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Dejeu V, Dejeu P, Muresan A, Bradea P, Dejeu D. Analysis of Patient Outcomes following Curative R0 Multiorgan Resections for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3010. [PMID: 38792552 PMCID: PMC11121797 DOI: 10.3390/jcm13103010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: This systematic review examines the efficacy of multiorgan resection (MOR) in treating locally advanced gastric cancer (LAGC), focusing on survival outcomes, postoperative morbidity, and mortality. Methods: We conducted a comprehensive search of studies in PubMed, Scopus, and Embase up to November 2023, based on the PRISMA guidelines. The inclusion criteria focused on clinical trials, observational studies, case-control studies, and qualitative research, involving patients of any age and gender diagnosed with LAGC undergoing MOR aimed at R0 resection, with secondary outcomes focusing on survival rates, postoperative outcomes, and the effects of adjuvant and neoadjuvant therapies. Exclusion criteria ruled out non-human studies, research not specifically focused on LAGC patients undergoing MOR, and studies lacking clear, quantifiable outcomes. The quality assessment was performed using the Newcastle-Ottawa Scale. The final analysis included twenty studies, involving a total of 2489 patients across a time span from 2001 to 2023. Results highlighted a significant variation in median survival times ranging from 10 to 27 months and R0 resection rates from 32.1% to 94.3%. Survival rates one-year post-R0 resection varied between 46.7% and 84.8%, with an adjusted weighted mean of 66.95%. Key predictors of reduced survival included esophageal invasion and peritoneal dissemination, the presence of more than six lymph nodes, and tumor sizes over 10 cm. Nevertheless, the meta-analysis revealed a significant heterogeneity (I2 = 87%), indicating substantial variability across studies, that might be caused by differences in surgical techniques, patient demographics, and treatment settings which influence survival outcomes. Results: The review underlines the important role of achieving R0 resection status in improving survival outcomes, despite the high risks associated with MOR. Variability across studies suggests that local practice patterns and patient demographics significantly influence results. Conclusions: The findings emphasize the need for aggressive surgical strategies to improve survival in LAGC treatment, highlighting the importance of achieving curative resection despite inherent challenges.
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Affiliation(s)
- Viorel Dejeu
- Bariatric Surgery Department, Life Memorial Hospital, Calea Grivitei 365, 010719 Bucuresti, Romania;
| | - Paula Dejeu
- Laboratory Medicine Unit, Betania Medical Center, Menumorut 12, 410004 Oradea, Romania
| | - Anita Muresan
- Surgical Oncology Department, Emergency County Hospital Oradea, Strada Gheorghe Doja 65, 410169 Oradea, Romania; (A.M.); (D.D.)
| | - Paula Bradea
- Gastroenterology Unit, Betania Medical Center, Menumorut 12, 410004 Oradea, Romania;
| | - Danut Dejeu
- Surgical Oncology Department, Emergency County Hospital Oradea, Strada Gheorghe Doja 65, 410169 Oradea, Romania; (A.M.); (D.D.)
- Bariatric Surgery Department, Medlife Humanitas Hospital, Strada Frunzisului 75, 400664 Cluj Napoca, Romania
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Díaz Del Arco C, Ortega Medina L, Estrada Muñoz L, Molina Roldán E, García Gómez de Las Heras S, Fernández Aceñero MJ. Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer. Ann Diagn Pathol 2023; 67:152209. [PMID: 37689040 DOI: 10.1016/j.anndiagpath.2023.152209] [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: 08/29/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Lymph node (LN) involvement is one of the most critical prognostic factors in resected gastric cancer (GC). Some analyses, mainly conducted in Asian populations, have found that patients with a higher number of total lymph nodes (NTLN) and/or negative lymph nodes (NNLN) have a better prognosis, although other authors have failed to confirm these results. MATERIALS AND METHODS Retrospective study including all patients with GC resected in a tertiary hospital in Spain between 2001 and 2019 (n = 315). Clinicopathological features were collected and patients were categorized according to the NTLN and the NNLN. Statistical analyses were performed. RESULTS Mean NNLN was 17. The NNLN was significantly related to multiple clinicopathological variables, including recurrence and tumor-related death. The classification based on the NNLN (N1: ≥16, N2: 8-15, N3: ≤7) effectively stratified the entire cohort into three distinct prognostic groups and maintained its prognostic value within both the pN0 and pN+ patient subsets. Furthermore, it was an independent prognostic indicator for both overall and disease-free survival. Conversely, the mean NTLN was 21.9. Patients with ≤16 LN retrieved exhibited distinct clinicopathological features compared to those with >16 LN, but no significant differences were observed in terms of recurrence or disease-associated death. The application of alternative cut-off points for NTLN (10, 20, 25, 30, and 40) showed no prognostic significance. CONCLUSIONS In Spanish patients with resected GC the NNLN hold prognostic significance, while the NTLN does not appear to be prognostically significant. Incorporating the NNLN into GC staging may enhance the accuracy of the TNM system.
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Affiliation(s)
- Cristina Díaz Del Arco
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Luis Ortega Medina
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lourdes Estrada Muñoz
- Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Móstoles, Madrid, Spain; Department of Pathology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
| | - Elena Molina Roldán
- Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Biobank, Hospital Clínico San Carlos, Madrid, Spain
| | | | - M Jesús Fernández Aceñero
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Mitra S, Simson DK, Gehani M, Barik S, Khurana R, Singh S, Talwar V, Goel V, Khurana H, Mishra M, Dewan A, Mukhi MJ. Survival and Recurrence Patterns in Patients With Stomach Adenocarcinoma Receiving Chemotherapy or Chemoradiotherapy After D2 Gastrectomy in a Tertiary Care Cancer Institute: A Retrospective Real-World Evidence Cohort Study. Adv Radiat Oncol 2023; 8:101280. [PMID: 38047217 PMCID: PMC10692297 DOI: 10.1016/j.adro.2023.101280] [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: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Clinical trials comparing the efficacy of adjuvant chemotherapy (CT) and chemo radiation therapy (CTRT) for stomach adenocarcinoma have reported equivocal results. Hence, the current retrospective cohort study assessed the long-term survival and recurrence outcomes of these therapies, to generate evidence in a real-world scenario. Methods and Materials Pathologically confirmed patients with stomach adenocarcinoma aged ≥18 years who underwent gastrectomy and D2 lymph nodal dissection at a tertiary cancer hospital from January 2010 to October 2017 were enrolled. Hospital-based follow-up was performed until December 2021. Data were gathered from electronic medical records, supplemented by telephonic interviews for patients who could not come for physical follow-up. CT-alone and CTRT cohorts were compared in terms of survival and recurrence outcomes. Results The analysis included 158 patients (mean age, 56.42 years; 63.9% male; CT-alone cohort, 69; CTRT cohort, 89). Patients in the CTRT cohort had significantly worse tumor characteristics at baseline (29.2% had the diffuse type of tumor, 94.4% had stage II or III, 68.5% had lympho-vascular space invasion, and 85.4% had lymph node involvement). Recurrence was observed in 13 (19.7%) of the 76 followed-up patients. Although locoregional recurrence was higher in the CT-alone cohort (7 vs 2), distant metastasis was higher in the CTRT cohort (3 vs 1). The overall 5-year survival was 67.0% (SE, 5.0%) and 5-year recurrence-free survival (RFS) was 75.0% (SE, 5.0%). On multivariate Cox regression, no variable was significantly associated with the overall survival, whereas age, positive lymph nodes without extracapsular extension, and lymph node-negative were significantly associated with RFS. The CTRT cohort had significantly (84.0%) higher RFS (hazard ratio, 0.161; 95% CI, 0.056-0.464; P < .001). Conclusions Patients who received adjuvant CTRT after D2 dissection showed similar overall survival but significantly higher RFS than the CT-alone cohort, despite having worse baseline tumor characteristics.
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Affiliation(s)
- Swarupa Mitra
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - David K. Simson
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Manish Gehani
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, India
| | - Soumitra Barik
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Ruparna Khurana
- Holistic Oncology with Patient Empathy (HOPE) Oncology Clinic, New Delhi, India
| | - Shivendra Singh
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Vineet Talwar
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Varun Goel
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | | | - Manindra Mishra
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Abhinav Dewan
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - M. Jwala Mukhi
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
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Biondi A, Lorenzon L, Santoro G, Agnes A, Laurino A, Persiani R, D'Ugo D. Profiling complete regression after pre-operative therapy in gastric cancer patients using clinical and pathological data. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106969. [PMID: 37414627 DOI: 10.1016/j.ejso.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/12/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The consistent use of pre-operative treatment before surgery for gastric cancer (GC) has resulted in increased rates of complete response. However, factors associated with response have been scantly investigated. METHODS Patients with GCs treated between 2017 and 2022 undergoing pre-operative treatment followed by resection were included. Clinicopathological data were analyzed for the association with tumor regression grades (TRG); secondary outcomes included the short-term overall (OS), disease-free (DFS) and disease specific survival (DSS). RESULTS Among 108 patients, 35.1% had an intestinal histotype GC, and 70.4% were treated with FLOT. Complete tumor regression (TRG1) was documented in 6.5% of patients. Univariable analyses documented that a higher pre-operative albumin (p = 0.04) and the expression of HER2 (p = 0.01) were associated to TRG1. In the multinominal regression model, the log-odds of being classified as TRG1 increased with the expression of HER2 by 170.247 times and with higher pre-operative albumin by 34.525 times, while with a higher Charlson Index and a diffuse hystotipe reduced it by 25.467 times and 3759.126 times, respectively. Among 49 patients (mean follow-up: 17.1 months), TRG1-2 was associated to better OS, DFS and DSS curves compared to TRG 3-5 (respectively p < 0.01, p 0.007 and p < 0.01), altogether with the reported negative impact of comorbidities in OS and DSS multivariable analyses (respectively p 0.04 and p 0.006). The random survival forest further confirmed the impact of HER2 and comorbidity on DSS. CONCLUSION A better clinical profile, HER2 expression and intestinal histotype significantly correlated with GC regression. A complete-major response was an independent factor for survival.
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Affiliation(s)
- Alberto Biondi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Gloria Santoro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annamaria Agnes
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Laurino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Ugo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Pereira C, Park JH, Campelos S, Gullo I, Lemos C, Solorzano L, Martins D, Gonçalves G, Leitão D, Lee HJ, Kong SH, André A, Borges C, Almeida D, Wälbhy C, Almeida R, Kim WH, Carneiro F, Yang HK, Almeida GM, Oliveira C. Comparison of East-Asia and West-Europe cohorts explains disparities in survival outcomes and highlights predictive biomarkers of early gastric cancer aggressiveness. Int J Cancer 2021; 150:868-880. [PMID: 34751446 DOI: 10.1002/ijc.33872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/09/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
Surgical resection with lymphadenectomy and peri-operative chemotherapy is the universal mainstay for curative treatment of gastric cancer (GC) patients with loco-regional disease. However, GC survival remains asymmetric in West- and East-world regions. We hypothesize this asymmetry derives from differential clinical management. Therefore, we collected chemo-naïve GC patients from Portugal and South-Korea to explore specific immunophenotypic profiles related to disease aggressiveness, and clinicopathological factors potentially explaining associated overall survival (OS) differences. Clinicopathological and survival data were collected from chemo-naïve surgical cohorts from Portugal (West-Europe cohort (WE-C); n=170) and South-Korea (East-Asia cohort (EA-C); n=367), and correlated with immunohistochemical expression profiles of E-cadherin and CD44v6 obtained from consecutive tissue microarrays sections. Survival analysis revealed a subset of 12.4% of WE-C patients, whose tumors concomitantly express E-cadherin_abnormal and CD44v6_very-high, displaying extremely poor OS, even at TNM stages I and II. These WE-C stages I and II patients were particularly aggressive compared to all other, invading deeper into the gastric wall (p=0.032) and more often permeating the vasculature (p=0.018) and nerves (p=0.009). A similar immunophenotypic profile was found in 11.9% of EA-C patients, but unrelated to survival. Stage I and II EA-C patients displaying both biomarkers also permeated more lymphatic vessels (p=0.003), promoting lymph node (LN) metastasis (p=0.019), being diagnosed on average 8-years earlier and submitted to more extensive LN dissection than WE-C. Concomitant E-cadherin_abnormal/CD44v6_very-high expression predicts aggressiveness and poor survival of stage I and II GC submitted to conservative lymphadenectomy.
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Affiliation(s)
- Carla Pereira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal.,Doctoral Programme in Biomedicine, Faculty of Medicine of the University of Porto, 4200-319, Porto, Portugal
| | - Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sofia Campelos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Department of Pathology, Ipatimup Diagnostics, Institute of Molecular Pathology and Immunology, University of Porto, 4200-135, Porto, Portugal
| | - Irene Gullo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Department of Pathology, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Medicine of the University of Porto, 4200-319, Porto, Portugal
| | - Carolina Lemos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,UniGENe, IBMC - Institute for Molecular and Cell Biology, 4200-135, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313, Porto, Portugal
| | - Leslie Solorzano
- Center for Image Analysis, Dept. of IT and SciLifeLab, Uppsala University, SE-751 05, Uppsala, Sweden
| | - Diana Martins
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal.,Department of Biomedical Laboratory Sciences, ESTESC- Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854, Coimbra, Portugal
| | - Gilza Gonçalves
- Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal
| | - Dina Leitão
- Department of Pathology, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Medicine of the University of Porto, 4200-319, Porto, Portugal
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ana André
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal
| | - Clara Borges
- Medical Oncology Department, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
| | - Daniela Almeida
- Medical Oncology Department, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal
| | - Carolina Wälbhy
- Center for Image Analysis, Dept. of IT and SciLifeLab, Uppsala University, SE-751 05, Uppsala, Sweden
| | - Raquel Almeida
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal.,Department of Pathology, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Sciences of the University of Porto, 4169-007, Porto, Portugal
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Fátima Carneiro
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal.,Department of Pathology, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.,Faculty of Medicine of the University of Porto, 4200-319, Porto, Portugal
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Gabriela M Almeida
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal.,Faculty of Medicine of the University of Porto, 4200-319, Porto, Portugal
| | - Carla Oliveira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, 4200-135, Porto, Portugal.,Faculty of Medicine of the University of Porto, 4200-319, Porto, Portugal
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