Influence of perineural invasion in predicting overall survival and disease-free survival in patients With locally advanced gastric cancer

e16019 Background: Postoperative adjuvant chemotherapy is commonly given after the curative resection of gastric cancer (GC) in both Eastern and Western countries. Several studies have investigated the feasibility and safety of S-1 plus docetaxel or S-1 plus cisplatin. However, the best choice of adjuvant treatment for patients with gastric cancer is still debated. Apatinib, an oral small molecular of VEGFR-2 TKI, has been confirmed to improve OS and PFS with acceptable safety profile in patients with advanced gastric cancer refractory to two or more lines of prior chemotherapy. In this study, we aimed to evaluate the efficacy and safety of apatinib combined with S-1/docetaxel for locally advanced gastric cancer (T3-4aN+M0). Methods: This is a prospective, randomized, controlled, multicenter clinical study. Patients with locally advanced gastric cancer, pathological stage T3-4aN+M0 who underwent D2 lymphadenectomy without prior anti-cancer therapy were included. All these patients were assigned to group A or B. Patients in group A received 6 cycles (21 days a cycle) of adjuvant therapy using S-1 (80-120mg/d, d1-14), and docetaxel (40mg/m2, d1). Group B received the same regimen with the addition of apatinib (250mg, qd.). The primary endpoint was disease-free survival (DFS). The final analysis cutoff date was 30 November, 2020. Results: A total of 45 patients were enrolled from January 2019 to November, 2010 and assigned to group A (21) or group B (24). The DFS was not reached in both of the groups. The 1-year disease-free survival rate was 60% in group A and 90% in the group B, while the difference was not significant. The main AEs in group A were anemia (55%), nausea (50%) and neutropenia (40%); The most common AEs in group B were anemia (45%) neutropenia (40%) and diarrhea (25%). There were no treatment-related deaths. The longest administered time of apatinib with no progression was 457 days. And the median time to receive apatinib was 329 days. Conclusions: Combination of apatinib with S-1/docexal chemotherapy shows clinical benefits in locally advanced gastric cancer (T3-4aN+M0), with tolerable toxicity. The study is still ongoing to reach our final endpoint, DFS. Clinical trial information: ChiCTR2000038900.

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Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer

JAMA ◽

10.1001/jama.2019.5359 ◽

2019 ◽

Vol 321 (20) ◽

pp. 1983 ◽

Cited By ~ 90

Author(s):

Jiang Yu ◽

Changming Huang ◽

Yihong Sun ◽

Xiangqian Su ◽

Hui Cao ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Distal Gastrectomy ◽

Locally Advanced ◽

Disease Free Survival ◽

Open Distal Gastrectomy ◽

Free Survival ◽

Locally Advanced Gastric Cancer ◽

Disease Free

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Effect of laparoscopic vs. open distal gastrectomy on 3-year disease free survival in patients with locally advanced gastric cancer: commentary on the class-01 randomized clinical trial

Translational Gastroenterology and Hepatology ◽

10.21037/tgh.2019.09.14 ◽

2019 ◽

Vol 4 ◽

pp. 78-78 ◽

Cited By ~ 1

Author(s):

Joyce Wong

Keyword(s):

Gastric Cancer ◽

Clinical Trial ◽

Advanced Gastric Cancer ◽

Distal Gastrectomy ◽

Locally Advanced ◽

Disease Free Survival ◽

Open Distal Gastrectomy ◽

Free Survival ◽

Locally Advanced Gastric Cancer ◽

Disease Free

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Three-year outcomes of the randomized phase III SEIPLUS trial of extensive intraoperative peritoneal lavage for locally advanced gastric cancer

Nature Communications ◽

10.1038/s41467-021-26778-8 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Jing Guo ◽

Aman Xu ◽

Xiaowei Sun ◽

Xuhui Zhao ◽

Yabin Xia ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Peritoneal Lavage ◽

Randomized Study ◽

Locally Advanced ◽

Disease Free Survival ◽

Disease Recurrence ◽

Phase Iii ◽

Free Survival ◽

Locally Advanced Gastric Cancer

AbstractWhether extensive intraoperative peritoneal lavage (EIPL) after gastrectomy is beneficial to patients with locally advanced gastric cancer (AGC) is not clear. This phase 3, multicenter, parallel-group, prospective randomized study (NCT02745509) recruits patients between April 2016 and November 2017. Eligible patients who had been histologically proven AGC with T3/4NxM0 stage are randomly assigned (1:1) to either surgery alone or surgery plus EIPL. The results of the two groups are analyzed in the intent-to-treat population. A total of 662 patients with AGC (329 patients in the surgery alone group, and 333 in the surgery plus EIPL group) are included in the study. The primary endpoint is 3-year overall survival (OS). The secondary endpoints include 3-year disease free survival (DFS), 3-year peritoneal recurrence-free survival (reported in this manuscript) and 30-day postoperative complication and mortality (previously reported). The trial meets pre-specified endpoints. Estimated 3-year OS rates are 68.5% in the surgery alone group and 70.6% in the surgery plus EIPL group (log-rank p = 0.77). 3-year DFS rates are 61.2% in the surgery alone group and 66.0% in the surgery plus EIPL group (log-rank p = 0.24). The pattern of disease recurrence is similar in the two groups. In conclusion, EIPL does not improve the 3-year survival rate in AGC patients.

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A prospective randomized trial comparing 5-fluorouracil (5-FU), mitomycin-C (MMC), and polysaccharide-K (PSK) versus UFT and PSK as adjuvant chemoimmunotherapy (CITX) for patients with locally advanced gastric cancer with curative resection

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15074 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15074-15074

Author(s):

J. Choi ◽

S. Kang ◽

J. Park ◽

H. Lee ◽

Y. Cho ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Randomized Trial ◽

Advanced Gastric Cancer ◽

Curative Resection ◽

Locally Advanced ◽

Disease Free Survival ◽

Target Number ◽

Stage Ib ◽

Locally Advanced Gastric Cancer

15074 Background: Adjuvant chemotherapy has demonstrated small but significant survival benefit in locally advanced gastric cancer in several meta-analyses, while adjuvant CITX showed improved outcome of patients (pts) compared to chemotherapy alone in a few trials. However, optimal chemotherapy regimen remains to be determined. We conducted a randomized trial comparing oral (PO) CITX with intravenous (IV) CITX in gastric cancer pts with curative resection. Methods: All enrolled pts underwent radical surgery with at least D2 dissection. After stratification for pathologic stage (IB or II vs. III) and primary tumor size (=5 cm vs. >5 cm), pts were randomized to IV CITX (5-FU 500 mg/m2 weekly for 24 weeks, MMC 8 mg/m2 every 6 weeks x 4) or PO CITX (UFT 400–600 mg/day for 12 months). Pts in both arms received PSK 3 g/day PO for 4 months. The planned target number of pts was 368 to prove the non-inferiority of PO CITX compared to IV CITX in overall survival. Results: A total of 82 pts (stage IB: 6, II: 29, IIIA: 30, IIIB: 17; 44 in IV arm, 38 in PO arm) were enrolled between May 2002 and October 2005, when the trial was closed due to poor accrual. Pts characteristics were well balanced. With a median follow-up of 39 months (14–55 months) in survivors, there were no significant differences in 3-year disease-free survival (82% vs. 61%, p=0.302) and overall survival (84% vs. 79%, p=0.838) between IV and PO arms. No grade 4 toxicity was observed in both arms. IV arm demonstrated higher incidence of grade 2 or 3 neutropenia (79% vs. 52%, p=0.025), thrombocytopenia (19% vs. 0%, p=0.008), and vomiting (36% vs. 9%, p=0.013). Conclusions: Although accrual was well below that planned, the results of this trial suggest that PO CITX with UFT might have similar efficacy with lower toxicity profile compared with 5-FU and MMC CITX in adjuvant treatment for gastric cancer. No significant financial relationships to disclose.

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Gastric Cancer Surgical Experience from a single expert Western center: case series results

10.21203/rs.3.rs-32645/v2 ◽

2020 ◽

Author(s):

Luigina graziosi ◽

elisabetta marino ◽

Stefano Avenia ◽

Maria Cristina Vannoni ◽

Annibale Donini

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Locally Advanced ◽

Case Series ◽

Disease Free Survival ◽

Curative Surgery ◽

Free Survival ◽

Entire Cohort ◽

Time Period ◽

Disease Free

Abstract Background Surgical treatment plays a key role in the cure of gastric cancer. Our aim was to analyze changes in epidemiology and outcome, over a time period of 15 years.Methods 410 patients operated between January 2004 and December 2018 were enrolled. Patients were subdivided into 3 groups. The entire cohort was evaluated, and a more detailed analysys was made in patients that underwent a curative surgery. Survival outcomes and oncological surgical outcomes have been described and correlated with Overall Survival.Results Results showed an increase trend in gastric cancer operation over the time period analyzed (p< 0.05). Overall and disease free survival did not vary in the different time periods. In patients treated with the intent to cure: 5- and 10-Year survivals were respectively: 44% and 34.7%; 5- and 10 years disease free survival were 50.7 and 49.4%. Type of lymphadenectomy and number of lymphondal harvested changed significantly over the time (p < 0.05). Conclusions Our result showed an increasing trend in number of surgery for gastric adenocarcinoma in our center, probably due to the increasing in absolute number of cases in Italy and worldwide. We have also show that tumor location is shifting towards a distal location in the last period. Moreover in the last period there is also an improving trend in overall survival, probably due to a more aggressive surgery adopted and also due to an improved learning curve. Gastric surgery must be done in an experienced center to obtain oncological outcomes; in selected cases an extended lymphadenectomy could give survival benefit to patients with locally advanced gastric cancer.

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Preoperative Versus Postoperative Chemo-Radiotherapy For Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis

10.21203/rs.3.rs-644806/v1 ◽

2021 ◽

Author(s):

Ning Li ◽

Xiaoyong Xiang ◽

Dongbin Zhao ◽

Xin Wang ◽

Yuan Tang ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Locally Advanced ◽

Disease Free Survival ◽

Postoperative Treatment ◽

Long Term Outcome ◽

Free Survival ◽

Locally Advanced Gastric Cancer

Abstract Background: peri-operative chemo-radiotherapy played important role in locally advanced gastric cancer. Whether preoperative strategy can improve the long-term prognosis compared with postoperative treatment is unclear. The study purpose to compare long-term oncologic outcomes in locally advanced gastric cancer patients treated with preoperative chemo-radiotherapy (pre-CRT) and postoperative chemo-radiotherapy (post-CRT). Methods: From January 2009 to April 2019, 222 patients from 2 centers with stage T3/4 and/or N positive gastric cancer who received pre-CRT and post-CRT were included. After propensity score matching (PSM), comparisons of local regional control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were performed using Kaplan-Meier analysis and log-rank test between pre- and post-CRT groups.Results: The median follow-up period was 30 months. 120 matched cases were generated for analysis. Three-year LC, DMFS, DFS and OS for pre- vs. post-CRT groups were 93.8% vs. 97.2% (p=0.244), 78.7% vs. 65.7% (p=0.017), 74.9% vs. 65.3% (p=0.042) and 74.4% vs. 61.2% (p=0.055), respectively. Pre-CRT were significantly associated with DFS in uni- and multi-variate analysis. Conclusion: Preoperative CRT showed advantages of long-term outcome compared with postoperative CRT. Trial registration: ClinicalTrial.gov NCT01291407, NCT03427684 and NCT04062058, date of registration: Feb 8, 2011

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Overexpression of NUAK1 is associated with disease-free survival and overall survival in patients with gastric cancer

Medical Oncology ◽

10.1007/s12032-014-0061-1 ◽

2014 ◽

Vol 31 (7) ◽

Cited By ~ 8

Author(s):

Xiao-tian Ye ◽

Ai-jun Guo ◽

Peng-fei Yin ◽

Xian-dong Cao ◽

Jia-cong Chang

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free

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Feasibility study of TAS-118 plus oxaliplatin as perioperative chemotherapy for patients with locally advanced gastric cancer (APOLLO-11).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.205 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 205-205

Author(s):

Daisuke Takahari ◽

Manabu Ohashi ◽

Atsuo Takashima ◽

Takuro Mizukami ◽

Naoki Ishizuka ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Locally Advanced ◽

Dose Intensity ◽

Complete Response ◽

Free Survival ◽

D2 Gastrectomy ◽

Locally Advanced Gastric Cancer ◽

Grade 3

205 Background:TAS-118 (S-1 and leucovorin) + oxaliplatin (L-OHP) improved overall survival (OS) compared to S-1 + cisplatin for patients (pts) with advanced gastric cancer (GC) (Kang, Lancet Oncol. 2020). This study investigated the feasibility of peri (pre and post)-operative (op) chemotherapy (chemo) with TAS-118 ± L-OHP in pts with locally advanced resectable GC. While it was reported that pre-op TAS-118 + L-OHP followed by D2 gastrectomy was well tolerated and showed promising efficay (Takahari, ASCO-GI. 2020), the recommended post-op chemo regimen, TAS-118 or TAS-118 + L-OHP, has yet to be determined. Methods:Eligible pts with GC of clinical T3-4N1-3M0 were enrolled. The protocol treatment consisted of pre-op chemo with 4 courses of TAS-118 (40-60 mg/body, orally, twice daily, 7 days) + L-OHP (85 mg/m2, intravenously, day 1) in a 2-week cycle, and gastrectomy with D2 lymphadenectomy, followed by post-op chemo with 12 courses of TAS-118 (step 1) and 8 courses of TAS-118 + L-OHP (step 2). Step 2 was started if the dose-limiting toxicity (DLT) occurred in < 6 of 10 pts in step 1. Up to 20 pts were included in the analysis of feasibility after a recommended regimen was determined. Results:Between December 2016 and February 2019, 45 pts were enrolled. The numbers of pts with cT3/4a and cN1/2/3 were 13/32 and 25/17/3, respectively. Excluding 14 pts (4 achieving pathological complete response, 4 not satisfying the criteria for post-op chemo, 3 physician judgement or pt withdrawal, 2 progressive disease, 1 adverse event [AE]), 31 pts (11/20 in step 1/2) received the post-op chemo. No DLT was observed in either step. The post-op chemo completion rate was 90.9% (95% CI, 63.6-99.5) in step 1 and 80.0% (95% CI, 59.9-92.9) in step 2. The median relative dose intensity of TAS-118 in step 1 was 83.3%, and those of TAS-118 and L-OHP in step 2 were 69.9% and 74.3%, respectively. One pt in step 2 discontinued post-op chemo due to AE. Grade ³ 3 AEs observed in ≥ 10% of pts were weight loss in both step 1 and step 2 (2 in each), and hypokalemia (n = 3) and neutropenia (n = 2) in step 2. At 1-year follow-up after the last pt was enrolled, recurrence-free survival and OS rates were 91.1% (95% CI, 78.0-96.6) and 100%, respectively at 12 months, and 69.1% (95% CI, 49.6-82.3) and 95.5% (95% CI, 71.9-99.3), respectively at 24 months. Conclusions:Taken together with the feasibility and efficacy of pre-op chemo, peri-op chemo with TAS-118 + L-OHP with D2 gastrectomy was well tolerated and showed promising efficacy. Clinical trial information: UMIN000024688.

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