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Abboretti F, Lambert C, Schäfer M, Pereira B, Le Roy B, Mège D, Piessen G, Gagnière J, Gronnier C, Mantziari S. Neoadjuvant Chemotherapy Does Not Improve Survival in cT2N0M0 Gastric Adenocarcinoma Patients: A Multicenter Propensity Score Analysis. Ann Surg Oncol 2024; 31:5273-5282. [PMID: 38762640 PMCID: PMC11236876 DOI: 10.1245/s10434-024-15418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences. OBJECTIVE The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients. METHODS A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups. RESULTS Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p < 0.001) and had a better health status (World Health Organization performance status = 0 in 60.3% of CS patients vs. 34.5% of S patients; p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW. CONCLUSIONS Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone.
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Affiliation(s)
- Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Bruno Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Diane Mège
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Johan Gagnière
- Department of Digestive Surgery and Liver Transplantation, Estaing University Hospital, Clermont-Ferrand, France
- U1071 Inserm/Clermont-Auvergne University, Clermont-Ferrand, France
| | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
- Faculty of Medicine, Bordeaux Ségalen University, Bordeaux, France
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
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de Jong DM, den Hoed CM, Willemssen FEJA, Thomeer MGJ, Bruno MJ, Koerkamp BG, de Jonge J, Alwayn IPJ, van Hooft JE, Hoogwater F, van der Heide F, Inderson A, van Vilsteren FGI, van Driel LMJW. Impact of EUS in liver transplantation workup for patients with unresectable perihilar cholangiocarcinoma. Gastrointest Endosc 2024; 99:548-556. [PMID: 37890597 DOI: 10.1016/j.gie.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/02/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND AIMS For a highly selected group of patients with unresectable perihilar cholangiocarcinoma (pCCA), liver transplantation (LT) is a treatment option. The Dutch screening protocol comprises nonregional lymph node (LN) assessment by EUS, and whenever LN metastases are identified, further LT screening is precluded. The aim of this study is to investigate the yield of EUS in patients with pCCA who are potentially eligible for LT. METHODS In this retrospective, nationwide cohort study, all consecutive patients with suspected unresectable pCCA who underwent EUS in the screening protocol for LT were included from 2011 to 2021. During EUS, sampling of a "suspicious" nonregional LN was performed based on the endoscopist's discretion. The primary outcome was the added value of EUS, defined as the number of patients who were precluded from further screening because of malignant LNs. RESULTS A total of 75 patients were included in whom 84 EUS procedures were performed, with EUS-guided tissue acquisition confirming malignancy in LNs in 3 of 75 (4%) patients. In the 43 who underwent surgical staging according to the protocol, nonregional LNs with malignancy were identified in 6 (14%) patients. Positive regional LNs were found in 7 patients in post-LT-resected specimens. CONCLUSIONS Our current EUS screening for the detection of malignant LNs in patients with pCCA eligible for LT shows a limited but clinically important yield. EUS with systematic screening of all LN stations, both regional and nonregional, and the sampling of suspicious lymph nodes according to defined and set criteria could potentially increase this yield.
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Affiliation(s)
- David M de Jong
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Caroline M den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Francois E J A Willemssen
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Jeroen de Jonge
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands; Department of Surgery, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Ian P J Alwayn
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederik Hoogwater
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Frans van der Heide
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederike G I van Vilsteren
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Lydi M J W van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands.
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Janczewski LM, Shah D, Wells A, Bentrem DJ, Abad JD, Chawla A. The inaccuracies of gastric adenocarcinoma clinical staging and its predictive factors. J Surg Oncol 2023; 127:1116-1124. [PMID: 36905333 PMCID: PMC10147580 DOI: 10.1002/jso.27233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Accurate clinical staging (CS) of gastric adenocarcinoma is important to guide treatment planning. Our objectives were to (1) assess clinical to pathologic stage migration patterns for patients with gastric adenocarcinoma, (2) identify factors associated with inaccurate CS, and (3) evaluate the association of understaging with survival. METHODS The National Cancer Database was queried for patients who underwent upfront resection for stage I-III gastric adenocarcinoma. Multivariable logistic regression was used to detect factors associated with inaccurate understaging. Kaplan-Meier analyses and cox proportional hazards regression were performed to assess overall survival (OS) for patients with inaccurate CS. RESULTS Of 14 425 analyzed patients, 5781 (40.1%) patients were inaccurately staged. Factors associated with understaging included treatment at a Comprehensive Community Cancer Program, presence of lymphovascular invasion, moderate to poor differentiation, large tumor size, and T2 disease. Based on overall CS, median OS was 51.0 months for accurately staged patients and 29.5 months for understaged patients (<0.001). CONCLUSION Clinical T-category, large tumor size, and worse histologic features lead to inaccurate CS for gastric adenocarcinoma, impacting OS. Improvements to staging parameters and diagnostic modalities focusing on these factors may improve prognostication.
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Affiliation(s)
- Lauren M Janczewski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dhavan Shah
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy Wells
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David J Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John D Abad
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Akhil Chawla
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL
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de Nucci G, Gabbani T, Impellizzeri G, Deiana S, Biancheri P, Ottaviani L, Frazzoni L, Mandelli ED, Soriani P, Vecchi M, Manes G, Manno M. Linear EUS Accuracy in Preoperative Staging of Gastric Cancer: A Retrospective Multicenter Study. Diagnostics (Basel) 2023; 13:diagnostics13111842. [PMID: 37296694 DOI: 10.3390/diagnostics13111842] [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: 04/01/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Preoperative gastric cancer (GC) staging is the most reliable prognostic factor that affects therapeutic strategies. Contrast-enhanced computed tomography (CECT) and radial endoscopic ultrasound (R-EUS) scans are the most commonly used staging tools for GC. The accuracy of linear EUS (L-EUS) in this setting is still controversial. The aim of this retrospective multicenter study was to evaluate the accuracy of L-EUS and CECT in preoperative GC staging, with regards to depth of tumor invasion (T staging) and nodal involvement (N staging). MATERIALS AND METHODS 191 consecutive patients who underwent surgical resection for GC were retrospectively enrolled. Preoperative staging had been performed using both L-EUS and CECT, and the results were compared to postoperative staging by histopathologic analysis of surgical specimens. RESULTS L-EUS diagnostic accuracy for depth of invasion of the GC was 100%, 60%, 74%, and 80% for T1, T2, T3, and T4, respectively. CECT accuracy for T staging was 78%, 55%, 45%, and 10% for T1, T2, T3, and T4, respectively. L-EUS diagnostic accuracy for N staging of GC was 85%, significantly higher than CECT accuracy (61%). CONCLUSIONS Our data suggest that L-EUS has a higher accuracy than CECT in preoperative T and N staging of GC.
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Affiliation(s)
- Germana de Nucci
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, 20094 Garbagnate Milanese, Italy
| | - Tommaso Gabbani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Giovanna Impellizzeri
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Simona Deiana
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Paolo Biancheri
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Laura Ottaviani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, Surgical and Medical Sciences Department, Sant'Orsola Malpighi Hospital, 40138 Bologna, Italy
| | - Enzo Domenico Mandelli
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, 20094 Garbagnate Milanese, Italy
| | - Paola Soriani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Maurizio Vecchi
- Gastroenterology Unit, Major Policlinic Hospital, 20122 Milan, Italy
| | - Gianpiero Manes
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, 20094 Garbagnate Milanese, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
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Liu S, Liang W, Huang P, Chen D, He Q, Ning Z, Zhang Y, Xiong W, Yu J, Chen T. Multi-modal analysis for accurate prediction of preoperative stage and indications of optimal treatment in gastric cancer. LA RADIOLOGIA MEDICA 2023; 128:509-519. [PMID: 37115392 DOI: 10.1007/s11547-023-01625-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Accurate preoperative clinical staging of gastric cancer helps determine therapeutic strategies. However, no multi-category grading models for gastric cancer have been established. This study aimed to develop multi-modal (CT/EHRs) artificial intelligence (AI) models for predicting tumor stages and optimal treatment indication based on preoperative CT images and electronic health records (EHRs) in patients with gastric cancer. METHODS This retrospective study enrolled 602 patients with a pathological diagnosis of gastric cancer from Nanfang hospital retrospectively and divided them into training (n = 452) and validation sets (n = 150). A total of 1326 features were extracted of which 1316 radiomic features were extracted from the 3D CT images and 10 clinical parameters were obtained from electronic health records (EHRs). Four multi-layer perceptrons (MLPs) whose input was the combination of radiomic features and clinical parameters were automatically learned with the neural architecture search (NAS) strategy. RESULTS Two two-layer MLPs identified by NAS approach were employed to predict the stage of the tumor showed greater discrimination with the average ACC value of 0.646 for five T stages, 0.838 for four N stages than traditional methods with ACC of 0.543 (P value = 0.034) and 0.468 (P value = 0.021), respectively. Furthermore, our models reported high prediction accuracy for the indication of endoscopic resection and the preoperative neoadjuvant chemotherapy with the AUC value of 0.771 and 0.661, respectively. CONCLUSIONS Our multi-modal (CT/EHRs) artificial intelligence models generated with the NAS approach have high accuracy for tumor stage prediction and optimal treatment regimen and timing, which could facilitate radiologists and gastroenterologists to improve diagnosis and treatment efficiency.
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Affiliation(s)
- Shangqing Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Weiqi Liang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Pinyu Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Dianjie Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Qinglie He
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhenyuan Ning
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Yu Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Wei Xiong
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiang Yu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Tao Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Gastrointestinal and Hernia Surgery, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, 341000, Jiangxi, China.
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Clinical Study on the Evaluation of the Condition of Patients with Gastric Tumors and the Choice of Surgical Treatment by Gastric Ultrasonic Filling Method. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3960929. [PMID: 35800228 PMCID: PMC9203228 DOI: 10.1155/2022/3960929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the clinical value of the gastric ultrasonic filling method in evaluating the condition of patients with gastric tumors and guiding the selection of treatment methods, provide data support for clinical gastric filling ultrasonography in the evaluation of gastric cancer patients, and provide the basis for the choice of surgical treatment. Methods. This study retrospectively analyzed 50 patients with gastric cancer treated in our hospital from April 2017 to January 2022. All 50 patients were examined by the gastric ultrasound filling method. The TNM staging results of gastric cancer were analyzed with the results of gastroscopic biopsy or postoperative pathological examination as the diagnostic gold standard. Results. The ultrasonic detection rate of 50 patients with gastric cancer was 94.00% (47/50). Among them, 3 cases missed diagnosis were of early intramucosal carcinoma, which were only diagnosed as erosive gastritis. 1 case was located in the gastric body, and the other 2 cases were located in the gastric antrum. Ultrasound assessment of gastric mucosal thickness in T1-T2 stage was 9.8 mm, which was significantly lower than that in T3-T4 stage, which was 17.0 mm (p < 0.05). The diagnostic accuracy of the gastric ultrasound filling method in the diagnosis of T1, T2, T3, and T4 was 41.67%, 57.14%, 96.00%, and 83.33%, respectively. The total diagnostic accuracy of T-stage was 76.00% (38/50). The total judgment rate of too shallow and too deep was 10.00% and 14.00%, respectively. The diagnostic accuracy of the gastric ultrasound filling method was 88.89%, 81.81%, 70.00%, and 82.00%, respectively. The diagnostic accuracy of the gastric ultrasound filling method in the diagnosis of M0 and M1 stages was 100.00%, and the total diagnostic accuracy of the M-stage was 100.00%. The ROC curve drawn by GFUS in the diagnosis of T-stage of gastric cancer had three components: the specificity was the horizontal axis, the sensitivity was the vertical axis, and the area under the curve was 0.978. The difference was statistically significant (p < 0.05). Conclusion. Before the operation of patients with gastric cancer, using the gastric ultrasonic filling method and ultrasonic examination method to diagnose them can timely clarify the clinical stage of patients, so that clinicians can choose the most appropriate operation method according to their clinical stage, which is worthy of popularization and application in clinic.
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Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Cooke D, Corvera C, Das P, Enzinger PC, Enzler T, Fanta P, Farjah F, Gerdes H, Gibson MK, Hochwald S, Hofstetter WL, Ilson DH, Keswani RN, Kim S, Kleinberg LR, Klempner SJ, Lacy J, Ly QP, Matkowskyj KA, McNamara M, Mulcahy MF, Outlaw D, Park H, Perry KA, Pimiento J, Poultsides GA, Reznik S, Roses RE, Strong VE, Su S, Wang HL, Wiesner G, Willett CG, Yakoub D, Yoon H, McMillian N, Pluchino LA. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:167-192. [PMID: 35130500 DOI: 10.6004/jnccn.2022.0008] [Citation(s) in RCA: 590] [Impact Index Per Article: 295.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastric cancer is the third leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability (MSI) status, and the expression of programmed death-ligand 1 (PD-L1), has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with localized gastric cancer. This selection from the NCCN Guidelines for Gastric Cancer focuses on the management of unresectable locally advanced, recurrent, or metastatic disease.
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Affiliation(s)
| | | | - David J Bentrem
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Prajnan Das
- The University of Texas MD Anderson Cancer Center
| | - Peter C Enzinger
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | - Farhood Farjah
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | - Rajesh N Keswani
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Samuel J Klempner
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Jill Lacy
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - Michael McNamara
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Mary F Mulcahy
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Haeseong Park
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Kyle A Perry
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Scott Reznik
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Robert E Roses
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | - Danny Yakoub
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
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Ao S, Wang Y, Song Q, Ye Y, Lyu G. Current status and future perspectives on neoadjuvant therapy in gastric cancer. Chin J Cancer Res 2021; 33:181-192. [PMID: 34158738 PMCID: PMC8181872 DOI: 10.21147/j.issn.1000-9604.2021.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer, with high morbidity and mortality rates, is one of the most heterogeneous tumors. Radical gastrectomy and postoperative chemotherapy are the standard treatments. However, the safety and efficacy of neoadjuvant therapy (NAT) need to be confirmed by many trials before implementation, creating a bottleneck in development. Although clinical benefits of NAT have been observed, a series of problems remain to be solved. Before therapy, more contributing factors should be offered for choice in the intended population and ideal regimens. Enhanced computed tomography (CT) scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors (RECIST), yet CT scanning results sometimes differ from pathological responses. After NAT, the appropriate time for surgery is still empirically defined. Our review aims to discuss the abovementioned issues regarding NAT for GC, including indications, selection of regimens, lesion assessment and NAT-surgery interval time.
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Affiliation(s)
- Sheng Ao
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Yuchen Wang
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Qingzhi Song
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Guoqing Lyu
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
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Post-surgery Survival in Patients with Adenocarcinoma of Stomach Using Multistate Model. J Gastrointest Cancer 2021; 53:311-317. [PMID: 33591561 DOI: 10.1007/s12029-021-00599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Stomach neoplasms are the fifth common cancer worldwide. The related factors for survival following stomach neoplasms are well-studied; however, information on recurrent events is limited. This study aimed to identify the related factors on recurrent and deaths following stomach neoplasms. METHODS In this cohort study, information on 672 patients with adenocarcinoma who were hospitalized during 1995-2012 was used. Multistate models were applied to determine the effective factors on recurrent and death events. RESULTS Median of survival time (months) and 5-year survival was estimated as 24.5 and 25%, respectively. The probability of death was 57% for non-recurrent patients, which increased to 88% among recurrent patients. Hazard of death was 49% lower for females (Hazard Ratio (HR):0.51, P = 0.009) while females had higher hazard of death following recurrent (HR:3.55, P < 0.001). Male patients and those with cardia involvement had higher risk of recurrence. A significant effect of age on the risk of death among patients with and without recurrence was estimated (HR:1.02, 1.03; P = 0.001 for both). Age, cardia involvement, and disease stage are amongst the effective factors on non-recurrent death while complement treatments increased the non-recurrent and recurrent survival. CONCLUSION In patients, effects of some factors for survival may vary throughout the course of disease and depend on recurrence status. We found that while female patients experienced lower recurrence, they had higher risk of death following recurrence. Age, tumor location, and type of therapy were risk factors for non-recurrent death. Finally, tumor location and type of surgery had significant effects on recurrence.
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Margalit O, Shacham-Shmueli E, Yang YX, Lawerence YR, Levy I, Reiss KA, Golan T, Halpern N, Aderka D, Giantonio B, Mamtani R, Boursi B. Prognostic Implications of Tumor Differentiation in Clinical T1N0 Gastric Adenocarcinoma. Oncologist 2020; 26:e111-e114. [PMID: 32969129 PMCID: PMC7794188 DOI: 10.1002/onco.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Current guidelines recommend neoadjuvant chemotherapy in patients with locoregional gastric adenocarcinoma. Patients diagnosed with early stage gastric adenocarcinoma are usually managed with upfront surgical intervention. However, pathologic staging in a subset of these clinically staged patients identifies more advanced locoregional disease requiring adjuvant treatment. Therefore, identifying these patients prior to surgical intervention is critical to ensure employment of the appropriate treatment paradigm. The aim of the current study was to define patient characteristics associated with clinical understaging in early gastric cancer. Methods Using the National Cancer Database (2004–2014) we identified 3,892 individuals with clinical T1N0 gastric adenocarcinoma who underwent upfront definitive surgery, had negative surgical margins, and did not receive preoperative chemotherapy or radiotherapy. Patient characteristics were compared between those with pathologic stage T1N0 disease and those who were upstaged upon surgery. Results Twenty‐seven percent of clinical T1N0 gastric adenocarcinomas had a change in stage because of pathologically defined ≥T2 disease or positive lymph nodes. Individuals who were upstaged had a higher tumor grade compared with those with pathologic stage T1N0 disease. Specifically, 41.9% (530/1,264) of individuals with a poorly differentiated tumor were upstaged, compared with only 10.7% (70/656) with a well‐differentiated tumor. Approximately 75% of cases involved upstaging because of T misclassification. The highest percentage of upstaging was shown for tumors located at the fundus and body of the stomach. Conclusion Upstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy. Implications for Practice Upstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy. This article evaluates the frequency of upstaging following surgery among cT1N0 gastric cancer and defines the corresponding patient characteristics, with the goal of better identifying those patients who require preoperative chemotherapy.
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Affiliation(s)
- Ofer Margalit
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yaacov R Lawerence
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel.,Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Idan Levy
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Kim A Reiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Talia Golan
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Aderka
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Bruce Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronac Mamtani
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Israel.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Factors Affecting the Accuracy of Endoscopic Ultrasonography in the Diagnosis of Early Gastric Cancer Invasion Depth: A Meta-analysis. Gastroenterol Res Pract 2019; 2019:8241381. [PMID: 31933632 PMCID: PMC6942824 DOI: 10.1155/2019/8241381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/02/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background Endoscopic ultrasonography (EUS) is the first imaging modality for investigating the depth of invasion in early gastric cancer (EGC). However, there is presently no consensus on the accuracy of EUS in diagnosing the invasion depth of EGC. Aim This study is aimed at systematically evaluating the accuracy of EUS in diagnosing the invasion depth of EGC and its affecting factors. Methods The literatures were identified by searching PubMed, SpringerLink, Cochrane Library, Web of Science, Nature, and Karger knowledge databases. Two researchers extracted the data from the literature and reconstructed these in 2 × 2 tables. The Meta-DiSc software was used to evaluate the overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic advantage ratio, and 95% confidence interval (CI). The SROC was drawn, and the area under the curve (AUC) was calculated to evaluate the diagnostic value. Results A total of 17 articles were selected, which included 4525 cases of lesions. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic dominance ratio, and 95% CI of EUS for diagnosing EGC was 0.87 (95% CI: 0.86-0.88), 0.67 (95% CI: 0.65-0.70), 2.90 (95% CI: 2.25-3.75), 0.17 (95% CI: 0.13-0.23), and 18.25 (95% CI: 12.61-26.39), respectively. The overall overstaging rate of mucosa/submucosa 1 (M/SM1) and SM by EUS was 13.31% and 32.8%, respectively, while the overall understaging rate of SM was 29.7%. The total misdiagnosis rates for EUS were as follows: 30.4% for lesions ≥ 2 cm and 20.9% for lesions < 2 cm, 27.7% for ulcerative lesions and 21.4% for nonulcerative lesions, and 22% for differentiated lesions and 26.9% for undifferentiated lesions. Conclusion EUS has a moderate diagnostic value for the depth of invasion of EGC. The shape, size, and differentiation of lesions might be the main factors that affect the accuracy of EUS in diagnosing EGC.
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12
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Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:371-378. [PMID: 32377111 PMCID: PMC7192292 DOI: 10.14744/semb.2019.30643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
Objectives Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival. Methods A total of 63 patients with tumor invasion stage T1a or T1b who were operated on for early GC between 2010 and 2018 were included in the study. Parameters were investigated retrospectively to identify predictive factors for LNM and overall survival. Significance was defined with a 2-sided p-value of <0.05. Results Among the 63 patients, 21 (33.3%) had LNM. Lymphovascular invasion (LVI) (p=0.02) and a high-grade tumor (p=0.02) were significantly associated with LNM. The overall survival rate was 73.0%. The number of patients with LNM was greater among the deceased patients compared with the censored group (p=0.03). The median follow-up time of the entire group was 28 months (range: 12-55 months) while it was 23 months (range: 7-39 months) in the deceased group and 33.5 months (15.5-60 months) in the censored group (p=0.06). The mean survival was 62.36 months in patients with LNM and 71.99 months in those without LNM (p=0.09). The cut-off value determined for the neutrophil-to-lymphocyte ratio (NLR) was 2.33 and it was an effective value in survival analysis (p<0.05). Conclusion Surgical treatment should be considered for early GC patients with high-grade tumors and cases demonstrating LVI. The overall survival was shorter in patients with a high NLR value and LNM.
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13
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Bonelli P, Borrelli A, Tuccillo FM, Silvestro L, Palaia R, Buonaguro FM. Precision medicine in gastric cancer. World J Gastrointest Oncol 2019; 11:804-829. [PMID: 31662821 PMCID: PMC6815928 DOI: 10.4251/wjgo.v11.i10.804] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/11/2019] [Accepted: 09/05/2019] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer (GC) is a complex disease linked to a series of environmental factors and unhealthy lifestyle habits, and especially to genetic alterations. GC represents the second leading cause of cancer-related deaths worldwide. Its onset is subtle, and the majority of patients are diagnosed once the cancer is already advanced. In recent years, there have been innovations in the management of advanced GC including the introduction of new classifications based on its molecular characteristics. Thanks to new technologies such as next-generation sequencing and microarray, the Cancer Genome Atlas and Asian Cancer Research Group classifications have also paved the way for precision medicine in GC, making it possible to integrate diagnostic and therapeutic methods. Among the objectives of the subdivision of GC into subtypes is to select patients in whom molecular targeted drugs can achieve the best results; many lines of research have been initiated to this end. After phase III clinical trials, trastuzumab, anti-Erb-B2 receptor tyrosine kinase 2 (commonly known as ERBB2) and ramucirumab, anti-vascular endothelial growth factor receptor 2 (commonly known as VEGFR2) monoclonal antibodies, were approved and introduced into first- and second-line therapies for patients with advanced/metastatic GC. However, the heterogeneity of this neoplasia makes the practical application of such approaches difficult. Unfortunately, scientific progress has not been matched by progress in clinical practice in terms of significant improvements in prognosis. Survival continues to be low in contrast to the reduction in deaths from many common cancers such as colorectal, lung, breast, and prostate cancers. Although several target molecules have been identified on which targeted drugs can act and novel products have been introduced into experimental therapeutic protocols, the overall approach to treating advanced stage GC has not substantially changed. Currently, surgical resection with adjuvant or neoadjuvant radiotherapy and chemotherapy are the most effective treatments for this disease. Future research should not underestimate the heterogeneity of GC when developing diagnostic and therapeutic strategies aimed toward improving patient survival.
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Affiliation(s)
- Patrizia Bonelli
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G Pascale, Napoli 80131, Italy
| | - Antonella Borrelli
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G Pascale, Napoli 80131, Italy
| | - Franca Maria Tuccillo
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G Pascale, Napoli 80131, Italy
| | - Lucrezia Silvestro
- Abdominal Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G Pascale, Napoli 80131, Italy
| | - Raffaele Palaia
- Gastro-pancreatic Surgery Division, Istituto Nazionale Tumori - IRCCS - Fondazione G Pascale, Napoli 80131, Italy
| | - Franco Maria Buonaguro
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G Pascale, Napoli 80131, Italy
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14
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Chen J, Zhou C, He M, Zhen Z, Wang J, Hu X. A Meta-Analysis And Systematic Review Of Accuracy Of Endoscopic Ultrasound For N Staging Of Gastric Cancers. Cancer Manag Res 2019; 11:8755-8764. [PMID: 31632135 PMCID: PMC6774993 DOI: 10.2147/cmar.s200318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) is widely used as a staging modality for gastric cancer. However, the results of studies on the use of EUS for N staging in gastric cancer vary. This study aimed at studying the overall diagnostic accuracy of EUS for N staging of gastric cancer. METHODS Published studies were identified through searching the MEDLINE, Web of Science, EMBASE, SpringerLink and ScienceDirect databases. A bivariate random effect model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A hierarchical summary receiver operating characteristic curves (HSROC) based on the pooled data was also computed. RESULTS Fifty studies (5223 patients) were included in this analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS for N staging were 0.82 (95% CI 0.78 to 0.85), 0.68 (0.63 to 0.73), 2.6 (2.2 to 3.0), 0.27 (0.22 to 0.32), and 10 (8 to 12), respectively. The area under the HSROC was 0.83. CONCLUSION The EUS may provide a clinically useful tool to guide physicians in the N staging of gastric cancer. However, physicians must note that the EUS has a relatively low specificity.
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Affiliation(s)
- Jiafei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Min He
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Zhiming Zhen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Jie Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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15
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Park SH, Son T, Seo WJ, Lee JH, Choi YY, Kim HI, Cheong JH, Noh SH, Hyung WJ. Prognostic Impact of Extended Lymph Node Dissection versus Limited Lymph Node Dissection on pN0 Proximal Advanced Gastric Cancer: a Propensity Score Matching Analysis. J Gastric Cancer 2019; 19:212-224. [PMID: 31245166 PMCID: PMC6589420 DOI: 10.5230/jgc.2019.19.e20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/02/2019] [Accepted: 05/19/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Splenic hilar lymph node dissection (LND) during total gastrectomy is regarded as the standard treatment for proximal advanced gastric cancer (AGC). This study aimed to investigate whether splenic hilar LND or D2 LND is essential for proximal AGC of pT2-4aN0M0 stage. Materials and Methods Data of curative total gastrectomies (n=370) performed from 2000 to 2010 for proximal AGC of pT2-4aN0 stage were retrospectively reviewed. Clinicopathological characteristics and long-term outcomes were compared using propensity score matching between patients who underwent splenectomy (n=43) and those who did not (n=327) and between patients who underwent D2 LND (n=122) and those who underwent D1+ LND (n=248). Results Tumors of larger size and a more advanced T stage and significantly lower overall and relapse-free survival (P<0.001) were observed in the splenectomy group than in the 2 spleen-preserving groups. Before propensity score matching, worse overall and relapse-free survival (P<0.001) was observed in the splenectomy group than in the non-splenectomy group. After matching, although the overall survival became similar (P=0.123), relapse-free survival was worse in the splenectomy group (P=0.021). Compared with D1+ LND, D2 LND had no positive impact on the overall (P=0.619) and relapse-free survival (P=0.112) after propensity score matching. Conclusions Splenic hilar LND with or without splenectomy may not have an oncological benefit for patients with pathological AGC with no LN metastasis.
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Affiliation(s)
- Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Won Jun Seo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Joong Ho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Youn Young Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
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16
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Costa JM, Gonçalves B, Miguel Gomes M, Fernandes D, Gonçalves R, Soares JB. Accuracy of endoscopic ultrasound in gastric adenocarcinoma patient selection for neoadjuvant therapy. United European Gastroenterol J 2018; 7:278-286. [PMID: 31081829 DOI: 10.1177/2050640618818942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022] Open
Abstract
Background Recent studies demonstrated the positive impact of neoadjuvant treatment in locally advanced gastric cancer. Objective To assess the accuracy of endoscopic ultrasound (EUS) in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy (T ≥ 2 and/or N+). Methods Retrospective analysis of patients with an anatomopathological diagnosis of gastric adenocarcinoma between January 2011 and June 2017, who had EUS for staging and underwent surgery as a first therapeutic attempt. The concordance (k) and accuracy (area under the curve (AUC)) of EUS for T ≥ 2 and/or N+ were assessed using the anatomopathological staging of the resected surgical specimen as the gold standard. Results The final sample included 152 patients (66.4% male, 67.1 ± 12.2 years). The concordance, accuracy, sensitivity and specificity of the EUS for T ≥ 2 and/or N+ were 0.72, 0.86 ± 0.03, 88.5% and 83.1%, respectively. The results were higher in proximal (k = 0.93, AUC = 0.96 ± 0.05, sensitivity (S) = 99.0% and specificity (E) = 90.9%) compared with distal lesions (k = 0.67, AUC = 0.84 ± 0.04, S = 85.7% and E = 81.5%), and in intestinal subtype (k = 0.77, AUC = 0.88 ± 0.04, S = 92.6% and E = 84.1%) compared with diffuse (k = 0.58, AUC = 0.79 ± 0.10, S = 85.0% and E = 72.7%) or mixed-subtype tumours (k = 0.65, AUC = 0.84 ± 0.10, S = 76.9% and E = 90.0%). Conclusion In one of the largest series of patients, we showed that EUS has overall high agreement and accuracy in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy, although the agreement and accuracy are greater for proximal and intestinal lesions.
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Affiliation(s)
- Juliana M Costa
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | | | - Dália Fernandes
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - João B Soares
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
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17
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Chen XL, Pu H, Yin LL, Li JR, Li ZL, Chen GW, Hou NY, Li H. CT volumetry for gastric adenocarcinoma: association with lymphovascular invasion and T-stages. Oncotarget 2017; 9:12432-12442. [PMID: 29552323 PMCID: PMC5844759 DOI: 10.18632/oncotarget.23478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/13/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose To determine whether gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict presence of lymphovascular invasion and T-stages. Results Gross tumor volume increased with the lymphovascular invasion (r = 0.426, P < 0.0001) and T stage (r = 0.656, P < 0.0001). Univariate analysis showed gross tumor volume could predict lymphovascular invasion (P < 0.0001). Multivariate analyses indicated gross tumor volume as an independent risk factor of lymphovascular invasion (P = 0.026, odds ratio = 2.284). The Mann-Whitney U test showed gross tumor volume could distinguish T2 from T3, T1 from T2–T4a, T1–T2 from T3–T4a and T1–T3 from T4a (P = 0.000). In the development cohort, gross tumor volume could predict lymphovascular invasion (cutoff, 15.92 cm3; AUC, 0.760), and distinguish T2 from T3 (cutoff, 10.09 cm3; AUC, 0.828), T1 from T2-T4a (cutoff, 8.20 cm3; AUC, 0.860), T1-T2 from T3-T4a (cutoff, 15.88 cm3; AUC, 0.883), and T1-T3 from T4a (cutoff, 21.53 cm3; AUC, 0.834). In validation cohort, gross tumor volume could predict presence of lymphovascular invasion (AUC, 0.742), and distinguish T2 from T3 (AUC, 0.861), T1 from T2-T4a (AUC, 0.859), T1–T2 from T3–T4a (AUC, 0.875), and T1–T3 from T4a (AUC, 0.773). Materials and Methods 360 consecutive patients with gastric adenocarcinoma were retrospectively identified. Gross tumor volume was evaluated on multidetector computed tomography images. Statistical analysis was performed to determine whether gross tumor volume could predict presence of lymphovascular invasion and T-stages. Cutoffs of gross tumor volume were first investigated in 212 patients and then validated in an independent 148 patients using area under the receiver operating characteristic curve (AUC) for predicting lymphovascular invasion and T-stages. Conclusions Gross tumor volume of resectable gastric adenocarcinoma at multidetector computed tomography demonstrated capability in predicting lymphovascular invasion and distinguishing T-stages.
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Affiliation(s)
- Xiao-Li Chen
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Hong Pu
- Department of Radiology, Affiliated Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Long-Lin Yin
- Department of Radiology, Affiliated Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Jun-Ru Li
- Department of Out-Patient, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Guang-Wen Chen
- Department of Radiology, Affiliated Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Neng-Yi Hou
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Qingyang District, Chengdu, Sichuan, China
| | - Hang Li
- Department of Radiology, Affiliated Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
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18
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Gabriel E, Attwood K, Narayanan S, Brady M, Nurkin S, Hochwald S, Kukar M. Does neoadjuvant/perioperative chemotherapy improve overall survival for T2N0 gastric adenocarcinoma? J Surg Oncol 2017; 117:659-670. [DOI: 10.1002/jso.24894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/05/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Emmanuel Gabriel
- Department of Surgery; Section of Surgical Oncology; Mayo Clinic; Jacksonville Florida
| | - Kristopher Attwood
- Department of Biostatistics; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Sumana Narayanan
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Maureen Brady
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Steven Nurkin
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Steven Hochwald
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Moshim Kukar
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
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19
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Merkow RP, Herrera G, Goldman DA, Gerdes H, Schattner MA, Markowitz AJ, Strong VE, Brennan MF, Coit DG. Endoscopic Ultrasound as a Pretreatment Clinical Staging Tool for Gastric Cancer: Association with Pathology and Outcome. Ann Surg Oncol 2017; 24:3658-3666. [PMID: 28815443 DOI: 10.1245/s10434-017-6050-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is a guideline-recommended diagnostic test to estimate pretreatment clinical stage in gastric cancer. The impact of EUS to discriminate long-term outcomes has not been established. OBJECTIVES The objectives of our study were to (1) evaluate the association between EUS and pathologic stage; (2) evaluate the ability of EUS to predict disease-specific survival (DSS); and (3) determine how neoadjuvant chemotherapy (NCT) affects these relationships. METHODS A prospective gastric cancer database at a tertiary care cancer center identified 734 patients who underwent curative intent resection. Patients were separated into EUS low-risk (T1-2, N0) and EUS high-risk (T3-4 Nany, or Tany N+) groups. Agreement statistics and 5-year DSS were estimated stratified by NCT. RESULTS Between 1987 and 2015, 68% (502/734) of patients were not treated with NCT. Among these patients, percentage agreement between EUS and pathology was moderate (individual T stage: 52%; N stage: 70%; risk group: 73%). EUS accurately estimated pathologic risk group in 73% (365/502) of patients, whereas it overestimated pathologic risk group in 19% (93/502) of patients and underestimated risk in 8% (41/502) of patients. EUS in non-NCT staging was able to discriminate DSS for T stage (hazard ratio [HR] 5.07, p < 0.05), N stage (HR 3.58, p < 0.05), and risk group (HR 6.35, p < 0.05). Among patients treated with NCT, EUS was unable to discriminate DSS for T stage (HR 0.94, p > 0.05), N stage (HR 1.46, p > 0.05) and risk group (HR 0.50, p > 0.05). CONCLUSIONS Pretreatment clinical staging based on EUS alone could lead to over- or under treatment in 27% of patients and can discriminate DSS in NCT-naive patients. EUS should be used in the context of other validated clinical risk tools.
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Affiliation(s)
- Ryan P Merkow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gabriel Herrera
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Gerdes
- Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark A Schattner
- Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnold J Markowitz
- Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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吴 海. 数字胃肠造影与腹部CT对胃癌的临床诊断. Shijie Huaren Xiaohua Zazhi 2017; 25:1640-1644. [DOI: 10.11569/wcjd.v25.i18.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
目的 研究数字胃肠造影技术与腹部CT在临床中对胃癌的诊断价值.
方法 选取2015-11/2016-11经天津医科大学宝坻临床学院采用CT和数字胃肠检查胃癌的患者纳入42例, 检查结果均已得到病理学和临床手术证实. 比较两种检查结果并对影像学特点进行分析.
结果 经数字胃肠造影显示42例胃癌患者特征: 胃癌性溃疡3例、胃黏膜皱璧破坏2例、胃腔内充盈缺损6例、胃蠕动减弱消失5例、胃轮廓缩窄变形4例; CT检测显示: 肝脏转移2例、胃腔狭窄2例、胃壁增厚3例、腹水及幽门梗阻6例、胃腔内肿块2例、胃部淋巴结转移和腹部主动脉、肝门区、门腔静脉间隙2例、胰腺转移3例, 增强扫描可见胃壁强化异常2例. 数字胃肠造影特异度为77.50%、灵敏度96.61%, Kappa = 0.768; CT胃癌诊断特异度为72.50%、灵敏度93.22%, Kappa = 0.742; CT与数字胃肠造影均有较高的诊断率.
结论 数字胃肠造影与CT在临床中诊断胃癌各有优势和不足, 但CT对远处脏器转移转移和肿块范围、淋巴结的诊断及手术适应证评估明显优于数字胃肠造影, 两者结合值得临床推广应用.
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Hwang JJ, Lee DH, Yoon H, Shin CM, Park YS, Kim N. Clinicopathological characteristics of patients who underwent additional gastrectomy after incomplete endoscopic resection for early gastric cancer. Medicine (Baltimore) 2017; 96:e6172. [PMID: 28207556 PMCID: PMC5319545 DOI: 10.1097/md.0000000000006172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
To evaluate the clinicopathological characteristics and factors that lead to residual tumors in patients who underwent additional gastrectomy for incomplete endoscopic resection (ER) for early gastric cancer (EGC).Between 2003 and 2013, the medical records of patients underwent additional gastrectomy after incomplete ER were retrospectively reviewed. Those diagnosed with the presence of histologic residual tumor in specimens obtained by gastrectomy were assigned to the residual tumor (RT) group (n = 47); those diagnosed with the absence of histologic residual tumor were assigned to the nonresidual tumor (NRT) group (n = 33).In the multivariate analysis, endoscopic piecemeal resection, Helicobacter pylori infection, large tumor size (>2 cm), and both (lateral and vertical) marginal involvement were independent factors of the presence of residual tumor in additional gastrectomy after incomplete resection ER for EGC and the rates of independent factors were significantly higher in the RT group than in the NRT group (P < 0.05).Before ER, preexamination to accurately determine the GC invasion depth and the presence of LN metastasis is very important. During ER, surgeons should attempt to perform en bloc resection and to resect the mucous membrane with adequate safety margins to prevent tumor invasion into the lateral and vertical margins.
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Affiliation(s)
- Jae Jin Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonshunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Tang XL, Lin R, Han CQ, Ding Z. Role of endoscopic ultrasonography in TNM staging of gastric cancer. Shijie Huaren Xiaohua Zazhi 2016; 24:3641-3646. [DOI: 10.11569/wcjd.v24.i25.3641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Gastric cancer is a common malignancy that has a poor prognosis and high mortality. Cancer staging is the optimal method for evaluating prognosis. Endoscopic ultrasonography (EUS) has been considered the first-choice imaging modality for regional staging of gastric cancer because different structural layers of the gastric wall show remarkable differences in their echogenic appearance. However, the results of recent studies about the accuracy of EUS for staging of gastric cancer are contradictory. The aim of this article is to review the role of EUS in preoperative TNM staging of gastric cancer.
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Han C, Lin R, Shi H, Liu J, Qian W, Ding Z, Hou X. The role of endoscopic ultrasound on the preoperative T staging of gastric cancer: A retrospective study. Medicine (Baltimore) 2016; 95:e4580. [PMID: 27603347 PMCID: PMC5023869 DOI: 10.1097/md.0000000000004580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasonography (EUS) is used for preoperative assessment of gastric cancer. However, recent studies suggested that EUS staging accuracy is lower than previously thought. We aimed to assess EUS efficacy and image characteristics in preoperative gastric cancer T staging.A retrospective review of clinical and imaging features of 232 gastric carcinoma patients who underwent preoperative EUS assessment of T stage was performed. Only cases with tumor-free resection margin status and no metastases were enrolled. Comparisons of preoperative EUS and postoperative histopathological stagings were also performed to identify vital EUS image features for evaluating gastric carcinoma.EUS accuracy for T staging was 64.2% (149/232) with the highest accuracy for T3 (75.0%). Enlarged lymph nodes, well differentiated histological type and Borrmann IV type were associated with diagnostic accuracy in predicting tumor invasion. Although no factors were associated with overstaging, circumferential lesions ≥1/2, signet ring cell adenocarcinoma, and Borrmann IV type had significantly higher risks of understaging. Gastric wall outer edge irregularity was also an indicator of serosal involvement with a sensitivity of 82.0%. The pancreas and colon were more frequent disease extension sites than previously predicted.Although EUS is likely the best and most accurate option that we have used to stage gastric cancer, the finding that factors including circumferential lesions, signet ring cell adenocarcinoma, and Borrmann IV type carcinoma were more frequently related to incorrect staging warrants attention.
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Affiliation(s)
| | | | | | | | | | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Zhen Ding, Associate Professor, Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, 430022, China (e-mail: )
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Wang Z, Ma L, Zhang XM, Zhou ZX. Risk of lymph node metastases from early gastric cancer in relation to depth of invasion: experience in a single institution. Asian Pac J Cancer Prev 2015; 15:5371-5. [PMID: 25041004 DOI: 10.7314/apjcp.2014.15.13.5371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. MATERIALS AND METHODS A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. RESULTS The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. CONCLUSIONS Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.
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Affiliation(s)
- Zheng Wang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China E-mail :
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Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev 2015; 2015:CD009944. [PMID: 25914908 PMCID: PMC6465120 DOI: 10.1002/14651858.cd009944.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is proposed as an accurate diagnostic device for the locoregional staging of gastric cancer, which is crucial to developing a correct therapeutic strategy and ultimately to providing patients with the best chance of cure. However, despite a number of studies addressing this issue, there is no consensus on the role of EUS in routine clinical practice. OBJECTIVES To provide both a comprehensive overview and a quantitative analysis of the published data regarding the ability of EUS to preoperatively define the locoregional disease spread (i.e., primary tumor depth (T-stage) and regional lymph node status (N-stage)) in people with primary gastric carcinoma. SEARCH METHODS We performed a systematic search to identify articles that examined the diagnostic accuracy of EUS (the index test) in the evaluation of primary gastric cancer depth of invasion (T-stage, according to the AJCC/UICC TNM staging system categories T1, T2, T3 and T4) and regional lymph node status (N-stage, disease-free (N0) versus metastatic (N+)) using histopathology as the reference standard. To this end, we searched the following databases: the Cochrane Library (the Cochrane Central Register of Controlled Trials (CENTRAL)), MEDLINE, EMBASE, NIHR Prospero Register, MEDION, Aggressive Research Intelligence Facility (ARIF), ClinicalTrials.gov, Current Controlled Trials MetaRegister, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), from 1988 to January 2015. SELECTION CRITERIA We included studies that met the following main inclusion criteria: 1) a minimum sample size of 10 patients with histologically-proven primary carcinoma of the stomach (target condition); 2) comparison of EUS (index test) with pathology evaluation (reference standard) in terms of primary tumor (T-stage) and regional lymph nodes (N-stage). We excluded reports with possible overlap with the selected studies. DATA COLLECTION AND ANALYSIS For each study, two review authors extracted a standard set of data, using a dedicated data extraction form. We assessed data quality using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. We performed diagnostic accuracy meta-analysis using the hierarchical bivariate method. MAIN RESULTS We identified 66 articles (published between 1988 and 2012) that were eligible according to the inclusion criteria. We collected the data on 7747 patients with gastric cancer who were staged with EUS. Overall the quality of the included studies was good: in particular, only five studies presented a high risk of index test interpretation bias and two studies presented a high risk of selection bias.For primary tumor (T) stage, results were stratified according to the depth of invasion of the gastric wall. The meta-analysis of 50 studies (n = 4397) showed that the summary sensitivity and specificity of EUS in discriminating T1 to T2 (superficial) versus T3 to T4 (advanced) gastric carcinomas were 0.86 (95% confidence interval (CI) 0.81 to 0.90) and 0.90 (95% CI 0.87 to 0.93) respectively. For the diagnostic capacity of EUS to distinguish T1 (early gastric cancer, EGC) versus T2 (muscle-infiltrating) tumors, the meta-analysis of 46 studies (n = 2742) showed that the summary sensitivity and specificity were 0.85 (95% CI 0.78 to 0.91) and 0.90 (95% CI 0.85 to 0.93) respectively. When we addressed the capacity of EUS to distinguish between T1a (mucosal) versus T1b (submucosal) cancers the meta-analysis of 20 studies (n = 3321) showed that the summary sensitivity and specificity were 0.87 (95% CI 0.81 to 0.92) and 0.75 (95% CI 0.62 to 0.84) respectively. Finally, for the metastatic involvement of lymph nodes (N-stage), the meta-analysis of 44 studies (n = 3573) showed that the summary sensitivity and specificity were 0.83 (95% CI 0.79 to 0.87) and 0.67 (95% CI 0.61 to 0.72), respectively.Overall, as demonstrated also by the Bayesian nomograms, which enable readers to calculate post-test probabilities for any target condition prevalence, the EUS accuracy can be considered clinically useful to guide physicians in the locoregional staging of people with gastric cancer. However, it should be noted that between-study heterogeneity was not negligible: unfortunately, we could not identify any consistent source of the observed heterogeneity. Therefore, all accuracy measures reported in the present work and summarizing the available evidence should be interpreted cautiously. Moreover, we must emphasize that the analysis of positive and negative likelihood values revealed that EUS diagnostic performance cannot be considered optimal either for disease confirmation or for exclusion, especially for the ability of EUS to distinguish T1a (mucosal) versus T1b (submucosal) cancers and positive versus negative lymph node status. AUTHORS' CONCLUSIONS By analyzing the data from the largest series ever considered, we found that the diagnostic accuracy of EUS might be considered clinically useful to guide physicians in the locoregional staging of people with gastric carcinoma. However, the heterogeneity of the results warrants special caution, as well as further investigation for the identification of factors influencing the outcome of this diagnostic tool. Moreover, physicians should be warned that EUS performance is lower in diagnosing superficial tumors (T1a versus T1b) and lymph node status (positive versus negative). Overall, we observed large heterogeneity and its source needs to be understood before any definitive conclusion can be drawn about the use of EUS can be proposed in routine clinical settings.
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Affiliation(s)
- Simone Mocellin
- Meta-Analysis Unit, Department of Surgery,Oncology and Gastroenterology, University of Padova, Via Giustiniani 2, Padova, Veneto, 35128, Italy. .
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Preoperative T staging of gastric cancer: comparison of diffusion- and T2-weighted magnetic resonance imaging. J Comput Assist Tomogr 2014; 38:544-50. [PMID: 24733002 DOI: 10.1097/rct.0000000000000090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of our study was to assess the clinical feasibility of diffusion-weighted (DW) magnetic resonance (MR) imaging in preoperative T staging of gastric cancer prospectively. METHODS Forty-five patients underwent axial T2-weighted (T2W) and DW (b, 0 and 1000 seconds/mm) MR imaging. Two radiologists interpreted the images for detection and staging of the tumors independently. The McNemar test was used to check differences in diagnostic accuracy with the reference of postoperative histopathological results. RESULTS Diffusion-weighted and T2W images detected 44 and 42 of 45 histologically confirmed lesions, respectively. Furthermore, DW images detected 11 of 12 pT1 lesions compared to 9 of 12 lesions by T2W images. The staging accuracy of advanced gastric cancer (≥pT2) in DW imaging is significantly higher than that in T2W imaging (87.9% and 69.7%, respectively; P < 0.05). CONCLUSIONS Diffusion-weighted is superior to T2W imaging in detection of early gastric cancers (pT1) and staging advanced cancers (≥pT2).
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Shan GD, Xu GQ, Li YM. Endoscopic ultrasonographic features of gastric linitis plastica in fifty-five Chinese patients. J Zhejiang Univ Sci B 2014; 14:844-8. [PMID: 24009205 DOI: 10.1631/jzus.b1200307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to investigate the endosonographic appearance of gastric linitis plastica (GLP) and to study the usefulness of endoscopic ultrasonography (EUS) for the T and N staging of GLP. EUS examinations of 55 patients with histologically proven GLP were retrospectively studied. In all patients, EUS showed that lesions involved at least one-third of the circumference of the stomach. Based on the findings of the EUS, the 55 patients were divided into two groups. There were 32 (58.2%) patients in the first group. EUS of this group showed that the five sonographic layers had disappeared and had been replaced by a hypoechogenic thickening of the gastric wall. There were 23 (41.8%) patients in the second group. EUS of this group showed that the first three sonographic layers were blurred and thickened, and the fourth layer was significantly thickened. The full thickness of the gastric wall was significantly thicker in first than in the second group of patients (P<0.01). The incidence of perigastric lesions was significantly higher in the first than in the second group of patients (P<0.01). Results for the 15 patients following preoperative EUS were compared postoperatively with histopathologic findings for T and N staging. The overall diagnostic accuracy of the T stage was 73.3% and of the N stage was 60.0%. In eight patients, we used EUS to assess a therapeutic response. No response was observed in five patients and a partial response in three. EUS images of GLP are characteristic. EUS is helpful in diagnosing GLP and for assessing the T and N stages.
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Affiliation(s)
- Guo-dong Shan
- Department of Gastroenterology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Robotic spleen-preserving total gastrectomy for gastric cancer: comparison with conventional laparoscopic procedure. Surg Endosc 2014; 28:2606-15. [PMID: 24695982 DOI: 10.1007/s00464-014-3511-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Robotic systems recently have been introduced to overcome technical limitations of conventional laparoscopic surgery, especially for complex procedures. Laparoscopic spleen-preserving total gastrectomy with D2 lymph node (LN) dissection (LTGD2) is one of the most complicated procedures. We hypothesized that robotic LN dissection would be more thorough and accurate. We compared robotic spleen-preserving total gastrectomy with D2 LN dissection (RTGD2) with LTGD2 to investigate the impact of robotics. METHODS Clinicopathologic characteristics and short-term and long-term outcomes of RTGD2 (n = 51) versus LTGD2 (n = 58) in gastric adenocarcinoma patients were extracted from a prospectively designed database and analyzed retrospectively. RESULTS There was no difference of patients' characteristics between groups. Mean operation time of RTGD2 was longer than LTGD2 (p < 0.001), and no differences in tumor histology, size, location, and TNM stage were seen. Total retrieved LNs from RTGD2 was similar to LTGD2 (mean 47.2 vs. 42.8, respectively), as were retrieved LNs at splenic hilum (1.3 vs. 0.8). However, mean numbers of retrieved LNs along the splenic artery from RTGD2 was higher than LTGD2 (2.3 vs. 1.0, respectively; p = 0.013), as was also the case at the splenic hilum and artery (3.6 vs. 1.9, p = 0.014). Postoperative complication (16 vs. 22 %, p = 0.374) and overall and disease-free survival between the two groups were not significantly different (p = 0.767 and p = 0.666, respectively). CONCLUSIONS Robotic spleen-preserving total gastrectomy with D2 LN dissection is feasible. Operation time and retrieved total LNs and splenic hilar LNs in the robotic procedure are acceptable.
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Wang Z, Zhang X, Hu J, Zeng W, Liang J, Zhou H, Zhou Z. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience. J Surg Res 2014; 191:130-3. [PMID: 24768142 DOI: 10.1016/j.jss.2014.03.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prognosis of early gastric cancer (EGC) with signet ring cell histology is more favorable than other undifferentiated gastric adenocarcinomas. An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of EGC with signet ring cell histology. Therefore, this study analyzed the predictive factors associated with lymph node metastasis in patients with this type of EGC. METHODS A total of 136 EGC with signet ring cell histology patients who underwent D2 radical gastrectomy were reviewed in this study. The clinicopathologic features were analyzed to identify predictive factors for lymph node metastasis. RESULTS The overall rate of lymph node metastasis in EGC with signet ring cell histology was 10.3%. Using a univariate analysis, the risk factors for lymph node metastasis were identified as the tumor size, depth of tumor invasion, and lymphovascular invasion. The multivariate analysis revealed that tumor size >2 cm, submucosal invasion, and lymphovascular invasion were independent risk factors of lymph node metastasis (P < 0.05). CONCLUSIONS The risk of lymph node metastasis of EGC with signet ring cell histology was high in those with tumor sizes ≥2 cm, submucosal tumors, and lymphovascular invasion. A minimally invasive treatment, such as endoscopic resection, might be possible in highly selective cases of EGC with signet ring cell histology with intramucosal invasion, tumor size <2 cm, and no lymphovascular invasion.
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Affiliation(s)
- Zheng Wang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Xingmao Zhang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Junjie Hu
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Weigen Zeng
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Jianwei Liang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Haitao Zhou
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Zhixiang Zhou
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China.
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Huang CM, Xu M, Wang JB, Zheng CH, Li P, Xie JW, Lin JX, Lu J. Is tumor size a predictor of preoperative N staging in T2-T4a stage advanced gastric cancer? Surg Oncol 2014; 23:5-10. [PMID: 24508061 DOI: 10.1016/j.suronc.2014.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to assess the relationship between tumor size and preoperative N staging in patients with T2-T4a stage advanced gastric cancer. METHODS A total of 697 patients with gastric cancer were analyzed. The correlations between the number of metastatic lymph nodes (LNs) and other clinicopathologic factors were investigated. The Kappa consistency test was used to test the agreement between predicted and pathologic N staging. RESULTS Multivariate analysis showed that tumor size was independently (r = 0.987, P < 0.05) and linearly (R(2) = 0.940, P < 0.05) correlated with the number of metastatic LNs. The numbers of predicted metastatic LNs in patients with primary tumors <2.02 cm, 2.02-4.07 cm, 4.07-6.80 cm, and ≥ 6.80 cm in size were 0 (Stage N0), 1-2 (Stage N1), 3-6 (Stage N2), and ≥ 7 (Stage N3), respectively. There was good agreement between N staging predicted by tumor size and pathologic N staging (Kappa value = 0.531, P < 0.05). The overall accuracy of tumor size for preoperative N staging was 82.13%. The 5-year survival rates of patients with predicted Stages N0, N1, N2, and N3 were 80.0%, 71.1%, 56.8%, and 39.8%, respectively (P < 0.05). There were no significant differences in the survival rates of patients with predicted N staging and the corresponding pathologic N staging. CONCLUSIONS Tumor size is correlated with the number of LN metastases in patients with stage T2-T4a advanced gastric cancer. The measurements of tumor size can predict preoperative N staging.
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Affiliation(s)
- Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China.
| | - Mu Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China
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Liu S, He J, Guan W, Li Q, Yu H, Zhou Z, Bao S, Zhou Z. Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer. Clin Imaging 2013; 38:122-8. [PMID: 24411204 DOI: 10.1016/j.clinimag.2013.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/22/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the utilization of diffusion-weighted (DW) magnetic resonance (MR) imaging in T staging of gastric cancer prospectively. METHODS Fifty-one patients underwent T2-weighted (T2W), contrast-enhanced (CE) and DW MR imaging. Two radiologists independently interpreted the images for T staging of the tumors. RESULTS The overall accuracy of T staging in pT1-4 gastric cancers by T2W+CE+DW (88.2%) was significantly higher than that by T2W+CE and T2W+DW (both 76.5%, P=.031). CONCLUSION DW adds useful information to T2W and CE MR imaging in T staging of gastric cancer.
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Affiliation(s)
- Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Qiang Li
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Haiping Yu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Zhuping Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Shanhua Bao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
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Hwang EJ, Jang JY, Kim YW, Dong SH, Kim HJ, Kim BH, Chang YW. A case of early gastric cancer with solitary metastasis to the pleura. Clin Endosc 2013; 46:666-70. [PMID: 24340263 PMCID: PMC3856271 DOI: 10.5946/ce.2013.46.6.666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/17/2013] [Accepted: 02/01/2013] [Indexed: 01/28/2023] Open
Abstract
The incidence of early gastric cancer (EGC) has increased to >50% in Korea owing to a higher detection rate caused by rapid advances in diagnostic instrumentation. EGC with distant metastasis has been rarely reported. Here, we report the case of a 76-year-old woman in whom general EGC was initially diagnosed by endoscopy and endoscopic ultrasonography. She subsequently underwent endoscopic submucosal dissection (ESD). Histological examination of the ESD specimen revealed that neoplastic cells were located predominantly in the submucosal layer and submucosal lymphatic channels. Metastatic cancer cells were also found in the pleural effusion. After conducting all analyses, including immunohistochemical staining, we concluded that the patient had primary EGC with pleural metastasis.
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Affiliation(s)
- Eun Jung Hwang
- Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
The field of diagnostic and therapeutic endoscopic ultrasound (EUS) is growing rapidly. Although EUS has enhanced our ability to diagnose and treat a wide variety of GI conditions, there are many controversial issues regarding the appropriate application of EUS techniques. In this review we discuss five controversial topics in EUS: the utility of EUS in staging of esophageal and gastric cancer; selection of appropriate needle gauge for fine needle aspiration (FNA); use of the stylet in FNA; and the emerging role of contrast agents in endoscopic ultrasound.
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Affiliation(s)
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., USA
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Lei C, Huang L, Wang Y, Huang Y, Huang Y. Comparison of MRI and endoscope ultrasound detection in preoperative T/N staging of gastric cancer. Mol Clin Oncol 2013; 1:699-702. [PMID: 24649231 PMCID: PMC3915684 DOI: 10.3892/mco.2013.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/05/2013] [Indexed: 11/06/2022] Open
Abstract
Gastric cancer is a common malignancy and cause of mortality. The aim of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) detection in preoperative clinical T/N staging in gastric cancer. Thirty-eight patients diagnosed with gastric cancer by gastroscopy and pathological examination were included in the study. All 38 patients underwent MRI and EUS detection prior to surgery. The accuracy of MRI, EUS and MRI+EUS was evaluated according to postoperative pathological staging. Results identified the accuracy of EUS, MRI and EUS+MRI in T clinical staging to be 86.64, 73.68 and 89.47%, respectively (MRI vs. EUS+MRI, P=0.035), while the accuracy for N clinical staging was 65.78, 68.42 and 71.05%, respectively (P>0.05). The accuracy rate in EUS and EUS+MRI detection in N0 stage was markedly higher compared with that in MRI (100 vs. 86.67%, P=0.032), whereas the rate in EUS detection in N2 stage was lower compared with that in MRI and EUS+MRI (45.45 vs. 54.54%, P=0.021). Thus, both MRI and EUS had a higher accuracy in preoperative T/N staging. Additionally, the accuracy rate was improved significantly when the two procedures were combined.
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Affiliation(s)
- Cui Lei
- Department of General Surgery, Yichang Central People's Hospital, China Three Gorges University, Yichang, Hubei 443000; ; Institute of Molecular Biology of China Three Gorges University, Yichang, Hubei 443000
| | - Liming Huang
- Institute of Molecular Biology of China Three Gorges University, Yichang, Hubei 443000
| | - Yanlin Wang
- Institute of Molecular Biology of China Three Gorges University, Yichang, Hubei 443000; ; Department of Oncology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yiling Huang
- Institute of Molecular Biology of China Three Gorges University, Yichang, Hubei 443000
| | - Yurong Huang
- Institute of Molecular Biology of China Three Gorges University, Yichang, Hubei 443000
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Li B, Zheng P, Zhu Q, Lin J. Accurate preoperative staging of gastric cancer with combined endoscopic ultrasonography and PET-CT. TOHOKU J EXP MED 2013; 228:9-16. [PMID: 22864063 DOI: 10.1620/tjem.228.9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accurate staging of gastric cancer is helpful to determine the most appropriate therapy, but no staging modality has been accepted as the standard. Objective is to evaluate the usefulness of endoscopic ultrasonograph (EUS) combined with position emission tomography and computed tomograph (PET-CT) in gastric cancer staging. A total of 124 patients confirmed with gastric cancer were subjected to staging with EUS and PET-CT scanning. The detection rate of primary tumor was 99.2% by combination use of two modalities and 97.6% by EUS alone (p = 0.6219), but the detection rate was 90.3% (112 of 124) by PET-CT alone (compared with the combination, p = 0.0027; compared with EUS alone, p = 0.0299). The locoregional lymph node invasion was identified in 84/124 (67.7%) by combined PET-CT and EUS, which was obviously higher than that with EUS (52.4%) or PET-CT (43.5%) alone (p = 0.0194 and p = 0.0002, respectively). There was no statistical difference in identification of celiac axis lymph node metastasis among three methods, but the combined examination or PET-CT alone was more effective than EUS alone in the detection of distant metastases (all p < 0.01). Furthermore, the combined EUS and PET-CT was more optimal than using EUS or PET-CT alone in the accurate T and N staging and the effect on change of treatment. The present study indicates that the combination of EUS and PET-CT is an ideal modality in the preoperative staging of gastric cancer and it provides beneficial guidance for the treatment of gastric cancer.
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Affiliation(s)
- Baiwen Li
- Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, PR China.
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Berzosa M, Davies SF, Gupta K, Debol SM, Li R, Miranda D, Mallery S. Diagnostic bedside EUS in the intensive care unit: a single-center experience. Gastrointest Endosc 2013; 77:200-8. [PMID: 23218946 DOI: 10.1016/j.gie.2012.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/05/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND The knowledge of bedside diagnostic EUS in critically ill patients is limited. OBJECTIVE To investigate the indications, feasibility, safety, and clinical utility of diagnostic EUS in the intensive care unit (ICU). DESIGN Retrospective. SETTING Tertiary-care referral teaching hospital. PATIENTS All consecutive patients who had EUS done in the ICU within a 6-year period. INTERVENTION Bedside EUS and EUS-guided FNA. MAIN OUTCOME MEASUREMENTS EUS indications, complications, and impact on management. RESULTS A total of 64 EUS procedures were performed in 63 patients (38 men, 25 women; age range 27-78 years); 1 patient underwent 2 separate EUS procedures. EUS was performed while the patients were mechanically ventilated in 70% (45/64) of cases. Indications for EUS included jaundice (n = 24), mass of unknown etiology (n = 25), unexplained pancreatitis (n = 7), and staging of known cancer (n = 3). In 5 cases, EUS was used as an alternative to other imaging modalities because of morbid obesity (n = 3) or contraindication to intravenous contrast material (n = 2). Complications included reversible oxygen desaturation (n = 4), nonsustained ventricular tachycardia (n = 1), and transient hypotension (n = 1). Overall, EUS influenced management in 97% (62/64) of cases. LIMITATIONS Retrospective, single-center study. CONCLUSION ICU-based EUS can be performed with few intraprocedural complications and can be a valuable diagnostic modality in the ICU setting. It appears to be particularly useful for determining the etiology of jaundice, masses of unknown etiology, and pancreatitis. It may have particular value as a diagnostic technique on selected patients with unstaged cancer and when morbid obesity or the inability to use intravenous contrast material precludes the use of other imaging modalities in the critically ill patient.
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Affiliation(s)
- Manuel Berzosa
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA
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Lee HH, Lim CH, Park JM, Cho YK, Song KY, Jeon HM, Park CH. Low accuracy of endoscopic ultrasonography for detailed T staging in gastric cancer. World J Surg Oncol 2012; 10:190. [PMID: 22978534 PMCID: PMC3502182 DOI: 10.1186/1477-7819-10-190] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/14/2011] [Indexed: 01/05/2023] Open
Abstract
Background The accuracy of endoscopic ultrasonography (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS tumor (T) and node (N) staging, and to identify the histopathological factors influencing accuracy based on the detailed tumor depth of gastric cancer. Methods In total, 309 patients with gastric cancer with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary’s Hospital, Korea, between January and December 2009. The T and N staging of EUS and the pathologic report were compared. Results The overall accuracies of EUS for T stage and the detailed T stages were 70.2% and 43.0%, respectively. In detailed stage, tumors greater than 50 mm in diameter were significantly associated with T overstaging (odds ratio (OR) = 2.094). The overall accuracy of EUS for N staging was 71.2%. Tumor size (20 mm ≤ size < 50 mm, OR = 4.389; and 50 mm ≤ size, OR = 8.170), cross-sectional tumor location (circumferential, OR = 4.381) and tumor depth (submucosa, OR = 3.324; muscular propria, OR = 6.923; sub-serosa, OR = 4.517; and serosa-exposed, OR = 6.495) were significant factors affecting incorrect nodal detection. Conclusions Careful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging.
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Affiliation(s)
- Han Hong Lee
- Department of Surgery, Division of Gastrointestinal Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Cardoso R, Coburn N, Seevaratnam R, Sutradhar R, Lourenco LG, Mahar A, Law C, Yong E, Tinmouth J. A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer. Gastric Cancer 2012; 15 Suppl 1:S19-26. [PMID: 22237654 DOI: 10.1007/s10120-011-0115-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 10/31/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer. METHODS Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 1 December 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Meta-analysis for the performance of EUS was analyzed by calculating agreement (Kappa statistic), and pooled estimates of accuracy, sensitivity, and specificity for all EUS examinations, using histopathology as the reference standard. Subgroup analyses were also performed. RESULTS Twenty-two articles met our inclusion criteria and were included in the review. EUS pooled accuracy for T staging was 75% with a moderate Kappa (0.52). EUS was most accurate for T3 disease, followed by T4, T1, and T2. EUS pooled accuracy for N staging was 64%, sensitivity was 74%, and specificity was 80%. There was significant heterogeneity between the included studies. Subgroup analyses found that annual EUS volume was not associated with EUS T and N staging accuracy (P = 0.836, 0.99, respectively). CONCLUSION EUS is a moderately accurate technique that seems to describe advanced T stage (T3 and T4) better than N or less advanced T stage. Stratifying by EUS annual volume did not affect EUS performance in staging gastric cancer.
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Affiliation(s)
- Roberta Cardoso
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
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Yoshinaga S, Oda I, Nonaka S, Kushima R, Saito Y. Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers. World J Gastrointest Endosc 2012; 4:218-26. [PMID: 22720122 PMCID: PMC3377863 DOI: 10.4253/wjge.v4.i6.218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/27/2012] [Accepted: 05/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.
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Affiliation(s)
- Shigetaka Yoshinaga
- Shigetaka Yoshinaga, Ichiro Oda, Satoru Nonaka, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Hasegawa F, Kiyozaki H, Takata O, Tokai K, Uehara T, Yoshida Y, Nokubi M, Konishi F. Lymphatic invasion in small differentiated-type mucosal gastric cancer. Clin J Gastroenterol 2012; 5:234-8. [PMID: 26182327 DOI: 10.1007/s12328-012-0308-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/22/2012] [Indexed: 02/01/2023]
Abstract
Endoscopic resection for early gastric cancer is indicated for patients who are at negligible risk of lymph node metastasis. A 71-year-old female underwent endoscopic resection for a 15-mm differentiated-type mucosal gastric tumor, as recommended in the Japanese treatment guidelines. A histological examination revealed lymphatic invasion. Therefore, we performed laparoscopy-assisted distal gastrectomy and D1+ lymph node dissection. A histological examination detected no.3 lymph node metastasis, but no residual cancer cells were observed at the site of the endoscopic resection. This case is rare as lymphatic invasion and lymph node metastasis are highly unusual in small differentiated-type mucosal gastric cancer. Having experienced this case, we consider that en-bloc endoscopic resection of such lesions is extremely important, as it allows precise histological examinations to be performed, which can determine the necessity of additional treatment.
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Affiliation(s)
- Fumi Hasegawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Hirokazu Kiyozaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Osamu Takata
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Koichi Tokai
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yukio Yoshida
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Mitsuhiro Nokubi
- Department of Pathology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Fumio Konishi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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Owaki T, Matsumoto M, Okumura H, Uchicado Y, Kita Y, Setoyama T, Sasaki K, Sakurai T, Omoto I, Shimada M, Sakamoto F, Yoshinaka H, Ishigami S, Ueno S, Natsugoe S. Endoscopic ultrasonography is useful for monitoring the tumor response of neoadjuvant chemoradiation therapy in esophageal squamous cell carcinoma. Am J Surg 2012; 203:191-7. [DOI: 10.1016/j.amjsurg.2011.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/29/2022]
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Kubota K, Kuroda J, Yoshida M, Ohta K, Kitajima M. Medical image analysis: computer-aided diagnosis of gastric cancer invasion on endoscopic images. Surg Endosc 2011; 26:1485-9. [DOI: 10.1007/s00464-011-2036-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/31/2011] [Indexed: 12/18/2022]
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Double contrast-enhanced ultrasonography for the preoperative evaluation of gastric cancer: a comparison to endoscopic ultrasonography with respect to histopathology. Am J Surg 2011; 202:605-11. [PMID: 21824594 DOI: 10.1016/j.amjsurg.2010.09.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 09/09/2010] [Accepted: 09/09/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study was designed to compare the accuracy of endoscopic ultrasound (EUS) with double contrast-enhanced ultrasound (DCUS) in the staging of gastric malignancies. DCUS is a transabdominal ultrasound technique using both intravenous and intraluminal contrast to enhance sonographic visualization. METHODS This retrospective study included 162 patients with biopsy-proven gastric cancer who underwent DCUS and EUS preoperatively with the ultrasound results compared with the pathologic findings of the resected specimens. RESULTS The overall accuracy of DCUS and EUS for tumor (T) staging was 77.2% and 74.7%, respectively. Comparison of ultrasound techniques for T staging revealed that DCUS was superior to EUS only for a tumor depth of T3 (chi-square, P = .025). Lymph nodes were staged correctly with DCUS and EUS in 78.4% and 57.4% of cases, respectively (chi-square, P = .001). CONCLUSIONS DCUS offers a noninvasive approach for the staging of gastric cancer. DCUS was comparable to EUS in tumor depth evaluation but offered an advantage in lymph node detection.
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Xue N, Huang P, Aronow WS, Wang Z, Nair CK, Zheng Z, Shen X, Yin Y, Huang F, Cosgrove D. Predicting lymph node status in patients with early gastric carcinoma using double contrast-enhanced ultrasonography. Arch Med Sci 2011; 7:457-64. [PMID: 22295029 PMCID: PMC3258739 DOI: 10.5114/aoms.2011.23412] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 05/29/2010] [Accepted: 05/31/2010] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Double contrast-enhanced ultrasonography (DCUS) is a new method we used in predicting lymph node metastasis (LNM) in patients with early gastric cancer. MATERIAL AND METHODS Seventy-six patients with early gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined using DCUS preoperatively. Group N1 included 15 patients with LNM and group N0 61 patients without LNM. RESULTS In group N1, 13 patients (87%) had marked hyperenhancement during early arterial phase using DCUS, and 2 patients (13%) were unmarked as hyperenhancement. In group N0, 24 patients (39%) had marked hyperenhancement during early arterial phase using DCUS, and 37 patients (61%) had unmarked hyperenhancement. The sensitivity and specificity of marked hyperenhancement in predicting LNM in patients with early gastric cancer was 86.7% and 60.7% respectively, and the Youden's index was 0.474. The κ value of this method was 0.89. CONCLUSIONS Double contrast-enhanced ultrasonography is a new valuable method to evaluate LNM at an early stage of gastric cancer and prognosis of early gastric cancer preoperatively.
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Affiliation(s)
- Nianyu Xue
- 2 Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | - Pintong Huang
- 2 Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | | | - Zongmin Wang
- 2 Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | | | - Zhiqiang Zheng
- 2 Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | - Xuedong Shen
- Cardiac Center of Creighton University, Omaha, NE, USA
| | - Yimei Yin
- 2 Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | - Fuguang Huang
- 2 Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | - David Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, United Kingdom
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Mocellin S, Marchet A, Nitti D. EUS for the staging of gastric cancer: a meta-analysis. Gastrointest Endosc 2011; 73:1122-34. [PMID: 21444080 DOI: 10.1016/j.gie.2011.01.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/13/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of EUS in the locoregional staging of gastric carcinoma is undefined. OBJECTIVE We aimed to comprehensively review and quantitatively summarize the available evidence on the staging performance of EUS. DESIGN We systematically searched the MEDLINE, Cochrane, CANCERLIT, and EMBASE databases for relevant studies published until July 2010. SETTING Formal meta-analysis of diagnostic accuracy parameters was performed by using a bivariate random-effects model. PATIENTS Fifty-four studies enrolling 5601 patients with gastric cancer undergoing disease staging with EUS were eligible for the meta-analysis. MAIN OUTCOME MEASUREMENTS EUS staging accuracy across eligible studies was measured by computing overall sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). RESULTS EUS can differentiate T1-2 from T3-4 gastric cancer with high accuracy, with overall sensitivity, specificity, PLR, NLR, and DOR of 0.86 (95% CI, 0.81-0.90), 0.91 (95% CI, 0.89-0.93), 9.8 (95% CI, 7.5-12.8), 0.15 (95% CI, 0.11-0.21), and 65 (95% CI, 41-105), respectively. In contrast, the diagnostic performance of EUS for lymph node status is less reliable, with overall sensitivity, specificity, PLR, NLR, and DOR of 0.69 (95% CI, 0.63-0.74), 0.84 (95% CI, 0.81-0.88), 4.4 (95% CI, 3.6-5.4), 0.37 (95% CI, 0.32-0.44), and 12 (95% CI, 9-16), respectively. Results regarding single T categories (including T1 substages) and Bayesian nomograms to calculate posttest probabilities for any target condition prevalence are also provided. LIMITATIONS Statistical heterogeneity was generally high; unfortunately, subgroup analysis did not identify a consistent source of the heterogeneity. CONCLUSIONS Our results support the use of EUS for the locoregional staging of gastric cancer, which can affect the therapeutic management of these patients. However, clinicians must be aware of the performance limits of this staging tool.
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Affiliation(s)
- Simone Mocellin
- Meta-Analysis Unit, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
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Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel) 2011; 3:2141-59. [PMID: 24212800 PMCID: PMC3757408 DOI: 10.3390/cancers3022141] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 12/13/2022] Open
Abstract
Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it is diagnosed late and has a high frequency of nodal involvement [1]. Even in early gastric cancer (EGC), the incidence of lymph node (LN) metastasis exceeds 10%; it was reported to be 14.1% overall and was 4.8 to 23.6% depending on cancer depth [2]. It is important to evaluate LN status preoperatively for proper treatment strategy; however, sufficient results are not being obtained using various modalities. Surgery is the only effective intervention for cure or long-term survival. It is possible to cure local disease without distant metastasis by gastrectomy and LN dissection. However, there is no survival benefit from surgery for systemic disease with distant metastasis such as para-aortic lymph node metastasis [3]. Therefore, whether the disease is local or systemic is an important prognostic indicator for gastric cancer, and the debate continues over the importance of extended lymphadenectomy for gastric cancer. The concept of micro-metastasis has been described as a prognostic factor [4-9], and the biological mechanisms of LN metastasis are currently under study [10-12]. In this article, we review the status of LN metastasis including its molecular mechanisms and evaluate LN dissection for the treatment of gastric cancer.
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Affiliation(s)
- Tomonori Akagi
- Oita University Faculty of Medicine, Department of Gastroenterological Surgery, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; E-Mail:
- Author to whom correspondance should be addressed; E-Mail: ; Tel.: +81-97-586-5843, Fax: +81-97-549-6039
| | - Norio Shiraishi
- Surgical division, Center for community medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; E-Mail:
| | - Seigo Kitano
- Oita University Faculty of Medicine, Department of Gastroenterological Surgery, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; E-Mail:
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Kim MG, Kim BS, Kim TH, Kim KC, Yook JH, Oh ST, Kim BS. Surgical Treatment for Patients Who Underwent Endoscopic Mucosal Resection (EMR)/Endoscopic Submucosal Dissection (ESD) of Early Gastric Cancer (EGC). JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011. [DOI: 10.4174/jkss.2011.80.3.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Min Gyu Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Su Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hwan Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kap Choong Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hwan Yook
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Tae Oh
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Sik Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Venkataraman I, Rao HK, Singh P, Elangovan S, Kate V. Efficacy of hydrogastric sonography and spiral Computed Tomography in staging of gastric carcinoma--a comparative study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:480-485. [PMID: 20848570 DOI: 10.1002/jcu.20734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Accurate preoperative diagnosis and staging of patients with gastric cancer is essential for optimal treatment. The standard of care for staging gastric carcinoma is helical CT. This study was conducted to compare the efficacy of hydrogastric sonography (HGS) with that of helical CT in the staging of patients with gastric carcinoma. METHODS A total of 42 consecutive patients (29 men and 13 women) diagnosed with gastric carcinoma after endoscopy and biopsy were staged on the basis of TNM classification, preoperatively with HGS and helical CT and postoperatively with histopathologic examination (HPE). The findings of HGS and helical CT were compared with those on HPE with respect to TNM stage. RESULTS Regarding T stage, the accuracy of HGS was 78.6% (kappa = 0.68) and that of helical CT was 66.7% (kappa = 0.48). In evaluating the nodal status, the accuracy of HGS was 66.7% (kappa = 0.52) and that of helical CT was 54.6% (kappa = 0.39). Regarding distant metastases, accuracy was the same with HGS and helical CT (accuracy 95.2%, kappa = 0.89). CONCLUSIONS When compared with HPE, HGS was found to be more accurate than helical CT for assessment of T and N staging. Sonographic and helical CT were equally accurate for the assessment of M stage.
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Affiliation(s)
- I Venkataraman
- Department of Radiology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
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Okada K, Fujisaki J, Kasuga A, Omae M, Yoshimoto K, Hirasawa T, Ishiyama A, Yamamoto Y, Tsuchida T, Hoshino E, Igarashi M, Takahashi H. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection. Surg Endosc 2010; 25:841-8. [PMID: 20734082 DOI: 10.1007/s00464-010-1279-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 07/19/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has become a reliable method for predicting the invasion depth of early gastric cancer (EGC). This study evaluated the accuracy of EUS in identifying lesions meeting expanded-indication criteria for endoscopic submucosal dissection (ESD) and analyzed clinicopathologic factors influencing the diagnostic accuracy of EUS in assessing tumor invasion depth. METHODS This study investigated 542 EGCs of 515 patients who underwent EUS pretreatment. The pretreatment EUS-determined diagnosis was compared with the final histopathologic evaluation of resected specimens, and the impact of various clinicopathologic parameters on diagnostic accuracy was analyzed. RESULTS The diagnostic accuracy of EUS in identifying lesions meeting expanded-indication criteria for ESD was 87.8% (259/295) for differentiated adenocarcinoma (D-type) 30 mm in diameter or smaller, 43.5% (10/23) for D-type tumor larger than 30 mm in diameter, and 75% (42/56) for undifferentiated adenocarcinoma (UD-type) 20 mm in diameter or smaller. Using multivariate analysis, the diagnostic accuracy of EUS in predicting tumor invasion depth was determined to be decreased significantly by ulcerous change and large tumor size (diameter, ≥30 mm). CONCLUSION For patients with EGC, D-type lesions 30 mm in diameter or smaller and UD-type lesions 20 mm in diameter or smaller can be diagnosed with high accuracy by EUS, but larger D-type lesions (diameter, >30 mm) should be considered carefully in terms of EUS-based treatment decisions. Findings of ulceration and large tumors are associated with incorrect diagnosis of tumor invasion depth by EUS.
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Affiliation(s)
- Kazuhisa Okada
- Ariake Hospital of Japanese Foundation for Cancer Research,Tokyo, Japan
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Horisoko E, Tsushima Y, Taketomi-Takahashi A, Tokunaga M, Endo K. Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer. BMC Med Inform Decis Mak 2010; 10:33. [PMID: 20534137 PMCID: PMC2906417 DOI: 10.1186/1472-6947-10-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 06/09/2010] [Indexed: 12/29/2022] Open
Abstract
Background There have been no reports discussing which imaging procedures are truly necessary before treatment of endoscopically-diagnosed early gastric cancer (eEGC). The aim of this pilot study was to show which imaging examinations are essential to select indicated treatment or appropriate strategy in patients with eEGC. Methods In 140 consecutive patients (95 men, 45 women; age, 66.4 +/- 11.3 years [mean +/- standard deviation], range, 33-90) with eEGC which were diagnosed during two years, the pre-treatment results of ultrasonography (US) and contrast-enhanced computed tomography (CT) of the abdomen, barium enema (BE) and chest radiography (CR) were retrospectively reviewed. Useful findings that might affect indication or strategy were evaluated. Results US demonstrated useful findings in 13 of 140 patients (9.3%): biliary tract stones (n = 11) and other malignant tumors (n = 2). Only one useful finding was demonstrated on CT (pancreatic intraductal papillary mucinous tumor) but not on US (0.7%; 95% confidential interval [CI], 2.1%). BE demonstrated colorectal carcinomas in six patients and polyps in 10 patients, altering treatment strategy (11.4%; 95%CI, 6.1-16.7%). Of these, only two colorectal carcinomas were detected on CT. CR showed three relevant findings (2.1%): pulmonary carcinoma (n = 1) and cardiomegaly (n = 2). Seventy-nine patients (56%) were treated surgically and 56 patients were treated by endoscopic intervention. The remaining five patients received no treatment due to various reasons. Conclusions US, BE and CR may be essential as pre-treatment imaging examinations because they occasionally detect findings which affect treatment indication and strategy, although abdominal contrast-enhanced CT rarely provide additional information.
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Affiliation(s)
- Eri Horisoko
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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