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Ronellenfitsch U, Friedrichs J, Barbier E, Bass GA, Burmeister B, Cunningham D, Eyck BM, Grilli M, Hofheinz RD, Kieser M, Kleeff J, Klevebro F, Langley R, Lordick F, Lutz M, Mauer M, Michalski CW, Michl P, Nankivell M, Nilsson M, Seide S, Shah MA, Shi Q, Stahl M, Urba S, van Lanschot J, Vordermark D, Walsh TN, Ychou M, Proctor T, Vey JA. Preoperative Chemoradiotherapy vs Chemotherapy for Adenocarcinoma of the Esophagogastric Junction: A Network Meta-Analysis. JAMA Netw Open 2024; 7:e2425581. [PMID: 39093560 PMCID: PMC11297377 DOI: 10.1001/jamanetworkopen.2024.25581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/05/2024] [Indexed: 08/04/2024] Open
Abstract
Importance The prognosis of patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG) is poor. From current evidence, it remains unclear to what extent preoperative chemoradiotherapy (CRT) or preoperative and/or perioperative chemotherapy achieve better outcomes than surgery alone. Objective To assess the association of preoperative CRT and preoperative and/or perioperative chemotherapy in patients with AEG with overall survival and other outcomes. Data Sources Literature search in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and International Clinical Trials Registry Platform was performed from inception to April 21, 2023. Study Selection Two blinded reviewers screened for randomized clinical trials comparing preoperative CRT plus surgery with preoperative and/or perioperative chemotherapy plus surgery, 1 intervention with surgery alone, or all 3 treatments. Only data from participants with AEG were included from trials that encompassed mixed histology or gastric cancer. Among 2768 initially identified studies, 17 (0.6%) met the selection criteria. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for extracting data and assessing data quality by 2 independent extractors. A bayesian network meta-analysis was conducted using the 2-stage approach. Main Outcomes and Measures Overall and disease-free survival, postoperative morbidity, and mortality. Results The analyses included 2549 patients (2206 [86.5%] male; mean [SD] age, 61.0 [9.4] years) from 17 trials (conducted from 1989-2016). Both preoperative CRT plus surgery (hazard ratio [HR], 0.75 [95% credible interval (CrI), 0.62-0.90]; 3-year difference, 105 deaths per 1000 patients) and preoperative and/or perioperative chemotherapy plus surgery (HR, 0.78 [95% CrI, 0.64-0.91]; 3-year difference, 90 deaths per 1000 patients) showed longer overall survival than surgery alone. Comparing the 2 modalities yielded similar overall survival (HR, 1.04 [95% CrI], 0.83-1.28]; 3-year difference, 15 deaths per 1000 patients fewer for CRT). Similarly, disease-free survival was longer for both modalities compared with surgery alone. Postoperative morbidity was more frequent after CRT plus surgery (odds ratio [OR], 2.94 [95% CrI, 1.01-8.59]) than surgery alone. Postoperative mortality was not significantly more frequent after CRT plus surgery than surgery alone (OR, 2.50 [95% CrI, 0.66-10.56]) or after chemotherapy plus surgery than CRT plus surgery (OR, 0.44 [95% CrI, 0.08-2.00]). Conclusions and Relevance In this meta-analysis of patients with AEG, both preoperative CRT and preoperative and/or perioperative chemotherapy were associated with longer survival without relevant differences between the 2 modalities. Thus, either of the 2 treatments may be recommended to patients.
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Affiliation(s)
- Ulrich Ronellenfitsch
- Department of Abdominal, Vascular and Endocrine Surgery, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany
| | - Juliane Friedrichs
- Department of Abdominal, Vascular and Endocrine Surgery, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany
| | - Emilie Barbier
- Fédération Francophone de Cancérologie Digestive, Centre de Recherche Institut, Institut National de la Santé et de la Recherche Médicale, Epidemiology of Digestive Cancers, University of Burgundy, Franche-Comté, France
| | - Gary A. Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia
| | - Bryan Burmeister
- Department of Radiation Oncology, GenesisCare Fraser Coast and the Hervey Bay Hospital, Urraween, Australia
| | - David Cunningham
- Institute of Cancer Research, National Institute for Health and Care Research Biomedical Research Centre, The Royal Marsden Hospital, London, United Kingdom
| | - Ben M. Eyck
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf-Dieter Hofheinz
- Day Treatment Center, Interdisciplinary Tumor Center Mannheim and Third Department of Internal Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Jörg Kleeff
- Department of Abdominal, Vascular and Endocrine Surgery, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany
| | - Fredrik Klevebro
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Center for Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ruth Langley
- MRC (Medical Research Council) Clinical Trials Unit, University College London, London, United Kingdom
| | - Florian Lordick
- Department of Oncology, University Cancer Center Leipzig and Cancer Center Central Germany, University of Leipzig Medical Center, Leipzig, Germany
| | - Manfred Lutz
- Department of Gastroenterology, Endocrinology, and Infectiology, Caritasklinik St Theresia, Saarbrücken, Germany
| | - Murielle Mauer
- Statistics Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Christoph W. Michalski
- Department of General, Abdominal and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Michl
- Department of Gastroenterology, Infectiology and Toxicology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthew Nankivell
- MRC (Medical Research Council) Clinical Trials Unit, University College London, London, United Kingdom
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Center for Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
- Boehringer Ingelheim, Ingelheim, Germany
| | - Manish A. Shah
- Solid Tumor Oncology, Weill Cornell Medicine, New York, New York
| | - Qian Shi
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Michael Stahl
- Department of Medical Oncology and Hematology With Integrated Palliative Medicine, Protestant Hospital Essen-Mitte, Essen, Germany
| | - Susan Urba
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jan van Lanschot
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Dirk Vordermark
- Department of Radiotherapy, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany
| | | | - Marc Ychou
- Montpellier Cancer Institute, Montpellier, France
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Johannes A. Vey
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
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Pang T, Nie MM, Fan L, Wang JY, Liu ZR, Qin Y, Yin K. The impact of the length of proximal margin on the prognosis in adenocarcinoma of gastroesophageal junction: A real-world study and strategies. Asian J Surg 2024; 47:2613-2622. [PMID: 38565445 DOI: 10.1016/j.asjsur.2024.03.135] [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: 11/17/2023] [Revised: 01/23/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The optimal proximal margin (PM) length for Siewert II/III adenocarcinoma of the esophagogastric junction (AEJ) remains unclear. This study aimed to determine the optimal PM length using an abdominal approach to guide surgical decision-making. METHODS A prospective study analyzed 304 consecutive patients diagnosed with Siewert II/III AEJ between January 2019 and December 2021. Total gastrectomy was performed via the abdominal approach, and PM length was measured on fixed gross specimens. X-Tile software determined the optimal PM cut-point based on progression-free survival (PFS). Univariate analyses compared baseline characteristics across PM groups, while survival analyses utilized Kaplan-Meier estimation and Cox proportional hazards regression for assessing the impact of margin length on survival. Multivariable analyses were conducted to adjust for confounding variables. RESULTS The study included 264 AEJ cases classified as Siewert II (71.97%) or III (28.03%). The median gross PM length was 1.0 cm (IQR: 0.5 cm-1.5 cm, range: 0 cm-6 cm). PM length ≥1.2 cm was associated with a lower risk of disease progression compared to PM length 0.4 cm on PFS (HR = 0.41, 95% CI 0.20-0.84, P = 0.015). Moreover, PM ≥ 1.2 cm improved prognosis in subgroups of T4 or N3, tumor size <4 cm, Siewert II, and Lauren classification. CONCLUSIONS For Siewert type II/III AEJ, a proximal margin length ≥1.2 cm (1.65 cm in situ) is associated with improved outcomes. These findings offer valuable insights into the association between PM length and outcomes in Siewert II/III AEJ, providing guidance for surgical approaches and aiding clinical decision-making to enhance patient outcomes.
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Affiliation(s)
- Tao Pang
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
| | - Ming Ming Nie
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Lei Fan
- General Education Research Office, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jia Yang Wang
- General Education Research Office, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Zhao Rui Liu
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Yingyi Qin
- Department of Military Health Statistics, Naval Medical University, Shanghai, China.
| | - Kai Yin
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
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Pang T, Nie M, Yin K. The correlation between the margin of resection and prognosis in esophagogastric junction adenocarcinoma. World J Surg Oncol 2023; 21:316. [PMID: 37814242 PMCID: PMC10561513 DOI: 10.1186/s12957-023-03202-7] [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: 08/08/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023] Open
Abstract
Adenocarcinoma of the gastroesophageal junction (AEG) has become increasingly common in Western and Asian populations. Surgical resection is the mainstay of treatment for AEG; however, determining the distance from the upper edge of the tumor to the esophageal margin (PM) is essential for accurate prognosis. Despite the relevance of these studies, most have been retrospective and vary widely in their conclusions. The PM is now widely accepted to have an impact on patient outcomes but can be masked by TNM at later stages. Extended PM is associated with improved outcomes, but the optimal PM is uncertain. Academics continue to debate the surgical route, extent of lymphadenectomy, preoperative tumor size assessment, intraoperative cryosection, neoadjuvant therapy, and other aspects to further ensure a negative margin in patients with gastroesophageal adenocarcinoma. This review summarizes and evaluates the findings from these studies and suggests that the choice of approach for patients with adenocarcinoma of the esophagogastric junction should take into account the extent of esophagectomy and lymphadenectomy. Although several guidelines and reviews recommend the routine use of intraoperative cryosections to evaluate surgical margins, its generalizability is limited. Furthermore, neoadjuvant chemotherapy and radiotherapy are more likely to increase the R0 resection rate. In particular, intraoperative cryosections and neoadjuvant chemoradiotherapy were found to be more effective for achieving negative resection margins in signet ring cell carcinoma.
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Affiliation(s)
- Tao Pang
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Mingming Nie
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Kai Yin
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
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Molena D. Commentary: Crossing off CROSS for treatment of esophageal adenocarcinoma. J Thorac Cardiovasc Surg 2023; 165:906-907. [PMID: 35221026 DOI: 10.1016/j.jtcvs.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Zheng YH, Zhao EH. Recent advances in multidisciplinary therapy for adenocarcinoma of the esophagus and esophagogastric junction. World J Gastroenterol 2022; 28:4299-4309. [PMID: 36159003 PMCID: PMC9453767 DOI: 10.3748/wjg.v28.i31.4299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/22/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Esophageal adenocarcinoma (EAC) and adenocarcinoma of the esophagogastric junction (EGJA) have long been associated with poor prognosis. With changes in the spectrum of the disease caused by economic development and demographic changes, the incidence of EAC and EGJA continues to increase, making them worthy of more attention from clinicians. For a long time, surgery has been the mainstay treatment for EAC and EGJA. With advanced techniques, endoscopic therapy, radiotherapy, chemotherapy, and other treatment methods have been developed, providing additional treatment options for patients with EAC and EGJA. In recent decades, the emergence of multidisciplinary therapy (MDT) has enabled the comprehensive treatment of tumors and made the treatment more flexible and diversified, which is conducive to achieving standardized and individualized treatment of EAC and EGJA to obtain a better prognosis. This review discusses recent advances in EAC and EGJA treatment in the surgical-centered MDT mode in recent years.
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Affiliation(s)
- Yi-Han Zheng
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - En-Hao Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Ronellenfitsch U, Klose J, Kleeff J. Multimodal Therapy of Upper Gastrointestinal Malignancies. Cancers (Basel) 2021; 13:793. [PMID: 33672858 PMCID: PMC7918428 DOI: 10.3390/cancers13040793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, University Medical Center Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (J.K.); (J.K.)
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Li Y, Ma FH, Xue LY, Tian YT. Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study. World J Gastroenterol 2020; 26:818-827. [PMID: 32148379 PMCID: PMC7052534 DOI: 10.3748/wjg.v26.i8.818] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.
AIM To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.
METHODS This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach (cT3/4 and cN any) diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis (cTNM) staging system. We performed 1:1 propensity score matching (PSM) to reduce bias in patient selection. The histologic and prognostic effects of neoadjuvant chemotherapy were assessed. The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.
RESULTS Of the 144 patients eligible for this study, 36 received neoadjuvant chemotherapy, and 108 received initial surgery after diagnosis. After adjustment by PSM, 36 pairs of patients were generated, and baseline characteristics, including age, sex, American Society of Anesthesiologists score, tumor location, and cTNM stage, were similar between the two groups. The R0 resection rates were 88.9% and 86.1% in the surgery-first and neoadjuvant chemotherapy groups after PSM, respectively (P = 1.000). The median follow-up period was 46.4 mo. The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0% and 65.0% (P = 0.235), respectively, before PSM and 50% and 64.7% (P = 0.192), respectively, after PSM. Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.
CONCLUSION Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma. For resectable gastric signet-ring cell carcinoma, upfront surgery should be the primary therapy.
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Affiliation(s)
- Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li-Yan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Chen C, Dong H, Shou C, Shi X, Zhang Q, Liu X, Zhu K, Zhong B, Yu J. The Correlation Between Computed Tomography Volumetry and Prognosis of Advanced Gastric Cancer Treated with Neoadjuvant Chemotherapy. Cancer Manag Res 2020; 12:759-768. [PMID: 32099471 PMCID: PMC7006857 DOI: 10.2147/cmar.s231636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/07/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose To investigate the feasibility and utility of computer tomography (CT) volumetry in evaluating the tumor response to neoadjuvant chemotherapy (NAC) in advanced gastric cancer (AGC) patients. Patients and Methods One hundred and seventeen Patients with AGC who received NAC followed by R0 resection between January 2006 and December 2012 were included. Tumor volumes were quantified using OsiriX software. The volume reduction rate (VRR) was calculated as follows: VRR = [(pre-chemotherapy total volume) − (post-chemotherapy total volume)]/(pre-chemotherapy total volume) × 100%. The optimal cut-off VRR for differentiating favorable from unfavorable prognosis was determined by receiver operating characteristic (ROC) analysis. Overall survival was calculated using Kaplan-Meier analysis and values were compared using the Log-rank test. Multivariate analysis was determined by the Cox proportional regression model. Results The optimal cut-off VRR was 31.95% according to ROC analysis, with a sensitivity of 70.4% and a specificity of 71.7%. Based on the cut-off VRR, patients were divided into the VRR-High (VRR ≥ 31.95%, n = 63) and VRR-Low (VRR < 31.95%, n = 54) groups. The VRR-Low group exhibited a worse prognosis than that of the VRR-High group (HR, 2.85; 95% CI, 1.69–4.82, P < 0.001), with 3-year survival rates of 40.7% and 79.4%, and 5-year survival rates of 31.5% and 63.5%, respectively. Conclusion CT volumetry is a feasible and reliable method for assessing the tumor response to NAC in patients with AGC.
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Affiliation(s)
- Chao Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hao Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chunhui Shou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiaoxiao Shi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qing Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiaosun Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Kankai Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Baishu Zhong
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jiren Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Disease-free survival as a surrogate for overall survival in neoadjuvant trials of gastroesophageal adenocarcinoma: Pooled analysis of individual patient data from randomised controlled trials. Eur J Cancer 2019; 123:101-111. [DOI: 10.1016/j.ejca.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 01/05/2023]
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The Role of the Lymph Node Ratio in Advanced Gastric Cancer After Neoadjuvant Chemotherapy. Cancers (Basel) 2019; 11:cancers11121914. [PMID: 31805755 PMCID: PMC6966566 DOI: 10.3390/cancers11121914] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023] Open
Abstract
The ratio of positive lymph nodes (LNs) to the total LN harvest is called the LN ratio (LNR). It is an independent prognostic factor in gastric cancer (GC). The aim of the current study was to evaluate the impact of neoadjuvant chemotherapy (NAC) on the LNR (ypLNR) in patients with advanced GC. We retrospectively analyzed the data of patients with advanced GC, who underwent gastrectomy with N1 and N2 (D2) lymphadenectomy between August 2011 and January 2019 in the Department of Surgical Oncology at the Medical University of Lublin. The exclusion criteria were a lack of preoperative NAC administration, suboptimal lymphadenectomy (<D2 and/or removal of less than 15 lymph nodes), and a lack of data on tumor regression grading (TRG) in the final pathological report. A total of 95 patients were eligible for the analysis. A positive correlation was found between the ypLNR and tumor diameter (p < 0.001), post treatment pathological Tumour (ypT) stage (p < 0.001), Laurén histological subtype (p = 0.0001), and the response to NAC (p < 0.0001). A multivariate analysis demonstrated that the ypLNR was an independent prognostic factor in patients with intestinal type GC (p = 0.0465) and in patients with no response to NAC (p = 0.0483). In the resection specimen, tumor diameter and depth of infiltration, Laurén histological subtype, and TRG may reflect the impact of NAC on LN status, as quantified by ypLNR in advanced GC.
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Koch C, Reitz C, Schreckenbach T, Eichler K, Filmann N, Al-Batran SE, Götze T, Zeuzem S, Bechstein WO, Kraus T, Bojunga J, Düx M, Trojan J, Blumenstein I. Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma. PLoS One 2019; 14:e0223613. [PMID: 31639132 PMCID: PMC6805048 DOI: 10.1371/journal.pone.0223613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/24/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS Patients with gastric cancer often show signs of malnutrition. We sought to evaluate the influence of sarcopenia in patients with locally advanced, not metastasized, gastric or gastro-esophageal junction (GEJ) cancer undergoing curative treatment (perioperative chemotherapy and surgery) on morbidity and mortality in order to identify patients in need for nutritional intervention. PATIENTS AND METHODS Two-centre study, conducted in the Frankfurt University Clinic and Krankenhaus Nordwest (Frankfurt) as part of the University Cancer Center Frankfurt (UCT). 47/83 patients were treated in the FLOT trial (NCT01216644). Patients´ charts were reviewed for clinical data. Two consecutive CT scans were retrospectively analyzed to determine the degree of sarcopenia. Survival was calculated using the Kaplan-Meier method, multivariate analysis was performed using the Cox regression. RESULTS 60 patients (72.3%) were male and 23 (27.7%) female. 45 patients (54.2%) had GEJ type 1-3 and 38 (45.8%) gastric tumors, respectively. Sarcopenic patients were significantly older than non-sarcopenic patients (mean age 65.1 years vs. 59.5 years, p = 0.042), terminated the chemotherapy significantly earlier (50% vs. 22.6%, p = 0.037) and showed higher Clavien-Dindo scores, indicating more severe perioperative complications (score ≥3 43.3 vs. 17.0%, p = 0.019). Sarcopenic patients had a significantly shorter survival than non-sarcopenic patients (139.6 ± 19.5 [95% CI, 101.3-177.9] vs. 206.7 ± 13.8 [95% CI, 179.5-233.8] weeks, p = 0.004). Multivariate Cox regression analysis showed that, besides UICC stage, sarcopenia significantly influenced survival. CONCLUSION Sarcopenia is present in a large proportion of patients with locally advanced gastric or GEJ cancer and significantly influences tolerability of chemotherapy, surgical complications and survival.
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Affiliation(s)
- Christine Koch
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Cornelius Reitz
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Teresa Schreckenbach
- Department of General and Visceral Surgery, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute for Biostatistics and Mathematical Modelling, Goethe University, Frankfurt am Main, Germany
| | - Salah-Eddin Al-Batran
- Institute for Clinical Research, (IKF), Hospital Nordwest, Frankfurt am Main, Germany
| | - Thorsten Götze
- Institute for Clinical Research, (IKF), Hospital Nordwest, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Thomas Kraus
- Central Institute for Radiology and Neuroradiology, Nordwest Hospital, Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Markus Düx
- Department of General and Viseral Surgery, Hospital Nordwest, Frankfurt am Main, Germany
| | - Jörg Trojan
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Irina Blumenstein
- Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany
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Papaxoinis G, Kamposioras K, Weaver JMJ, Kordatou Z, Stamatopoulou S, Germetaki T, Nasralla M, Owen-Holt V, Anthoney A, Mansoor W. The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study. J Gastrointest Surg 2019; 23:1729-1741. [PMID: 30671799 DOI: 10.1007/s11605-018-04087-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 12/16/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this cohort study was to assess the benefit that patients with lower esophageal or gastroesophageal junction (E/GEJ) adenocarcinoma receive by continuing perioperative chemotherapy post-surgery. METHODS Three hundred twelve patients underwent radical tumor surgical resection after preoperative chemotherapy. Chemotherapy was mainly ECX (epirubicin, cisplatin, capecitabine). Propensity score matching (PSM) was used to compare continuation of chemotherapy post-surgery vs. no postoperative treatment. RESULTS Two hundred ten patients (67.3%) had GEJ and 102 (32.7%) lower esophageal adenocarcinoma. Microscopically clear surgical margins (R0), according to the Royal College of Pathologists, were achieved in 208 patients (66.7%). In total, 225 patients (72.1%) continued perioperative chemotherapy post-surgery. PSM was used to create two patient groups, well-balanced for basic epidemiological, clinical, and histopathological characteristics. The first included 148 patients who continued perioperative chemotherapy after surgery and the second 86, who did not receive postoperative treatment. The first group had non-significantly different median time-to-relapse (TTR 22.2 vs. 25.7 months, p = 0.627), overall survival (OS 46.1 vs. 36.7 months, p = 0.199), and post-relapse survival (15.3 vs. 8.7 months, p = 0.122). Subgroup analysis showed that only patients with microscopically residual disease after surgery (R1 resection) benefited from continuation of chemotherapy post-surgery for both TTR (hazard ratio [HR] 0.556, 95% CI 0.330-0.936, p = 0.027) and OS (HR 0.530, 95% CI 0.313-0.898, p = 0.018). CONCLUSIONS Continuation of perioperative chemotherapy post-surgery was not associated with improved outcome in patients with E/GEJ adenocarcinoma. Patients with microscopically residual disease post-surgery might receive a potential benefit from adjuvant chemotherapy.
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Affiliation(s)
- George Papaxoinis
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | | | - Jamie M J Weaver
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Zoe Kordatou
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Sofia Stamatopoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Theodora Germetaki
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Magdy Nasralla
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Vikki Owen-Holt
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Alan Anthoney
- Department of Medical Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK.
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Patrão AS, Papaxoinis G, Kordatou Z, Weaver JMJ, Owen-Holt V, Alkhaffaf B, Galloway S, Mansoor W. Prognostic significance of positive circumferential resection margin post neoadjuvant chemotherapy in patients with esophageal or gastro-esophageal junction adenocarcinoma. Eur J Surg Oncol 2019; 45:439-445. [DOI: 10.1016/j.ejso.2018.10.530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022] Open
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Jiang LX, Zhou SK, Liu S, Ye FF. Neoadjuvant chemotherapy combined with laparoscopic surgery for treatment of advanced gastric cancer: Efficacy and impact on quality of life. Shijie Huaren Xiaohua Zazhi 2018; 26:782-789. [DOI: 10.11569/wcjd.v26.i13.782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the clinical effect of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy in treating advanced gastric cancer and the effect on the quality of life of patients.
METHODS A retrospective analysis was performed of 104 cases of advanced gastric cancer admitted from February 2014 to November 2016 at Taizhou Hospital. According to whether the patients would like to undergo neoadjuvant chemotherapy or not, they were divided into an observation group (neoadjuvant chemotherapy plus laparoscopic surgery; n = 56) or a control group (direct laparoscopic-assisted radical gastrectomy; n = 48). Both groups were given six courses of XELOX chemotherapy after operation. Clinical efficacy, operation indexes, postoperative recovery, quality of life, adverse reactions, and recurrence or metastasis were compared between the two groups.
RESULTS After neoadjuvant chemotherapy, the effective rate and disease control rate in the observation group were 48.21% and 92.45%, respectively. There was no significant difference in operative time, intraoperative blood loss, number of cases of conversion to open laparotomy, surgical excision range, number of cases of palliative surgery, or number of lymph nodes dissected between the two groups (P > 0.05). The R0 resection rate in the observation group was significantly higher than that of the control group (85.71% vs 52.08%, P < 0.05). There was no significant difference in time to ambulation, time to anal exhaust, postoperative complications, or hospital stay between the two groups (P > 0.05). The KPS scores of the observation group at 3 and 6 months after chemotherapy were significantly higher than those of the control group (82.8 ± 6.9 vs 76.2 ± 5.1, 91.6 ± 8.1 vs 85.2 ± 7.3, P < 0.05). As of December 2017, the follow-up period ranged from 9 to 46 mo, and the median follow-up time was 24 mo. During the follow-up period, four patients died and ten patients developed recurrence or metastasis in the observation group. In the control group, 11 patients died and 19 developed recurrence or metastasis. There was a significant difference in the rates of death and recurrence/metastasis between the two groups (χ2 = 5.210, 6.067, P < 0.05). Log-rank test analysis showed that the risk of death in the observation group was significantly lower than that of the control group (P < 0.05).
CONCLUSION Neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy for advanced gastric cancer has significant curative effects and can significantly improve the resection rate and quality of life, reduce recurrence and metastasis, and improve the survival of patients.
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Affiliation(s)
- Liang-Xian Jiang
- Department of Gastrointestinal Surgery, Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Shen-Kang Zhou
- Department of Gastrointestinal Surgery, Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Shuai Liu
- Department of Gastrointestinal Surgery, Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
| | - Fei-Fei Ye
- Department of Gastrointestinal Surgery, Taizhou Hospital, Taizhou 317000, Zhejiang Province, China
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Zhang L, Zuo M, Ma X, Dong Y. Effects of neoadjuvant chemotherapy on minimum alveolar concentration values of sevoflurane and desflurane in patients with hepatocellular carcinoma complicated with jaundice. Oncol Lett 2018; 16:388-394. [PMID: 29928426 PMCID: PMC6006300 DOI: 10.3892/ol.2018.8621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
The effects of neoadjuvant chemotherapy on the minimum alveolar concentration (MAC) values of sevoflurane and desflurane in patients with hepatocellular carcinoma (HCC) complicated with jaundice were investigated. Eighty patients with HCC complicated with jaundice were selected. Forty patients underwent the neoadjuvant chemotherapy and were grouped into the desflurane group (Group D) and the sevoflurane group (Group S). Patients in all chemotherapy groups received 2 cycles of chemotherapy prior to surgery and underwent surgical treatment 3 weeks after chemotherapy. The remaining 40 patients in the control group were divided into the desflurane group (Group C1) and the sevoflurane group (Group C2). Changes in MAP, HR and BIS at different time points before and after anesthesia induction and skin incision were compared among the groups. Results showed that there were no significant differences in MAP, HR and BIS before anesthesia induction (T0) (P>0.05); at each time point from T1 to T6, MAP, HR and BIS of Group D were significantly lower than those of Group C1 (P>0.05). Furthermore, MAP, HR and BIS of Group S were significantly lower than those of Group C2 (P>0.05). The MACMean of sevoflurane and desflurane were compared among all patient groups using the mean method. MACMean values of Group D were significantly lower than those of Group C1 (P<0.05). Notably, MACDixon values of sevoflurane and desflurane were compared among all patient groups using the Dixon method and the differences were statistically significant (P<0.05). Logistic regression analyses were conducted, respectively, which revealed that the MAC of sevoflurane and desflurane were associated with whether patients received the neoadjuvant chemotherapy. MACLog of sevoflurane and desflurane were decreased in patients receiving the neoadjuvant chemotherapy. The results suggested that neoadjuvant chemotherapy can reduce MAC values of sevoflurane and desflurane in HCC patients complicated with jaundice and may improve these patients' sensitivity to sevoflurane and desflurane.
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Affiliation(s)
- Lin Zhang
- Department of Pharmacy, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Mingyan Zuo
- Department of Pulmonary Disease, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Xinxin Ma
- Department of Pharmacy, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
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Scientific surgery. Br J Surg 2018. [DOI: 10.1002/bjs.10874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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