1
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Li H, Cao GM, Gu GL, Li SY, Yan Y, Fu Z, Du XH. Expression characteristics of peripheral lymphocyte programmed death 1 and FoxP3 + Tregs in gastric cancer during surgery and chemotherapy. World J Gastroenterol 2023; 29:5582-5592. [PMID: 37970473 PMCID: PMC10642441 DOI: 10.3748/wjg.v29.i40.5582] [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: 08/07/2023] [Revised: 08/31/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Programmed death 1 (PD-1) and CD4+CD25+FoxP3+ expression in peripheral blood T-cells has been previously reported in various types of cancer. However, the specific variation tendency during surgery and chemotherapy, as well as their relationship in gastric cancer patients, still remain unclear. Understanding this aspect may provide some novel insights for future studies on tumor recurrence and tumor immune escape, and also serve as a reference for determining the optimal timing and dose of clinical anti-PD-1 antibodies. AIM To observe and analyze the expression characteristics of peripheral lymphocyte PD-1 and FoxP3+ regulatory T cells (FoxP3+ Tregs) before and after surgery or chemotherapy in gastric cancer patients. METHODS Twenty-nine stomach cancer patients undergoing chemotherapy after a D2 gastrectomy provided 10 mL peripheral blood samples at each phase of the perioperative period and during chemotherapy. This study also included 29 age-matched healthy donors as a control group. PD-1 expression was detected on lymphocytes, including CD4+CD8+CD45RO+, CD4+CD45RO+, and CD8+CD45RO+ lymphocytes as well as regulatory T cells. RESULTS We observed a significant increase of PD-1 expression on immune subsets and a larger number of FoxP3+ Tregs in gastric cancer patients (P < 0.05). Following D2 gastrectomy, peripheral lymphocytes PD-1 expression and the number of FoxP3+ Tregs notably decrease (P < 0.05). However, during postoperative chemotherapy, we only observed a decrease in PD-1 expression on lymphocytes in the CD8+CD45RO+ and CD8+CD45RO+ populations. Additionally, linear correlation analysis indicated a positive correlation between PD-1 expression and the number of CD4+CD45RO+FoxP3high activated Tregs (aTregs) on the total peripheral lymphocytes (r = 0.5622, P < 0.0001). CONCLUSION The observed alterations in PD-1 expression and the activation of regulatory T cells during gastric cancer treatment may offer novel insights for future investigations into tumor immune evasion and the clinical application of anti-PD-1 antibodies in gastric cancer.
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Affiliation(s)
- Hao Li
- Graduate School, Medical School of Chinese People’s Liberation Army, Beijing 100039, China
- Department of General Surgery, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Guan-Mei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Song-Yan Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100039, China
| | - Yang Yan
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100039, China
| | - Ze Fu
- Graduate School, Medical School of Chinese People’s Liberation Army, Beijing 100039, China
| | - Xiao-Hui Du
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100039, China
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2
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Luo XF, Luo YH, Zhao XY, Lin XT, Li WL, Jie J, Wu D, Fang G, Pang YZ, Huang A. Application and progress of palliative therapy in advanced gastric carcinomas. Front Oncol 2023; 13:1104447. [PMID: 36969008 PMCID: PMC10035333 DOI: 10.3389/fonc.2023.1104447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Gastric carcinomas have high morbidity and mortality. It produces no noticeable symptoms in the early stage while causing complex complications in its advanced stage, making treatment difficult. Palliative therapy aims to relieve the symptoms of cancer patients and focuses on improving their quality of life. At present, five palliative therapies for advanced gastric carcinomas are offered: resection, gastrojejunostomy, stenting, chemotherapy, and radiotherapy. In recent years, palliative therapy has been used in the clinical treatment of advanced gastric carcinomas and related complications because of its efficacy in gastric outlet obstruction and gastric bleeding. In the future, multimodal and interdisciplinary palliative therapies can be applied to control general symptoms to improve patients’ condition, prolong their lifespan and improve their quality of life.
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Affiliation(s)
- Xiao-fan Luo
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Ye-hao Luo
- School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-yi Zhao
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Xue-ting Lin
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Wen-ling Li
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Jie Jie
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Di Wu
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Gang Fang
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Yu-zhou Pang
- Key Laboratory of Basic and Applied Research of Zhuang Medicine Prescriptions, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
- *Correspondence: Yu-zhou Pang, ; An Huang,
| | - An Huang
- Zhuang Yao Pharmaceutical Engineering and Technology Research Center, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
- *Correspondence: Yu-zhou Pang, ; An Huang,
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3
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Ifthikar Z, Muthalib H, Mohammed S, Alfraih F, Aljohany H, Alsohaibani F. Extramedullary involvement of the ascending colon in relapsing acute lymphocytic leukemia: A case report. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:162-165. [PMID: 35602400 PMCID: PMC9121693 DOI: 10.4103/sjmms.sjmms_543_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/10/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) accounts for <1% of adult cancers. Extramedullary relapse of ALL has been primarily reported in pediatric patients or hematopoietic stem cell transplant recipients, and the gastrointestinal (GI) tract is a less frequently reported site of extramedullary relapse. Here, we report a case of a 30-year-old male who was a known case of ALL with multiple relapses and allogenic stem cell transplantations. The patient presented with acute lower GI bleeding and was confirmed to have an extramedullary relapse of ALL in the ascending colon. As the patient already had early relapses after two hematopoietic stem cell transplants in the past, he was managed with palliative chemotherapy, consisting of vincristine, dexamethasone, and rituximab, following which the patient achieved complete remission. This case highlights the importance of recognizing uncommon presentations of ALL such as those involving the GI tract.
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4
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Ifthikar Z, Muthalib H, Mohammed S, Alfraih F, Aljohany H, Alsohaibani F. Extramedullary involvement of the ascending colon in relapsing acute lymphocytic leukemia: A case report. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022. [DOI: 10.4103/1658-631x.343723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Santero M, Pérez-Bracchiglione J, Acosta-Dighero R, Meade AG, Antequera A, Auladell-Rispau A, Quintana MJ, Requeijo C, Rodríguez-Grijalva G, Salas-Gama K, Dorantes-Romandia R, Salazar J, Solà I, Urrútia G, Bonfill Cosp X. Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews. BMC Cancer 2021; 21:712. [PMID: 34134661 PMCID: PMC8207789 DOI: 10.1186/s12885-021-08330-5] [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: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. Results We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. Conclusions The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. Trial registration Open Science Framework, 10.17605/OSF.IO/7CHX6. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08330-5.
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Affiliation(s)
- M Santero
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - J Pérez-Bracchiglione
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain.,Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Viña del Mar, Chile
| | - R Acosta-Dighero
- School of Physiotherapy, Faculty of Health Sciences, Universidad San Sebastian, Santiago, Chile
| | - A G Meade
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - A Antequera
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - A Auladell-Rispau
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - M J Quintana
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain
| | - C Requeijo
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - G Rodríguez-Grijalva
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - K Salas-Gama
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - R Dorantes-Romandia
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - J Salazar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain
| | - I Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain
| | - G Urrútia
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain
| | - X Bonfill Cosp
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025, Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain.
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6
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Hsu JT, Liao JA, Chuang HC, Chen TD, Chen TH, Kuo CJ, Lin CJ, Chou WC, Yeh TS, Jan YY. Palliative gastrectomy is beneficial in selected cases of metastatic gastric cancer. BMC Palliat Care 2017; 16:19. [PMID: 28288593 PMCID: PMC5348866 DOI: 10.1186/s12904-017-0192-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 03/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background Salvage chemotherapy is the mainstay of treatment for metastatic gastric cancer (mGC). This study aimed to clarify the effects of palliative gastrectomy (PG) and identify prognostic factors in mGC patients undergoing PG. Methods This was a retrospective review of 333 mGC patients receiving PG or a non-resection procedure (NR) between 2000 and 2010. Clinicopathological factors affecting the prognosis of these patients were collected prospectively and analyzed. Results One hundred and ninety-three patients underwent PG and 140 NR. The clinicopathological characteristics were comparable between the two groups except for metastatic pattern. There were no significant differences in postoperative morbidity and mortality between the two groups. The PG group had a significantly longer median overall survival compared with the NR group (7.7 months vs. 4.9 months). In the PG group, age ≤58 years, preoperative albumin level >3 g/dL, ratio of metastatic to examined lymph nodes ≤0.58, and administration of chemotherapy were independent prognostic factors in multivariate analysis. Conclusions Patients undergoing PG had better outcomes than those undergoing NR. Among the patients undergoing resection, age ≤58 years, a better preoperative nutritional status, less nodal involvement and postoperative chemotherapy independently affected patient survival.
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Affiliation(s)
- Jun-Te Hsu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, #5, Fushing Street, Kweishan District, Taoyuan City, 333, Taiwan.
| | - Jian-Ann Liao
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, #5, Fushing Street, Kweishan District, Taoyuan City, 333, Taiwan
| | - Huei-Chieh Chuang
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, 333, Taiwan
| | - Tai-Di Chen
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, 333, Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, 333, Taiwan
| | - Chia-Jung Kuo
- Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, 333, Taiwan
| | - Chun-Jung Lin
- Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, 333, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, 333, Taiwan
| | - Ta-Sen Yeh
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, #5, Fushing Street, Kweishan District, Taoyuan City, 333, Taiwan
| | - Yi-Yin Jan
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, #5, Fushing Street, Kweishan District, Taoyuan City, 333, Taiwan
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7
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Mahar AL, Coburn NG, Kagedan DJ, Viola R, Johnson AP. Regional variation in the management of metastatic gastric cancer in Ontario. ACTA ACUST UNITED AC 2016; 23:250-7. [PMID: 27536175 DOI: 10.3747/co.23.3123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Geographic variation in cancer care is common when clear clinical management guidelines do not exist. In the present study, we sought to describe health care resource consumption by patients with metastatic gastric cancer (gc) and to investigate the possibility of regional variation. METHODS In this population-based cohort study of patients with stage iv gastric adenocarcinoma diagnosed between 1 April 2005 and 31 March 2008, chart review and administrative health care data were linked to study resource utilization outcomes (for example, clinical investigations, treatments) in the province of Ontario. The study took a health care system perspective with a 2-year time frame. Chi-square tests were used to compare proportions of resource utilization, and analysis of variance compared mean per-patient resource consumption between geographic regions. RESULTS A cohort of 1433 patients received 4690 endoscopic investigations, 12,033 computed tomography exams, 12,774 radiography exams, and 5059 ultrasonography exams. Nearly all patients were seen by a general practitioner (98%) and a specialist (99%), and were hospitalized (95%) or visited the emergency department (87%). Fewer than half received chemotherapy (43%), gastrectomy (37%), or radiotherapy (28%). The mean number of clinical investigations, physician visits, hospitalizations, and instances of patient accessing the emergency department or receiving radiotherapy or stent placement varied significantly by region. CONCLUSIONS Variations in health care resource utilization for metastatic gc patients are observed across the regions of Ontario. Whether those differences reflect differential access to resources, patient preference, or physician preference is not known. The observed variation might reflect a lack of guidelines based on high-quality evidence and could partly be ameliorated with regionalization of gc care to high-volume centres.
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Affiliation(s)
- A L Mahar
- Department of Public Health Sciences, Queen's University, Kingston, ON;; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre
| | - N G Coburn
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Institute of Health Policy, Management and Evaluation, University of Toronto and; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - D J Kagedan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - R Viola
- Department of Public Health Sciences, Queen's University, Kingston, ON;; Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON
| | - A P Johnson
- Department of Public Health Sciences, Queen's University, Kingston, ON;; Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON.; Centre for Health Services and Policy Research, Queen's University, Kingston, ON
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McCall MD, Graham PJ, Bathe OF. Quality of life: A critical outcome for all surgical treatments of gastric cancer. World J Gastroenterol 2016; 22:1101-1113. [PMID: 26811650 PMCID: PMC4716023 DOI: 10.3748/wjg.v22.i3.1101] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/16/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023] Open
Abstract
Surgery represents the main curative therapeutic modality for gastric cancer, and it is occasionally considered for palliation as well as prophylaxis. Most frequently, surgical outcomes are conveyed in terms of oncological outcomes such as recurrence and survival. However, quality of life (QoL) is also important and should be considered when making treatment decisions - including the extent of and approach to surgery. Measurement of QoL usually involves the application of questionnaires. While there are multiple QoL questionnaires validated for use in oncology patients, there are very few that have been validated for use in those with gastric cancer. In this review, we discuss and compare the current status of QoL questionnaires in gastric cancer. More importantly, the impact of surgery for treatment, palliation and prophylaxis of gastric cancer on QoL will be described. These data should inform the surgeon on the optimal approach to treating gastric cancer, taking into account oncological outcomes. Knowledge gaps are also identified, providing a roadmap for future studies.
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9
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Bani Hani M, Ihim I, Harps J, Cunningham SC. A breath of fresh air: a quality-improvement study comparing an air-circulating technique versus conventional technique to prevent nasogastric tube dysfunction. BMC Nurs 2015; 14:63. [PMID: 26617465 PMCID: PMC4661948 DOI: 10.1186/s12912-015-0111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/09/2015] [Indexed: 01/01/2023] Open
Abstract
Background Nasogastric tubes are an important component of care in patients with gastrointestinal obstructions. However, they are prone to malfunction despite conventional flushing techniques, with potentially severe consequences. There is no widely accepted, gold-standard way to ensure that a nasogastric tube succeeds in maintaining an empty stomach following flushing. Methods We have developed a flushing technique to better ensure successful tube function. We compared this technique to conventional flushing both in vitro (using a plastic stomach model) and in vivo (in a pig model), and we provide a didactic video. Results The mean gastric residual volume following our novel flushing technique is nearly 25-fold lower than following conventional flushing (13 mL vs. 330 mL). Conclusions Our simple technique is more effective than conventional techniques in maintaining nasogastric tube function and therefore should prevent dangerous vomiting and aspiration pneumonia better than conventional techniques.
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Affiliation(s)
- Murad Bani Hani
- The Department of Surgery, Saint Agnes Hospital, Baltimore, MD USA
| | - Ikenna Ihim
- The Department of Surgery, Saint Agnes Hospital, Baltimore, MD USA
| | - Joyce Harps
- The Department of Nursing, Saint Agnes Hospital, Baltimore, MD USA
| | - Steven C Cunningham
- The Department of Surgery, Saint Agnes Hospital, Baltimore, MD USA.,Pancreatic and Hepatobiliary Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD 21229 USA
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10
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Foster D, Shaikh MF, Gleeson E, Babcock BD, Ringold D, Bowne WB. Palliative Surgery for Advanced Cancer: Identifying Evidence-Based Criteria for Patient Selection: Case Report and Review of Literature. J Palliat Med 2015; 19:22-9. [PMID: 26565437 DOI: 10.1089/jpm.2015.0146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Criteria for selecting patients with advanced cancer for palliative surgery (PS) remains poorly defined. Decision making for PS requires realistic treatment goals with well-defined criteria. Here we discuss a 71-year-old Jehovah's Witness with advanced stage renal cell carcinoma (RCC) who presented with profound anemia due to intractable bleeding from gastric metastasis. After repeated attempts with endoscopic and angiographic management, she underwent surgical palliation. Through this case, we developed 10-item evidence-based criteria for selecting patients for PS. OBJECTIVE The study objective was to provide a review of pertinent literature for PS and identify evidence-based criteria for patient selection. These criteria were relevant for selecting this patient with metastatic RCC and may prove beneficial for selecting advanced cancer patients for PS. METHODS A MEDLINE search revealed 175 publications relevant to PS. Among these, 17 articles defining patient selection criteria (PSC) were reviewed. A frequency-based analysis of each criterion was performed. Another search returned 30 cases of RCC gastric metastases from 25 published reports. Outcome analysis was determined by the Kaplan-Meier actuarial method. RESULTS Ten criteria were identified: symptom control, prognosis, preoperative performance status, quality of life (QoL), tumor burden amenable to palliation, procedure-related morbidity and mortality, feasibility of nonsurgical therapies, anticipated hospitalization, requirement for additional palliation, and cost. This patient met all inclusion criteria and underwent a successful gastrectomy. Median survival for patients with RCC gastric metastasis was 20 months. CONCLUSIONS This report illustrates an example of implementation of evidence-based criteria for selecting advanced cancer patients for PS. Validation of these criteria is warranted.
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Affiliation(s)
- Deshka Foster
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Mohammad F Shaikh
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Elizabeth Gleeson
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Blake D Babcock
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Daniel Ringold
- 2 Department of Medicine, College of Medicine, Drexel University , Philadelphia, Pennsylvania
| | - Wilbur B Bowne
- 1 Department of Surgery, College of Medicine, Drexel University , Philadelphia, Pennsylvania
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11
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Park CH, Park JC, Kim EH, Chung H, An JY, Kim HI, Shin SK, Lee SK, Cheong JH, Hyung WJ, Lee YC, Noh SH, Kim CB. Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy. Gastrointest Endosc 2015; 81:321-32. [PMID: 25085332 DOI: 10.1016/j.gie.2014.06.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-expandable metal stent (SEMS) placement and palliative gastrojejunostomy (GJJ) are palliative treatment options for malignant gastric outlet obstruction. OBJECTIVE To compare clinical outcomes of palliative treatments for gastric outlet obstruction caused by unresectable gastric cancer. DESIGN Retrospective study. SETTING University-affiliated tertiary-care hospital in the Republic of Korea. PATIENTS Two hundred fifty-six patients with gastric outlet obstruction caused by unresectable gastric cancer. INTERVENTION SEMS placement and palliative GJJ. MAIN OUTCOME MEASUREMENTS Patency duration and overall survival duration. RESULTS In total, 217 and 39 patients underwent SEMS placement and palliative GJJ, respectively, as an initial palliative treatment. Treatment modality affected reobstruction after clinical success (hazard ratio [HR] [95% confidence interval {CI}], 0.5 [0.3-0.8] of palliative GJJ). In addition, carcinomatosis with ascites was an independent associated factor of clinical success and reobstruction (HR [95% CI], 0.3 [0.1-0.7] and 1.4 [1.0-2.0], respectively). In a subgroup of patients with good performance who had neither carcinomatosis nor ascites, patency duration and overall survival duration did not differ between the 2 groups (P = .079 and P = .290, respectively). In patients with good performance who had carcinomatosis without ascites, patency duration was longer in the palliative GJJ group than in the SEMS placement group (P = .016). Overall survival, however, did not differ between the 2 groups (P = .062). In a subgroup of patients with good performance who had carcinomatosis with ascites, both patency duration and overall survival were longer in the palliative GJJ group than in the SEMS placement group (P = .007 and P = .012, respectively). LIMITATIONS Nonrandomized, retrospective study. CONCLUSION Long-term clinical outcomes of the palliative treatment modality for gastric outlet obstruction caused by unresectable gastric cancer were affected by carcinomatosis and ascites status.
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Affiliation(s)
- Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hye Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunsoo Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Ho Cheong
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Chan Lee
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Choong Bae Kim
- Department of Surgery, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
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12
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Evidence for predictive role of BRCA1 and bTUBIII in gastric cancer. Med Oncol 2013; 30:545. [PMID: 23532817 DOI: 10.1007/s12032-013-0545-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 03/15/2013] [Indexed: 12/24/2022]
Abstract
Sensitivity of gastric cancer (GC) to conventional cytotoxic therapy may be at least in part attributed to molecular features of the tumor cells. We analyzed all patients with metastatic GC treated in the N.N. Petrov Institute of Oncology (St. Petersburg) within years 1999-2010 and identified 65 cases with evaluable treatment response and available biological material. Two of 65 patients (3 %) carried germ-line BRCA1 5382insC mutation and demonstrated particularly pronounced response to the treatment; both of their tumors showed loss of the remaining BRCA1 allele, thus confirming the causative role of BRCA1 heterozygosity in GC predisposition. RNA expression of TS, DPD, BRCA1, ERCC, TOP2A and bTUBIII was analyzed in the remaining 63 tumors. Low BRCA1 expression was associated with increased response rate [6/9 (67 %) vs. 17/54 (32 %), p = 0.04]. Low bTUBIII level correlated with the improved probability of tumor response [21/49 (43 %) vs. 1/13 (8 %), p = 0.02] and prolonged overall survival (10.5 vs. 7.1 months, p = 0.02); this trend was maintained both for taxane-containing and for taxane-free drug combinations. We conclude that GC should be considered as a part of BRCA1-related hereditary cancer syndrome. Tumors with BRCA1 inactivation and low bTUBIII expression demonstrate improved response to cytotoxic therapy.
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13
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Wang YY, Zhang W, Qian S, Liu R, Kan ZX, Wang JH. The effect of locoregional transarterial infusion chemotherapy on liver metastasis after gastric cancer resection. J Int Med Res 2013; 40:1141-8. [PMID: 22906288 DOI: 10.1177/147323001204000334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE A retrospective clinical study to evaluate the effect of transarterial infusion (TAI) chemotherapy and transarterial chemoembolization (TACE) on liver metastasis after gastric cancer resection. METHODS The study recruited patients who underwent surgical resection for stage T(2)N(2)M(0) gastric adenocarcinoma without liver metastasis. Patients chose to receive either TAI or systemic chemotherapy, based on the advantages and disadvantages of each regimen as explained by physicians. Both regimens comprised 100 mg/m2 oxaliplatin and 500 mg/m2 fluorodeoxy uridine, administered via TAI or a peripheral vein, commencing 30 days postsurgery. Patients who developed liver metastasis during the 3-year follow-up period were offered TACE. RESULTS Mean time from gastric cancer diagnosis to liver metastasis was significantly longer in the TAI group (n = 13) than in the systemic chemotherapy group (n = 29); 944 ± 231 days versus 506 ± 77 days. Patients who received TACE (n = 32) had a partial remission rate of 46.9% and a median survival of 14.7 months after diagnosis of liver metastasis. CONCLUSIONS Locoregional TAI chemotherapy was more effective in reducing liver metastasis after gastric cancer resection than conventional systemic chemotherapy. TACE is an effective treatment for liver metastasis.
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Affiliation(s)
- Y Y Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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14
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Kakuta T, Yajima K, Kayama S, Tsuno Y, Saito K, Ishikawa T, Kosugi SI, Kanda T. WallFlex™ Duodenal Stent Placement in a Gastric Cancer Patient with Malignant Stenosis of a Roux-en-Y Gastrojejunostomy following Distal Gastrectomy. Case Rep Oncol 2012; 5:554-60. [PMID: 23139671 PMCID: PMC3492972 DOI: 10.1159/000341851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 69-year-old Japanese woman with a history of distal gastrectomy with a Roux-en-Y reconstruction for advanced gastric cancer was admitted to our hospital complaining of severe dysphagia. On admission, the patient was only able to take liquids, and a firm, fist-sized tumor was palpable in her left upper abdomen. An endoscopic examination disclosed stenosis of the jejunal limb of the gastrojejunostomy. Abdominal computed tomography revealed that a recurrent tumor, 5.0 cm in diameter, was compressing the jejunal limb of the gastrojejunostomy. A knitted nitinol self-expandable metallic stent (WallFlex™ duodenal stent) was placed endoscopically at the stenotic jejunum from the gastrojejunostomy. The time required for stenting and total endoscopic manipulation was 12 and 35 minutes, respectively. No stent-related complications were observed. The patient could resume oral ingestion 1 day after endoscopic stenting and was discharged on the fifth day after treatment. She survived for 201 days after stenting. She continued oral ingestion for 194 days and stayed at home for 165 days. The WallFlex duodenal stent allows safe endoscopic stenting, even in cases of malignant stenosis of a gastrojejunostomy following distal gastrectomy. This stenting device will extend the indications for endoscopic palliation of gastric cancer patients with gastric outlet stenosis.
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Affiliation(s)
- Tomoyuki Kakuta
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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15
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Mariette C, Bruyère E, Messager M, Pichot-Delahaye V, Paye F, Dumont F, Brachet D, Piessen G. Palliative resection for advanced gastric and junctional adenocarcinoma: which patients will benefit from surgery? Ann Surg Oncol 2012; 20:1240-9. [PMID: 23064779 DOI: 10.1245/s10434-012-2687-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whereas palliative chemotherapy offers a median survival of approximately 10 months in advanced gastric and junctional adenocarcinoma (AGJA), the survival impact of primary tumor resection is controversial. Our purpose was to identify which AGJA patients benefit from palliative resection. METHODS In 3,202 AGJA patients scheduled for surgery in 21 French centers between 1997 and 2010, prognostic factors were identified in palliative group and the impact of each combination of these factors on survival was studied. RESULTS Surgery was defined as palliative due to solid organ metastasis (5.6 %), localized (4.6 %) or diffuse (2.3 %) peritoneal carcinomatosis (PC), or incomplete tumoral resection (12.8 %). Median survival of AGJA patients resected with a palliative intent (n = 677) was longer than in nonresected patients (n = 532; 11.9 vs. 8.5 months, P < 0.001). Multivariable analyses identified ASA score III-IV (P < 0.001) as a predictor of postoperative mortality and solid organ metastasis (P = 0.009), localized PC (P = 0.004), diffuse PC (P = 0.046), and signet ring cell histology (SRC; P = 0.02) as predictors of survival. Only ASA I-II patients with incomplete resection without metastasis or PC, one site solid organ metastasis without PC, or localized PC without SRC had a survival benefit after palliative surgery with median survivals from 12.0 to 18.3 months. Nonresected ASA I-II patients with same risk factors had median survivals from 3.5 to 8.8 months (P < 0.05 for each). CONCLUSIONS In AGJA, patient and tumor-related factors should be used to select candidates for palliative surgery in association with chemotherapy.
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Affiliation(s)
- Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University hospital Center, Place de Verdun, Lille Cedex, France.
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16
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Mahar AL, Coburn NG, Karanicolas PJ, Viola R, Helyer LK. Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review. Gastric Cancer 2012; 15 Suppl 1:S138-45. [PMID: 21727998 DOI: 10.1007/s10120-011-0070-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/27/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Relief of symptoms should be the primary focus of palliative treatment as defined by the World Health Organization. Evaluating the effectiveness of palliative interventions should incorporate this goal and include quality of life (QOL) outcome assessments. A systematic review of the surgical gastric cancer literature was performed to summarize the effectiveness of palliative surgical interventions in addressing QOL. METHODS An electronic literature search of EMBASE, Medline, and the Cochrane Database of Controlled Trials was performed from January 1, 1985 to December 1, 2009. English language abstracts and articles were reviewed independently by two reviewers. A systematic approach to data abstraction and presentation was followed. RESULTS No articles were identified as reporting true QOL outcomes using reliable, validated QOL instruments in surgically managed, advanced gastric cancer patients. Nine articles were identified as reporting outcomes measuring effectiveness of palliation. Commonly reported pre-procedure symptoms were weight loss, abdominal pain, vomiting, obstruction, and bleeding. Time to oral intake was reported in 5 of 9 studies, ranging from a mean of 2.9 days (laparoscopic gastrojejunostomy) to 8 days (surgical bypass). Length of postoperative inpatient stay ranged from a mean of 7 days (gastrojejunostomy) to 28 days (surgical bypass). Other measures of effective palliation included measures of clinical success, hospital re-admission rates, and post-procedure analgesic intake. CONCLUSION A paucity of literature exists regarding the QOL of surgically managed gastric cancer patients. Prospectively designed studies using credible QOL measures are necessary to better inform the treatment decision-making process for these patients.
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Affiliation(s)
- Alyson L Mahar
- Department of Community Health and Epidemiology, Queen's University, Kingston, Canada
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17
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Mahar AL, Coburn NG, Singh S, Law C, Helyer LK. A systematic review of surgery for non-curative gastric cancer. Gastric Cancer 2012; 15 Suppl 1:S125-37. [PMID: 22033891 DOI: 10.1007/s10120-011-0088-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/29/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most gastric cancer patients present with advanced stage disease precluding curative surgical treatment. These patients may be considered for palliative resection or bypass in the presence of major symptoms; however, the utility of surgery for non-curative, asymptomatic advanced disease is debated and the appropriate treatment strategy unclear. PURPOSE To evaluate the non-curative surgical literature to better understand the limitations and benefits of non-curative surgery for advanced gastric cancer. METHODS A literature search for non-curative surgical interventions in gastric cancer was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases from 1 January 1985 to 1 December 2009. All abstracts were independently rated for relevance by a minimum of two reviewers. Outcomes of interest were procedure-related morbidity, mortality, and survival. RESULTS Fifty-nine articles were included; the majority were retrospective, single institution case series. Definitions describing the treatment intent for gastrectomy were incomplete in most studies. Only five were truly performed with relief of symptoms as the primary indication for surgery, while the majority were considered non-curative or not otherwise specified. High rates of procedure-related morbidity and mortality were demonstrated for all surgeries across the majority of studies and treatment-intent categories. Median and 1-year survival were poor, and values ranged widely within surgical approaches and across studies. CONCLUSIONS A lack of transparent documentation of disease burden and symptoms limits the surgical literature in non-curative gastric cancer. Improved survival is not evident for all patients receiving non-curative gastrectomy. Further prospective research is required to determine the optimal intervention for palliative gastric cancer patients.
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Affiliation(s)
- Alyson L Mahar
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
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18
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Kulig P, Sierzega M, Kowalczyk T, Kolodziejczyk P, Kulig J. Non-curative gastrectomy for metastatic gastric cancer: rationale and long-term outcome in multicenter settings. Eur J Surg Oncol 2012; 38:490-6. [PMID: 22381671 DOI: 10.1016/j.ejso.2012.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Metastatic gastric cancer remains a significant problem as the majority of Western patients are diagnosed with disseminated disease and no routine therapeutic regimen is accepted in such cases. METHODS A cohort of 3141 patients with gastric cancer operated between 1990 and 2005 was evaluated using a multicenter data set held by the Polish Gastric Cancer Study Group to determine potential risks and benefits of non-curative gastrectomy for metastatic disease. Additionally, parameters of Quality of Life (QoL) were evaluated prospectively in 140 patients undergoing gastrectomy using the QLQ-C30 questionnaire. RESULTS Gastrectomy was carried out in 2258 patients. Distant organ metastases were diagnosed in 951 patients, 415 of which underwent non-curative gastrectomy. The overall mortality rates were significantly higher in patients undergoing non-resectional surgery (10%) than either curative (3%, P < 0.001) or non-curative (4%, P = 0.002) gastrectomy. The overall median survival in patients with metastatic disease was significantly higher for non-curative gastrectomy (10.6 months, 95% confidence interval (CI) 9.3-11.9) than for non-resective operations (4.4 months, 95% CI 4.0 to 4.8, P < 0.001). The hazard ratio of death in patients subject to non-resectional surgery compared to those treated by gastrectomy was 2.923 (95% CI 2.473 to 3.454, P < 0.001). A gradual impairment in QoL parameters was found over 12 months after non-curative resections but changes did not reach statistical significance and individual parameters were similar to gastrectomy without distant metastases. CONCLUSION Non-curative gastrectomy for metastatic gastric cancer is associated with significantly better survival compared to non-resective surgery and does not impair quality of life.
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Affiliation(s)
- P Kulig
- Department of Surgery, Jagiellonian University Medical College, 40 Kopernika Street, 31-501 Krakow, Poland.
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Gastric cancer surgery: an American perspective on the current options and standards. Curr Treat Options Oncol 2011; 12:72-84. [PMID: 21274666 DOI: 10.1007/s11864-010-0136-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastric cancer is prevalent globally, particularly in Asian countries such as Japan and Korea. While the prevalence of gastric cancer is not nearly as high in the United States (U.S.) as in Asia, the treatment armamentarium differs widely between regions. The role of surgery for gastric cancer in the U.S. has changed drastically over the last decade. While the natural history of gastric cancer seen in the U.S. markedly differs from that seen in Asia, the U.S. experience with endoscopic and minimally invasive techniques is beginning to parallel those seen in Japan and Korea. Minimally invasive surgery has truly come into the forefront of our surgical armamentarium, and its role, along with robotic and endoscopic approaches, remains to be defined as standard of care. At present, minimally invasive approaches appear to offer oncologically equivalent outcomes compared with standard open gastrectomy when performed by experienced surgeons. Extended lymphadenectomy does not appear to offer benefit with improved survival in our patient population, although sufficient lymph node sampling is imperative for adequate staging. Despite aggressive approaches to surgical resection for cure, the U.S. population tends to present with more advanced disease and have a worse prognosis than our Asian counterparts. Palliation with resection and possibly stent placement should be offered for improved quality of life in late-stage disease.
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Palliative gastrectomy and other factors affecting overall survival in stage IV gastric adenocarcinoma patients receiving chemotherapy: a retrospective analysis. Eur J Surg Oncol 2011; 37:312-8. [PMID: 21300519 DOI: 10.1016/j.ejso.2011.01.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 12/16/2010] [Accepted: 01/17/2011] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Most patients with gastric cancer present with locally advanced or metastatic disease and usually receive palliative therapy. We sought to identify factors influencing overall survival in patients with stage IV gastric cancer receiving palliative chemotherapy. PATIENTS AND METHODS The records of 311 patients with histological diagnosis of gastric adenocarcinoma were retrospectively reviewed and 17 clinicopathological and therapeutic parameters were evaluated for their influence on overall survival. RESULTS In multivariate analysis nine factors were found to independently influence survival: no previous palliative gastrectomy [Hazard ratio (HR, 12; CI 7.969-18.099)], single agent chemotherapy instead of combination chemotherapy (HR, 1.35; CI 1.068-1.721), histological grade III (HR, 1.39; 95% CI 1.098-1.782), the presence of hepatic (HR, 1.6; 95% CI 1.246-2.073) and abdominal metastasis (HR, 1.33; 95% CI 1.039-1.715), CA 72-4 > 7 U/L (HR, 1.39; 95% CI 1.026-1.887), LDH > 225 U/L (HR, 1.72; 95% CI 1.336-2.236], need for blood transfusions (HR, 1.58; 95% CI 1.213-2.082), and weight loss > 5% (HR, 1.96; 95% CI 1.352-2.853) at the time of initial diagnosis. Patients were stratified as low (0-2 factors), intermediate (3-6 factors) and high (7-9 factors) risk and the median survival was 76, 40 and 11 weeks, respectively. CONCLUSION Nine clinical and laboratory factors that adversely affect survival in patients with stage IV gastric cancer who receive chemotherapy were identified. Their concurrent presence seems to have an additive effect as patients with seven to nine factors have the worse prognosis. Palliative gastrectomy and combination chemotherapy appear to be associated with improved survival.
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21
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Advisability of Palliative Resections in Incurable Advanced Gastric Cancer. POLISH JOURNAL OF SURGERY 2011; 83:449-56. [DOI: 10.2478/v10035-011-0070-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Abstract
BACKGROUND Palliative resection for noncurable gastric cancer remains controversial, especially in the elderly. This retrospective study was designed to elucidate the clinicopathological factors and operative outcome in patients undergoing palliative gastric resection. METHODS From January 1988 to December 2008, 365 patients received palliative gastrectomy while 151 underwent exploratory laparotomy or gastrojejunostomy for noncurative gastric cancer at the Department of Surgery, Taipei Veterans General Hospital. Among the 365 patients, 182 patients (Group A) were aged 70 or less and 183 patients (Group B) were older than 70 years of age. Clinicopathological characteristics and surgical morbidity and mortality were analyzed. RESULTS The overall survival of patients who underwent resection was 10.2 months and that of patients without resection 4.48 months (p < 0.001). Compared to Group B, Group A patients were predominantly female (p < 0.001), had more advanced Borrmann-type tumors (p = 0.004), more diffuse type of Lauren classification (p < 0.001), and poorer cell differentiation (p < 0.001). The median overall survival was 10.5 months in Group A and 9.7 months in Group B (p = 0.854). The surgical morbidity was significant higher if the patients had comorbidity (p = 0.028). Both surgical morbidity (13.8% vs. 26.8%, p = 0.028) and mortality (0.5% vs. 6.0%, p < 0.0001) were significantly higher in Group B. CONCLUSIONS Gastric cancer is less aggressive in the elderly. Palliative gastrectomy can be performed in both younger and older patients, but younger patients tolerate surgery better. More attention should be paid to the perioperative care of the elderly.
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Nishiyama M, Wada S. Docetaxel: its role in current and future treatments for advanced gastric cancer. Gastric Cancer 2010; 12:132-41. [PMID: 19890692 DOI: 10.1007/s10120-009-0521-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 08/06/2009] [Indexed: 02/07/2023]
Abstract
A globally accepted standard chemotherapy remains undetermined in gastric cancer, but the recent introduction of active "new-generation agents" such as taxanes, irinotecan (CPT-11), oxaliplatin, S-1, and capecitabine, offers hope for markedly improving patient outcomes. Docetaxel, as well as the other new-generation agents, plays a key role in the development of the new-era chemotherapy, and the incorporation of taxanes has provided several regimens, such as docetaxel/cisplatin/5-fluorouracil (5-FU) (DCF), that could become standard treatment. The DCF regimen is now regarded as a standard treatment option in advanced gastric cancer in selected patients in good condition. Many institutions and cooperative groups continue to study a variety of docetaxel-based combinations with "new-generation cytotoxic agents" in various treatment settings, and recent attention has been focused on the incorporation of biological agents, such as cetuximab, bevacizumab, everolimus, and sunitinib, into docetaxel-containing combinations as another innovative approach. The ongoing clinical trials of a number of new regimens will clarify their clinical benefits in gastric cancer treatment. Along with the development of more active docetaxel combination regimens, the identification of predictive biomarkers for each regimen has been intensively studied recently. This review focuses on docetaxel as a key agent in gastric cancer chemotherapy, and discusses the role of this taxane in current and future treatments for advanced gastric cancer.
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Affiliation(s)
- Masahiko Nishiyama
- Translational Research Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
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Triweekly Oxaliplatin Plus Oral Capecitabine as First-Line Chemotherapy in Elderly Patients With Advanced Gastric Cancer. Am J Clin Oncol 2009; 32:559-63. [DOI: 10.1097/coc.0b013e3181967db3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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25
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Gálvez-Muñoz E, Gallego-Plazas J, Gonzalez-Orozco V, Menarguez-Pina F, Ruiz-Maciá JA, Morcillo MA. Hepatoid adenocarcinoma of the stomach - a different histology for not so different gastric adenocarcinoma: a case report. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY : ISSO 2009; 6:13. [PMID: 19674468 PMCID: PMC2731104 DOI: 10.1186/1477-7800-6-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 08/12/2009] [Indexed: 12/14/2022]
Abstract
Hepatoid adenocarcinoma is an extrahepatic tumor characterized by morphological similarities to hepatocellular carcinoma. Hepatoid adenocarcinoma of the stomach is a cancer with an extremely poor prognosis with few cases reported. Here, we describe a 75-year-old Spanish man referred to our hospital with a history of abdominal pain, general fatigue, anorexia and sickness. Initial study revealed anemia, and computed tomography scan and abdominal ultrasonography showed multiple metastases to the liver with hepatocellular carcinoma characteristics in a liver with no cirrhotic change. Further study included a serum level of alpha-fetoprotein (AFP), which resulted markedly elevated, and a conclusive esophagogastroduodenoscopy describing an elevated tumour growing through the cardia and gastroesophageal junction with foci of necrosis and haemorrhage. Gastric biopsies of the tumor revealed poorly differenciated adenocarcinoma, with hepatoid differentiation. After a diagnosis of AFP-producing hepatoid adenocarcinoma of the stomach with multiple liver metastases was made, pallitive total gastrectomy, without liver resection, was performed. Patient recovered well after surgery, and entered into a palliative systemich chemotherapy protocol. Although this illness is recognized as having poor prognosis, the patient remains alive 8 months after the operation. Accurate diagnosis of hepatoid adenocarcinoma of the stomach is important, and should be suspected under certain circumstances. We describe this rare case of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects.
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Affiliation(s)
- Elisa Gálvez-Muñoz
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Javier Gallego-Plazas
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | | | | | - José A Ruiz-Maciá
- Department of Pathology, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Miguel A Morcillo
- Department of General Surgery, Hospital Vega Baja, Orihuela, Alicante, Spain
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Pharmacokinetics and pharmacogenomics in gastric cancer chemotherapy. Adv Drug Deliv Rev 2009; 61:402-7. [PMID: 19133303 DOI: 10.1016/j.addr.2008.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 09/27/2008] [Indexed: 12/25/2022]
Abstract
Despite extensive efforts, treatment of gastric cancer by chemotherapy, the globally accepted standard, is yet undetermined, and uncertainty remains regarding the optimal regimen. Recent introduction of active "new generation agents" offers hope for improving patient outcomes. Current chemotherapeutic trials provided several regimens that may become a possible standard treatment, including docetaxel/cisplatin/5-FU (TCF) and cisplatin/S-1 for advanced and metastatic cancer and S-1 monotherapy in the adjuvant setting. Along with the development of novel active regimens, individual optimization of cancer chemotherapy has been attempted in order to reduce toxicity and enhance tumor response. Unlike the rare and limited contribution of pharmacokinetic studies, pharmacogenomic studies are increasing the potential to realize the therapeutics against gastric cancer. Despite the limited data, pharmacogenomics in gastric cancer have provided a number of putative biomarkers for the prediction of tumor response to chemotherapies and of toxicity.
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27
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Wu B, Zhu JS, Zhang Y, Shen WM, Zhang Q. Predictive value of MTT assay as an in vitro chemosensitivity testing for gastric cancer: One institution’s experience. World J Gastroenterol 2008; 14:3064-8. [PMID: 18494060 PMCID: PMC2712176 DOI: 10.3748/wjg.14.3064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the predictive clinical value of in vitro 3-(4,5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay for directing chemosensitivity in patients with gastric cancer.
METHODS: Results of a total of 353 consecutive patients with gastric cancer treated with MTT-directed chemotherapy or physician’s empirical chemotherapy from July 1997 to April 2003 were reviewed and analyzed retrospectively.
RESULTS: The overall 5-year survival rate of MTT-sensitive group (MSG) and control group (CG) was 47.5% and 45.1%, respectively. The results of subgroup analysis with Cox proportional-hazards model were favorable for the MSG-sensitive group. However, no statistically significant difference in survival rate was observed between the two groups.
CONCLUSION: Individualized chemotherapy based on in vitro MTT assay is beneficial, but needs to be confirmed by further randomized controlled trials.
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