The clinicopathological features and prognostic factors of gastric squamous cell carcinoma

Gastric squamous cell carcinoma: A rare malignancy, literature review and management recommendations (Review)

Gastric cancer serves a major role in the global cancer burden, being the fourth most frequent cause of mortality among all types of cancer. Gastric squamous cell carcinoma (GSCC) is a rare histological variant accounting for 0.04-0.5% of all gastric cancer cases. Diagnostic work-up of GSCC is essential and involves multiple criteria: i) Tumour not located in the cardia, ii) no oesophageal extension of the tumour, and iii) no evidence of SCC in any other part of the body. Little is known about this rare variant in terms of pathogenesis, risk factors or evolution. Consequently, neither the European Society of Medical Oncology nor the National Comprehensive Cancer Network societies have published recommendations for GSCC. The aim of the present review is to provide an in-depth analysis of the current literature on this pathology, from pathophysiological hypothesis and clinical presentation to diagnostic work-up and treatment trends, in order to establish a possible management algorithm.

Predictors of survival outcomes among patients with gastric cancer in a leading tertiary, teaching and referral hospital in Kenya

INTRODUCTION

The incidence of gastrointestinal malignancies in Kenya is increasing, although there is a paucity of data on survival outcomes among gastric cancer patients. Hence, this study aimed to assess survival outcomes among adult gastric cancer patients at Kenyatta National Hospital.

METHODS

A retrospective cohort study design was used to assess the survival outcomes among 247 gastric cancer patients. All medical records of adult (≥18 years) gastric cancer patients with complete medical records of diagnosis, stage of cancer, and treatment regimen in the study setting in the last 5 years (2016-2020) were included. A simple random sampling technique was employed to select the study participants. Data were collected using a data abstraction tool composed of socio-demographic and clinical characteristics. Survival outcomes were reported as the percentage of mortality, mean survival estimate, and mean cancer-specific survival. The data were entered and analyzed using version 20.0 SPSS statistical software. The mean survival estimates and predictors of mortality were computed using the Kaplan-Meier and Cox regression analysis.

RESULTS

The study showed that 33.3% (64) had new distant metastasis, and 42.1% (104) had disease progression. Besides, the mortality rate was high (33.6%), and 14.6% and 7.7% of patients had complete and partial responses, respectively. The five-year survival was 32.7% among gastric cancer patients. Comorbidity (p = 0.014), advanced-stage diseases (p = 0.03), chemotherapy (p = 0.008), and gastrectomy (p = 0.016) were significant determinants of mortality.

CONCLUSIONS

A significant proportion of patients had distant metastasis, disease progression, and a low five-year survival rate. Hence, early cancer-screening programs are indispensable to circumvent disease progression and improve survival outcomes.

An unusual non‑metastatic, mismatch repair‑deficient primary gastric squamous cell carcinoma presenting as a large, exophytic, bleeding tumor: A case report

Primary gastric squamous cell carcinoma (GSCC) is an extremely rare malignancy with a poor prognosis. Despite the improved knowledge regarding its pathogenesis and biology, the treatment options remain limited. The present study reported on the unique case of a mismatch repair-deficient (dMMR) primary GSCC in a 79-year-old woman reporting fatigue and symptoms of upper gastrointestinal tract bleeding. Physical examination revealed abdominal pain at palpation. Gastroscopy revealed a large, exophytic, bleeding tumor. Medical imaging confirmed a mushroom-like polyp in the lumen of the stomach, with no signs of disease spread. Total gastrectomy and D2 lymphadenectomy were performed. Pathological examination of the post-operational material confirmed a well-differentiated SCC invading the mucosa, submucosa and muscle layer. There were no signs of dissemination observed in any of the 32 excised lymph nodes. Notably, according to the last follow-up, the patient remains well, supporting the 5-year GSCC survival rate statistics. To the best of our knowledge, this is the first such GSCC case reported in the Surgical Oncology Outpatient Clinic (Copernicus Memorial Hospital, Lodz, Poland) and these findings add to the limited data on GSCC. Although this is a very rare condition, it should always be considered during the process of diagnosis of gastric tumors.

Metachronous squamous cell carcinoma of pancreas and stomach in an elderly female patient: A case report

BACKGROUND

Squamous cell carcinoma (SCC) in pancreas and stomach is a rare histologic subtype with aggressive behavior, poor prognosis, and no standardized therapy. Pancreatic SCC or gastric SCC has been previously reported. However, case of SCC occurring in both the pancreas and the stomach has not been reported yet.

CASE SUMMARY

A 75-year-old female with prior history of hypertension and diabetes mellitus visited our hospital with complaint of abdominal pain that started three months ago. Computed tomography (CT) scan of the abdomen showed 3.3 cm mass at the distal pancreas. She received surgical resection which was histologically found to be SCC of the pancreas with clear resection margins. After she was discharged, she no longer visited the hospital. Three years later, she was referred to our hospital after showing abnormal findings on a gastroscopy performed at another hospital. Gastroscopy revealed a single, 2cm sized, ill-defined irregular flat and hyperemic mass at high body. Histologic finding of the mass was SCC. CT scan and positive emission tomography CT showed metastatic lesions to the liver and the peritoneum. She received combination chemotherapy with capecitabine and oxaliplatin. However, she passed away 6 mo after diagnosis of gastric SCC.

CONCLUSION

To the best of our knowledge, this is the first case of metachronous SCC of stomach occurring after diagnosis of pancreatic SCC.

Primary gastric squamous cell carcinoma with a bilio-gastric fistula and Krukenberg syndrome

Primary squamous cell carcinoma of the stomach is a rare type of gastric malignancies. Diagnosis criteria are well defined but diagnosis is generally late being made at an advanced stage with metastases explaining its poor diagnosis.

Primary gastric squamous cell carcinoma presenting as a large submucosal mass: A case report and literature review

RATIONALE

Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear.

PATIENT CONCERNS

A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation.

DIAGNOSES

The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC.

INTERVENTIONS

Total gastrectomy, distal pancreatectomy, and splenectomy were performed.

OUTCOMES

The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery.

LESSONS

Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.

Metastatic Primary Gastric Squamous Cell Carcinoma: An Uncommon Presentation of a Rare Malignancy

Primary gastric squamous cell carcinoma is a very rare disease. A 53-year-old male with history of hypertension, alcoholism, and nicotine abuse presented to the hospital after a syncopal episode. He complained of bloating abdominal pain, early satiety, and poor appetite. A CT of his abdomen and pelvis revealed a gastric mass with diffuse hepatic metastasis. A gastric mass was seen on upper endoscopy and biopsies revealed gastric squamous cell carcinoma. There was no involvement of the esophagus. This case should add to the limited literature and serve as a reminder that while this is a rare malignancy, it must be considered when evaluating a gastric mass.

Expression of VEGF with tumor incidence, metastasis and prognosis in human gastric carcinoma

OBJECTIVE

To analysis the expression of VEGF in gastric carcinoma cell and tumor tissue, our study determined the relationship between the expression of VEGF and tumor incidence, metastasis and prognosis in human gastric carcinoma.

METHODS

Treatment of ZD6474 at dose of 30 μmol/L was performed in gastric carcinoma cell BGC823. qPCR and Western-blot were used to analysis the mRNA and protein expression of VEGF. MTT, wound healing and Transwell experiments were conducted to study the effect of VEGF on tumor incidence, metastasis and prognosis. Sixty patients with gastric cancer were selected as the gastric cancer group, and 30 patients with gastric ulcer receiving main gastric resection were selected as control group. The survival curve of patients with gastric cancer in five years was recorded. The correlation between expression of VEGF to incidence, metastasis and prognosis of gastric cancer was evaluated by Cox multifactor regression.

RESULTS

The mRNA and protein expression of VEGF in treatment group were significantly lower than that of control group (P< 0.01). The results of MTT, wound healing and Transwell experiments were showed that the cell proliferation, migration and invasion capacity in treatment group were significantly reduced compared to that of the control group (P< 0.01). The 5-year survival rate for patients with VEGF positive expression was significantly decreased compared to the patients with VEGF expression negative (P< 0.01). The tumor size, differentiation, lymph node metastasis and tumor stage were statistically related to VEGF level (P< 0.05). The results of Cox regression multifactor analysis showed that lymph node metastasis, tumor staging and the expression of VEGF were significantly associated to the prognosis of gastric cancer patients (P< 0.05).

CONCLUSION

Our data demonstrated that the expression of VEGF was significantly related to the tumor incidence, metastasis and prognosis of patients with gastric cancer, which provides new leads to the diagnosis of gastric cancer.

Gastric squamous cell carcinoma and gastric adenosquamous carcinoma, clinical features and outcomes of rare clinical entities: a National Cancer Database (NCDB) analysis

Background

Gastric squamous cell carcinoma (GSCC) and gastric adenosquamous carcinoma (GASC) comprise less than 2% of gastric cancers. The current knowledge about clinical presentation, treatment modalities and outcomes of GSCC and GASC is limited. The aim of this study is to characterize the clinicopathological features, treatment modalities, and outcomes of GSCC and GASC in comparison to gastric adenocarcinoma (GAC) in National Cancer Database (NCDB).

Methods

Patients with GSCC, GASC and GAC between 2004 and 2013 were identified using ICD-O-3 histology and topography codes 8070/3, 8560/3, 8140/3 and C16.0-9. Univariate, and multivariate analysis were performed, and Kaplan-Meier curves was used to compare survival based on histological subtype.

Results

A total of 61,215 patients were identified, 836 (1.4%) GSCC, 327 (0.5%) GASC, 60,052 (98.1%) GAC between 2004 and 2013, in which 77.4% was Caucasian and 68.7% was male, 46.6% of tumors were in gastric cardia and 13.7% in gastric antrum. Neoadjuvant and adjuvant chemotherapy was administered in 11.2%, 14.1%, 8.9% vs. 2.9%, 11.9%, 9.5% for GSCC, GASC, GAC. Surgery was performed in 26.0%, 54.4%, 45.2% of GSCC, GASC, GAC. Radiotherapy was administered in 48.1%, 37.6%, 31.6% of GSCC, GASC, GAC. Median overall survival was 8.9, 9.9 and 13.2 months for GSCC, GASC, GAC. On multivariate analysis squamous cell (HR =1.14; 95% CI, 1.06-1.24, P=0.001) and adenosquamous cell histology (HR =1.52; 95% CI, 1.35-1.73, P<0.001) was associated with worse survival compared to adenocarcinoma.

Conclusions

GSCC and GASC have poorer survival outcomes compared to GAC. Less patients with GSCC received surgery and adjuvant chemotherapy, more patients with GSCC received radiation therapy.