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Yao YH, Zhang H, Xiao Y, Liu ZT, Shi YY, Yu JY, Li Q, Cao BS. Systematic treatment in gastric cancer patients with overt bleeding: A propensity score matching analysis. World J Clin Oncol 2024; 15:1177-1187. [DOI: 10.5306/wjco.v15.i9.1177] [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] [Received: 03/22/2024] [Revised: 07/12/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Hemorrhage, which is not a rare complication in patients with gastric cancer (GC)/gastroesophageal junction cancer (GEJC), can lead to a poor prognosis. However, no study has examined the effectiveness and safety of chemotherapy as an initial therapy for GC/GEJC patients with overt bleeding (OB).
AIM To investigate the impact of OB on the survival and treatment-related adverse events (TRAEs) of GC/GEJC patients.
METHODS Patients with advanced or metastatic GC/GEJC who received systematic treatment at Peking University Third Hospital were enrolled in this study. Propensity score matching (PSM) analysis was performed.
RESULTS After 1:2 PSM analysis, 93 patients were assessed, including 32 patients with OB before treatment (OBBT) and 61 patients without OBBT. The disease control rate was 90.6% in the group with OBBT and 88.5% in the group without OBBT, and this difference was not statistically significant. There was no difference in the incidence of TRAEs between the group with OBBT and the group without OBBT. The median overall survival (mOS) was 15.2 months for patients with OBBT and 23.7 months for those without OBBT [hazard ratio (HR) = 1.101, 95% confidence interval (CI): 0.672-1.804, log rank P = 0.701]. The mOS was worse for patients with OB after treatment (OBAT) than for those without OBAT (11.4 months vs 23.7 months, HR = 1.787, 95%CI: 1.006-3.175, log rank P = 0.044).
CONCLUSION The mOS for GC/GEJC patients with OBBT was similar to that for those without OBBT, but the mOS for patients with OBAT was worse than that for those without OBAT.
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Affiliation(s)
- Yan-Hong Yao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
- Department of Cancer Center, Peking University Third Hospital, Beijing 100191, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Yu Xiao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Zhen-Tao Liu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Yan-Yan Shi
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Jin-Yu Yu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Qian Li
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Bao-Shan Cao
- Department of Cancer Center, Peking University Third Hospital, Beijing 100191, China
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
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Kawabata H, Fujii T, Yamamoto T, Satake H, Yamaguchi K, Okazaki Y, Nakase K, Miyata M, Motoi S. Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer Using Three-Dimensional Conformal Technique. Biomedicines 2022; 10:biomedicines10061394. [PMID: 35740415 PMCID: PMC9219767 DOI: 10.3390/biomedicines10061394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 12/24/2022] Open
Abstract
Optimal regimens using recent radiotherapy (RT) equipment for bleeding gastric cancer (GC) have not been fully investigated yet. We retrospectively reviewed the clinical data of 20 patients who received RT for bleeding GC in our institution between 2016 and 2021. Three-dimensional conformal RT was performed. The effectiveness of RT was evaluated by the mean serum hemoglobin (Hb) level and the number of transfused red blood cell (RBC) units 1 month before and after RT. The median first radiation dose was a BED of 39.9 Gy. The treatment success rate was 95% and the rebleeding rate was 10.5%. There was a significant increase in the mean Hb level (8.0 ± 1.1 vs. 9.8 ± 1.3 g/dL, p = 0.01), and a significant decrease in the mean number of transfused RBC units (6.8 ± 3.3 vs. 0.6 ± 1.5 units, p < 0.01). Severe toxicity was observed in two patients (anorexia [n = 1] and gastrointestinal [GI] perforation [n = 1]). Reirradiation was attempted in three patients (for hemostasis [n = 2] and for mass reduction [n = 1]). The retreatment success rate for rebleeding was 100%. GI perforation occurred in two patients who had received hemostatic reirradiation. Palliative RT for bleeding GC using recent technology had excellent efficacy. However, it may be associated with a risk of GI perforation.
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Affiliation(s)
- Hideaki Kawabata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
- Correspondence: ; Tel.: +81-774-48-5500
| | - Takashi Fujii
- Department of Radiology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan;
| | - Tetsuya Yamamoto
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Hiroaki Satake
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Katsutoshi Yamaguchi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Yuji Okazaki
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Kojiro Nakase
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Masatoshi Miyata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Shigehiro Motoi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
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Zou Y, Wu L, Yang Y, Shen X, Zhu C. Risk factors of tumor invasion and node metastasis in early gastric cancer with undifferentiated component: a multicenter retrospective study on biopsy specimens and clinical data. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:360. [PMID: 32355804 PMCID: PMC7186605 DOI: 10.21037/atm.2020.02.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Early gastric cancer (EGC) with undifferentiated component (UDC) is a more aggressive entity, where the significance of preoperative data to tumor invasion and lymph node metastasis (LNM) remains unclarified. Methods A total of 5,020 GC patients undergoing radical gastrectomy in three centers were reviewed, of which, EGC with UDC in preoperative biopsy specimens were enrolled. The histology of biopsy and surgical specimens was graded according to the proportion of UDC and signet ring cells (SRCs). Risk factors of tumor invasion and LNM were evaluated with histological, clinical and demographic data. Results Lower body mass index (BMI), melena and larger tumor size were the independent preoperative risk factors of both LNM and LVI, while ulcerative lesion (UL) and the lower third stomach were only correlated with LNM. No relevance was found between the histological features of biopsy specimens and LNM, but SRC or >50% UDC lowered the risk of lymphovascular invasion (LVI) and/or submucosal (SM) invasion. When surgical data (depth of invasion and LVI included) were added, lower BMI, melena and the lower third stomach were still the independent preoperative risk factors of LNM, and LVI, SRC and SM invasion also showed relevance to LNM. The performance of predictive models using pre- or postoperative histological data was comparable. Conclusions The preoperative data were significantly relevant to tumor invasion and LNM, showing comparable risk strength with surgical specimens in histology.
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Affiliation(s)
- Yi Zou
- Department of Pathology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Long Wu
- Department of Pathology, Union Hospital of Fujian Medical University, Fuzhou 350001, China
| | - Yubin Yang
- Department of Pathology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Xin Shen
- College of Computer Science and Technology, Zhejiang University, Hangzhou 310027, China
| | - Chunpeng Zhu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
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Management of Bleeding from Unresectable Gastric Cancer. Biomedicines 2019; 7:biomedicines7030054. [PMID: 31344824 PMCID: PMC6784219 DOI: 10.3390/biomedicines7030054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Bleeding from unresectable gastric cancer (URGC) is not a rare complication. Two major ways in which the management of this issue differs from the management of benign lesions are the high rate of rebleeding after successful hemostasis and that not only endoscopic therapy (ET) and transcatheter arterial embolization (TAE) but palliative radiotherapy (PRT) can be applied in the clinical setting. However, there are no specific guidelines concerning the management of URGC with bleeding. We herein discuss strategies for managing bleeding from URGC. A high rate of initial hemostasis for active bleeding is expected when using various ET modalities properly. If ET fails in patients with hemostatic instability, emergent TAE is considered in order to avoid a life-threating condition due to massive bleeding. Early PRT, especially, regimens with a high biologically effective dose (BED) of ≥39 Gy should be considered not only for patients with hemostatic failure but also for those with successful hemostasis and inactive hemorrhage, as longer duration of response with few complications can be expected. Further prospective, comparative studies considering not only the hemostatic efficacy of these modalities but the patients' quality of life are needed in order to establish treatment strategies for bleeding from URGC.
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Liu L, Bai Y, Gu H, Zhu H, Yu Y, Lu P, Wang Y, Zhang H, Li M. The prognostic efficacy of the 8th edition UICC TNM classifications for gastric cancer in Chinese patients: A study based on follow-up system of nursing department. Medicine (Baltimore) 2018; 97:e12284. [PMID: 30200173 PMCID: PMC6133638 DOI: 10.1097/md.0000000000012284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study aimed to analyze the applicability of the Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification 8th edition for Chinese patients with gastric cancer.A review of all inpatient and outpatient records of patients with gastric cancer was conducted in the First Affiliated Hospital of China Medical University and Liaoning Cancer Hospital and Institute. All patients who met the inclusion criteria and were seen from January 1980 through December 2009 were included in the study. The primary outcome was 5-year survival, which was analyzed according to the decade of diagnosis and TNM classifications.Two thousand five hundred fifty-four patients were enrolled in this study. When classified according to the UICC TNM classification of gastric cancer 8th edition, the prognoses of patients with stage IIIB (n = 250) and stage IIIC (n = 101) disease were not significantly different (P = .332). However, if T4aN2 patients were classified as having stage IIIB disease, and T4bN2 and T4aN3a patients were classified as having stage IIIC disease, the prognoses of stage IIIB (n = 221) and stage IIIC (n = 172) patients were significantly different (P = .03).Classifying T4bN0 patients as having stage IIIB disease, and T4bN2 and T4aN3a patients as having stage IIIC disease according to the 8th edition of UICC gastric cancer TNM classifications better stratified Chinese patients and predicted prognoses.
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Affiliation(s)
| | - Yu Bai
- Department of Thoracic Surgery
| | - Huizi Gu
- Department of Internal Neurology, the Second Hospital of Dalian Medical University, Dalian
| | - Haitao Zhu
- Department of Gastric Surgery, Liaoning Cancer Hospital and Institute
| | - Ying Yu
- Liaoning Medical Device Test Institute
| | - Ping Lu
- Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang
| | | | | | - Min Li
- Department of Nursing, the Second Hospital of Dalian Medical University, Dalian, China
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Zuo X, Cai J, Chen Z, Zhang Y, Wu J, Wu L, Wang J. Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence. Ther Clin Risk Manag 2018; 14:965-972. [PMID: 29881278 PMCID: PMC5978462 DOI: 10.2147/tcrm.s164929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose Unplanned reoperation (URO) after radical gastrectomy for gastric cancer (GC) mostly results from serious postoperative complications. At present, there is still controversy over the predictive factors for URO. Our goal was to identify the risk factors for URO and to investigate its potential impact on long-term survival. Patients and methods We included 2,852 GC patients who underwent a gastrectomy. Multivariate logistic regression analyses were performed to determine the risk factors for URO. Patients were randomly selected from the non-URO group by 1:4 propensity score matching with multiple parameters with patients from the URO group. The survival disparity of 34 URO patients and 136 non-URO patients was examined using the Kaplan-Meier method and the multivariate Cox proportional hazard model. Results The incidence of URO was 1.4% (39/2, 852). The primary cause of URO was intra-abdominal bleeding (53.9%, 21/39). Multivariate logistic regression analyses revealed that male gender (OR = 4.630, 95% CI = 1.412-15.152, P = 0.011), diabetes (OR = 4.189, 95% CI = 1.705-10.290, P = 0.002), and preoperative hypoproteinemia (OR = 2.305, 95% CI = 1.079-4.923, P = 0.031) were independent risk factors for URO. With regard to early surgical outcomes, patients undergoing URO had a longer hospital stay (P < 0.001), higher incidence of postoperative complications (P < 0.001), and greater mortality (P < 0.001) compared with the non-URO group. No significant correlation was found between URO and cancer-specific survival in univariate (P = 0.275) and multivariate (P = 0.090) survival analyses. Conclusion Male gender, diabetes, and preoperative hypoproteinemia were suggested as independent risk factors for URO. URO was associated with longer hospital stay and increased perioperative mortality, but might not be correlated with long-term mortality.
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Affiliation(s)
- Xueliang Zuo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Juan Cai
- Department of Oncology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Zhiqiang Chen
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, China
| | - Yao Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, China
| | - Jian Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Liangyu Wu
- Department of General Surgery, Qingyang County People's Hospital, Qingyang, China
| | - Jinguo Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, China
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7
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Gu H, Li D, Zhu H, Zhang H, Yu Y, Qin D, Yi M, Li X, Lu P. The prognostic efficacy and improvements of the 7th edition Union for International Cancer Control tumor-node-metastasis classifications for Chinese patients with gastric cancer: Results based on a retrospective three-decade population study. Tumour Biol 2017; 39:1010428317694548. [PMID: 28351302 DOI: 10.1177/1010428317694548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study aimed to evaluate survival trends for patients with gastric cancer in northeast China in the most recent three decades and analyze the applicability of the UICC tumor-node-metastasis (TNM) classification 7th edition for Chinese patients with gastric cancer. A review of all inpatient and outpatient records of patients with gastric cancer was conducted in the first hospital of China Medical University and the Liaoning Cancer Hospital and Institute. All patients who met the inclusion criteria and were seen from January 1980 through December 2009 were included in the study. The primary outcome was 5-year survival, which was analyzed according to decade of diagnosis and TNM classifications. From 1980 through 2009, the 5-year survival rates for patients with gastric cancer (n=2414) increased from 39.1% to 57.3%. Decade of diagnosis was significantly associated with patient survival (p = 0.013), and the 5-year survival rate in the 2000s was remarkably higher than that in the 1980s and 1990s (p = 0.004 and 0.049, respectively). When classified according to the UICC TNM classification of gastric cancer 7th edition, the prognoses of stage IIIA and stage IIIB patients were not significantly different (p = 0.077). However, if stage T4b and stage N0 patients were classified as stage IIIA, the prognoses of stage IIIA and stage IIIB patients were significantly different (p < 0.001). Hence, there was a significant difference in survival during the three time periods in Northeast China. Classifying stage T4b and stage N0 patients as stage IIIA according to the 7th edition of UICC gastric cancer TNM classifications better stratified Chinese patients and predicted prognoses.
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Affiliation(s)
- Huizi Gu
- 1 Department of Internal Neurology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Dongmei Li
- 2 Department of Radiology, Dalian Hospital of Traditional Chinese Medicine, Dalian, China
| | - Haitao Zhu
- 3 Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Hao Zhang
- 4 Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ying Yu
- 5 Liaoning Medical Device Test Institute, Shenyang, China
| | - Dongxue Qin
- 6 Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Mei Yi
- 6 Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xiang Li
- 6 Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ping Lu
- 7 Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, China
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