Adjuvant therapy in gastric cancer: what is the optimal approach?

Time trends of clinicopathologic features and surgical treatment for gastric cancer: Results from 2 high-volume institutions in southern China

BACKGROUND

The objective of this study was to evaluate the time-related trends of tumor characteristics and postoperative survival of patients with gastric cancer (GC) in 2 high-volume centers in high incidence areas of southern China.

METHODS

Based on the meticulously collected data from 5,327 patients with GC treated with operative intervention at Sun Yat-sen University Cancer Center and Fujian Medical University Union Hospital, we analyzed the differences in clinicopathologic features and postoperative survival over the following 4 consecutive periods: 1991-1995 (period 1), 1996-2000 (period 2), 2001-2005 (period 3), and 2006-2010 (period 4).

RESULTS

Tumor size decreased (P = .001), but the proportion of poorly differentiated tumors increased (P < .001) over the study periods. Early GC was diagnosed more often in later periods, gradually increasing from 7 to 15% (P < .001). A surprising improvement was observed in the mean number of retrieved lymph nodes, ranging from 10.36 to 26.22 (P < .001). The radical resection rate increased from 88 to 93%. The overall 5-year survival rate improved steadily over the 4 periods, from 39 to 53% (P < .001). Multivariate analysis revealed that age, tumor location, histologic type, tumor size, depth of invasion, lymphatic invasion, number of retrieved lymph nodes, radical resection, and time periods were independent prognostic factors.

CONCLUSION

The clinicopathologic features of tumors changed during the observation period in our region. The increasingly early detection of patients with GC and more standardized regimens for operative management, including routinely performed D2 lymphadenectomy, most likely resulted in the increase in overall survival.

Gastric carcinoma at Tanta Cancer Center: a comparative retrospective clinico-pathological study of the elderly versus the non-elderly

BACKGROUND AND AIMS

To study the clinico-pathological features, treatments and outcomes of gastric carcinoma (GC) in the elderly (⩾65 years) and the non-elderly Egyptian patients.

METHODS

This retrospective cohort study included 168 patients with histologically confirmed GC treated at Tanta Cancer Center between 2003 and 2007.

RESULTS

Compared to the non-elderly, elderly patients had significantly higher proportion of tumors involving the cardia (p=0.034) and of adenocarcinoma NOS histology (p=0.032). Treatments were largely comparable in the two groups. Response to palliative chemotherapy was achieved in 44.4% of the elderly and 25.5% of the non-elderly patients (p=0.417). The median overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were 6, 17 and 3 months, respectively. The median OS was 4 months in the elderly compared to 9 months in the non-elderly (p=0.005). The median DFS was 4 months in the elderly compared to 20 months in the non-elderly (p=0.004). The median PFS was 2 months in the elderly compared to 3 months in the non-elderly (p=0.685). In multivariate analysis, poor performance status was an independent predictor of poor OS, DFS and PFS. Non-curative or no surgery and lack of chemotherapy use were independent predictors of poor OS. Age was an independent predictor of poor DFS.

CONCLUSIONS

Compared to the non-elderly, GC in the elderly has similar clinico-pathological characteristics and exhibits comparable outcomes with the same treatment options. Treatments should be tailored to each patient.

Efficacy of SOX regimen versus XELOX regimen in concurrent chemoradiotherapy for postoperative recurrent gastric carcinoma

AIM: To evaluate the efficacy and safety of SOX regimen (S-1 + L-OHP) versus XELOX regimen (capecitabine + L-OHP) in concurrent chemoradiotherapy for postoperative recurrent gastric carcinoma.

METHODS: Sixty-six elderly patients with postoperative recurrent gastric cancer were randomly divided into two groups: an SOX group (n = 34) and a XELOX group (n = 32). The SOX group received oral S-1 (< 1.25 m², 40 mg; 1.25-1.5 m2, 50 mg; > 1.5 m², 60 mg), twice daily, d1-14; L-OHP (85 mg/m², d1); and three-dimensional conformal radiation (1.8 Gy/d, 5 d/wk and the total dose was 45 Gy). The XELOX group was treated with capecitabine (2000 mg/m², separated to twice, d1-14), plus the same regimen of radiation and L-OHP as those in the SOX group. Each cycle lasted three weeks. The efficacy and toxicity were evaluated after two cycles of treatment.

RESULTS: The efficacy and toxicity could be evaluated in 66 cases. There were no significant differences in the overall response rate (55.9% vs 46.9%), median time to progression (TTP) (6.3 mo vs 5.8 mo) or median overall survival (OS) (12.8 mo vs 12.2 mo) (P > 0.05) between the two groups. The most common toxicities in the two groups were neutropenia, thrombopenia, nausea, vomiting and diarrhea, all of which could be tolerated. However, the incidence of hand-foot syndrome was significantly higher in the SOX group than in the XELOX group (P < 0.05).

CONCLUSION: The efficacy of chemoradiotherapy based on the SOX regimen for postoperative recurrent gastric carcinoma is better than that of concurrent chemoradiotherapy based on the XELOX regimen in terms of well-tolerated toxicity.

miR-34a regulates cisplatin-induce gastric cancer cell death by modulating PI3K/AKT/survivin pathway

The purposes of this study were to determine the expression profiles of microRNA-34a (miR-34a) in human gastric cancer cell line (SGC-7901) and cisplatin-resistant cell lines (SGC-7901/DDP), and to establish the correlation between miR-34a expression profile and the sensitivity of human gastric cancer cell to cisplatin-based pattern, thereby providing new methods and strategies for treating gastric cancer. Gastric cancer cell line (SGC-7901) and cisplatin-resistant cell line (SGC-7901/DDP) were cultivated in vitro, respectively. Quantitative real-time PCR (qRT-PCR) and Western blot were utilized to determine the expression profiles of miR-34a and survivin in both gastric cancer cell lines. With miR-34a mimic and miR-34a inhibitor transfected into SGC-7901 and SGC-7901/DDP for 48 h, post-transfection changes of miR-34a expression was determined; the effects of miR-34a ectopic expression on the viability of cisplatin-induce gastric cancer cell were assayed by the MTT method. The effects of miR-34a ectopic expression on apoptosis of cisplatin-induce gastric cancer cell were determined by Annexin V/propidium iodide (PI) double staining method and flow cytometry. The effects of miR-34a ectopic expression on the AKT and p-AKT expression of cisplatin-induce gastric cancer cells were determined by Western blot and flow cytometry with the PI3K pathway inhibitor Wortmannin. As shown by qRT-PCR and Western blot analyses, the expression of miR-34a in cisplatin-resistant cell lines decreased significantly in comparison to that of SGC-7901 cell line (p < 0.05), while significant up-regulation of survivin expression was also observed (p < 0.05). Compared with the control group, the expression of miR-34a increased significantly in SGC-7901 cells transfected with miR-34a mimic for 48 h (p < 0.01). After miR-34a inhibitor transfection, the expression of miR-34a decreased significantly (p < 0.05). The viability of cisplatin-induce gastric cancer cells increased significantly (p < 0.05) with significant decrease of apoptosis after miR-34a expression inhibition, as demonstrated by MTT and flow cytometry with miR-34a over-expression, the viability of cisplatin-induce gastric cancer cells decreased significantly (p < 0.05), with significant apoptosis increase (p < 0.05). As shown by Western blot and flow cytometry, in comparison to the control group, Wortmannin could inhibit miR-34a inhibitor and DDP induced up-regulation of p-AKT significantly (p < 0.05) and stimulated apoptosis. In conclusion, miR-34a expression was down-regulated in cisplatin-resistant cell lines. miR-34a over-expression could improve the sensitivity of gastric cancer cells against cisplatin-based chemotherapies, with PI3K/AKT/survivin signaling pathway possibly involved in the mechanism.