzed GC patients admitted to Zhejiang Provincial People's Hospital from June 2016 to November 2019. All patients were pathologically diagnosed, had unresectable factors, and received SOX regimen with or without apatinib as conversion therapy. RESULTS A total of 50 patients were enrolled in the study. Altogether 33 patients (66%) received conversion surgery and 17 patients (34%) received conversion therapy without surgery. The median progression-free survival (PFS) between surgery group and non-surgery group were 21.0 versus 4.0 months (p < 0.0001), and the median overall survival (OS) were 29.0 versus 14.0 months (p < 0.0001). In conversion surgery group, 16 patients (16/33) were treated with SOX plus apatinib, and the R0 resection rate was 81.3%; 17 patients (17/33) were treated with SOX regimen along, and the R0 resection rate was 41.2% (p = 0.032). The PFS in the SOX combined with apatinib group was significantly longer than that of SOX group (25.5 versus 16 months, p = 0.045), and the median OS were 34.0 versus 23.0 months (p = 0.048). The addition of apatinib did not increase the incidence of serious adverse reactions throughout the preoperative therapy period. CONCLUSIONS Patients with advanced inoperable gastric cancer could benefit probably from conversion chemotherapy and subsequence conversion surgery. Apatinib-targeted therapy combined with SOX chemotherapy may be a safe and feasible option for conversion therapy.
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Affiliation(s)
- Ya-Ya Deng
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
| | - Ding-Yi Jiang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
| | - Peng-Fei Zhu
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, 233000, Anhui Province, China
| | - Hongrui Lu
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, 233000, Anhui Province, China
| | - Qian Liu
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
| | - Xinyue Zhang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
| | - Shuang-Yue Pan
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China
- Graduate School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310014, Zhejiang Province, China
| | - Zhe-Ling Chen
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China.
| | - Liu Yang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
- The Qingdao University Medical College, Qingdao, Shandong Province, 260075, China.
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Kawazoe T, Ito S, Ohgaki K, Fujinaka Y, Funakoshi H, Otake A, Wang H, Morita K, Fushimi F, Ikeda Y. Successful conversion surgery following chemotherapy with an immune checkpoint inhibitor in an older adult patient with stage IVB esophageal squamous cell carcinoma: a case report. Surg Case Rep 2023; 9:51. [PMID: 36995570 PMCID: PMC10063768 DOI: 10.1186/s40792-023-01634-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Chemotherapy and chemoradiotherapy are common treatments for esophageal squamous cell carcinoma with distant metastasis; however, the prognosis remains poor, and complete remission is difficult to achieve. Here, we report a case of an older adult patient with esophageal squamous cell carcinoma who underwent surgery following combined treatment of immunotherapy and chemotherapy and achieved pathological complete response. CASE PRESENTATION An 80-year-old woman presenting with difficulty swallowing was referred to our hospital. She was diagnosed with esophageal squamous cell carcinoma with distant metastasis of the lymph node at the dorsal side of the IVC and the left supraclavicular lymph node. She was treated with pembrolizumab, cisplatin, and 5-fluorouracil. After four pharmacotherapy courses, primary tumor and metastatic lymph node shrinkage was observed. The patient underwent thoracoscopic subtotal esophagectomy and regional lymph node dissection. The lymph node at the dorsal side of the IVC was not resected, and the left supraclavicular lymph node was removed. Histological examination revealed complete response with no residual tumor or lymph node metastasis. The patient had no recurrence 10 months postoperatively without adjuvant chemotherapy. CONCLUSIONS Conversion surgery following preoperative therapy, including immunotherapy, may be an effective treatment strategy for improving survival in patients with esophageal squamous cell carcinoma even among older adult patients.
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Affiliation(s)
- Tetsuro Kawazoe
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan.
| | - Shuhei Ito
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Kippei Ohgaki
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Yoshihiko Fujinaka
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Hiroki Funakoshi
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Akihiko Otake
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Huanlin Wang
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Kazutoyo Morita
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
| | - Fumiyoshi Fushimi
- Department of Pathology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Yoichi Ikeda
- Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1 Shiobaru, Minami-Ku, Fukuoka-City, Fukuoka, 815-8588, Japan
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47
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Affiliation(s)
- Can Hu
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China; Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Hangzhou 310022, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Monagakubo, Nagaizumi-cho, Sunto-gun, Nagaizumi, Shizuoka 411-8777, Japan
| | - Xiangdong Cheng
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China; Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Hangzhou 310022, China; Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou 310022, China.
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48
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Fanotto V, Salani F, Vivaldi C, Scartozzi M, Ribero D, Puzzoni M, Montagnani F, Leone F, Vasile E, Bencivenga M, De Manzoni G, Basile D, Fornaro L, Masi G, Aprile G. Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice. Cancers (Basel) 2023; 15:cancers15030900. [PMID: 36765854 PMCID: PMC9913845 DOI: 10.3390/cancers15030900] [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: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in life-threatening complications. While retrospective series have suggested that surgery on the primary tumor may confer a survival advantage even in asymptomatic patients, randomized trials seem not to definitively support this hypothesis. We discuss the evidence for and against primary tumor resection for patients with metastatic gastrointestinal (colorectal, gastric and pancreatic) cancers treated with systemic therapies and put in context the pros and cons of the onco-surgical approach in the time of precision oncology. We also evaluate current ongoing trials on this topic, anticipating how these will influence both research and everyday practice.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Francesca Salani
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
- Institute of Interdisciplinary Research “Health Science”, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy
| | - Caterina Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Mario Scartozzi
- Unit of Medical Oncology, University Hospital, University of Cagliari, 09124 Cagliari, Italy
| | - Dario Ribero
- Division of General and Oncologic Surgery Multimedica, A.O. Santa Croce e Carle, 12100 Cuneo, Italy
| | - Marco Puzzoni
- Unit of Medical Oncology, University Hospital, University of Cagliari, 09124 Cagliari, Italy
| | - Francesco Montagnani
- Department of Oncology, Azienda Sanitaria Locale di Biella, 13900 Ponderano, Italy
| | - Francesco Leone
- Department of Oncology, Azienda Sanitaria Locale di Biella, 13900 Ponderano, Italy
| | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, Verona University (VR), 37134 Verona, Italy
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Verona University (VR), 37134 Verona, Italy
| | - Debora Basile
- Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-Vicenza, 36100 Vicenza, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050992466
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-Vicenza, 36100 Vicenza, Italy
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Successful second conversion surgery after trastuzumab deruxtecan for recurrent HER2-positive gastric cancer. Clin J Gastroenterol 2023; 16:330-335. [PMID: 36708503 DOI: 10.1007/s12328-023-01764-3] [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: 06/22/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
A 65-year-old woman with HER2-positive gastric cancer with multiple liver metastases underwent first conversion surgery of gastrectomy with D2 lymph nodes dissection and three liver metastases after combination therapy with capecitabine, cisplatin, and trastuzumab. Two years later, she experienced multiple liver metastases that were refractory to combination therapy with paclitaxel albumin-bound nanoparticles and ramucirumab. She participated in the DESTINY-Gastric01 trial and received tri-weekly trastuzumab deruxtecan as third-line treatment for 26 cycles. The recurrent lesions markedly shrank, and this effect continued for 19 months. We then performed partial hepatectomy for the one remaining lesion. No adjuvant chemotherapy was given, and she remains alive without recurrence 18 months after the second conversion surgery. Trastuzumab deruxtecan may generate a notable tumor response and subsequent conversion surgery could be a treatment option for HER2-positive stage IV gastric cancer.
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Bai J, Huang M, Song B, Luo W, Ding R. The Current Status and Future Prospects for Conversion Therapy in the Treatment of Hepatocellular Carcinoma. Technol Cancer Res Treat 2023; 22:15330338231159718. [PMID: 36855803 PMCID: PMC9983081 DOI: 10.1177/15330338231159718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide. In China, most HCC patients are diagnosed with advanced disease and in these cases surgery is challenging. Conversion therapy can be used to change unresectable HCC into resectable disease and is a potential breakthrough treatment strategy. The resection rate for unresectable advanced HCC has recently improved as a growing number of patients have benefited from conversion therapy. While conversion therapy is at an early stage of development, progress in patient selection, optimum treatment methods, and the timing of surgery have the potential to deliver significant benefits. In this article, we review the current evidence and clinical experience of conversion therapy in HCC. General conversion modalities such as systemic treatments (systemic chemotherapy, targeted therapy, or immunotherapy), locoregional therapy (transarterial chemoembolization, hepatic arterial infusion chemotherapy, or selective internal radiation therapy), and combination therapy were summarized. We also discuss the current challenges of conversion therapy and provide identify areas for future research to improve the development of conversion therapy in advanced HCC.
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Affiliation(s)
- Jinfeng Bai
- 531840The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ming Huang
- 531840The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bohan Song
- 531840The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Luo
- 531840The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rong Ding
- 531840The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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