The long-term survival rate and prognostic difference between primary gastrectomy and conversion surgery in clinically diagnosed with stage IV gastric cancer (GC) patients

78 Background: Conversion surgery could be an option for unresectable stage IV gastric cancer when distant metastasis (M1) is disappeared by chemotherapy. However, the indication and the optimal timing of conversion surgery in stage IV gastric cancer remain unclear, even if metastatic lesions disappear with chemotherapy. Guideline of National Comprehensive Cancer Network also shows no principle after down-staging. Methods: This retrospective study examined 34 gastric cancer patients who underwent curative conversion surgery at our institute between 2005 and 2014. Clinicopathologic characteristics and patient outcomes were analyzed, with particular focus on the potential to select patients who might benefit from surgical resection. Results: The number of M1 factors was one in 31 patients and two in 3, including metastases to non-regional lymph node in 21, peritoneum in 8, liver in 5, and lung in 3. The regimen of chemotherapy was Docetaxel/CDDP/S-1 in 23 patients, Docetaxel/CDDP/S-1+Trastuzmab in 6, S-1/CDDP in 2, Docetaxel/S-1 in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. The median duration from initiation of chemotherapy to the operation was 114 days (range 37-653 days). Total gastrectomy was performed in 27 patients and distal gastrectomy was performed in 7 patients. Complete resection with no residual tumor (R0) was achieved in 23 of 34 patients, microscopic residual tumor status (R1) in 10, and macroscopic residual tumor (R2) in 1. The 3-year overall survival (OS) rate among the patients who underwent conversion therapy was 58.0% with MST of 1190 days. Univariate analysis among the patents with conversion surgery identified intestinal differentiation, pathological response grade≧1b, R0 resection as significant prognostic factors. Patients operated on more than 91 days from initiation of chemotherapy had the 3-year survival rate of 68.2%, compared to 40.0% for patients operated on less than 90 days. Conclusions: Our data demonstrate the increased 3-year survival rate associated with delayed conversion surgery for stage IV gastric cancer. Delayed conversion surgery should be considered for patients, even if metastatic lesions disappear with chemotherapy.

Download Full-text

T stage and venous invasion are crucial prognostic factors for long-term survival of patients with remnant gastric cancer: a cohort study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02400-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Kentaro Matsuo ◽

Sang-Woong Lee ◽

Ryo Tanaka ◽

Yoshiro Imai ◽

Kotaro Honda ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Venous Invasion ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Factors Associated ◽

T Stage ◽

History Of

Abstract Background The incidence of remnant gastric cancer (RGC) after distal gastrectomy is 1–5%. However, as the survival rate of patients with gastric cancer improves due to early detection and treatment, more patients may develop RGC. There is no consensus on the surgical and postoperative management of RGC, and the clinicopathological characteristics correlated with the long-term outcomes remain unclear. Therefore, we investigated the clinicopathological factors associated with the long-term outcomes of RGC. Methods We included 65 consecutive patients who underwent gastrectomy for RGC from January 2000 to December 2015 at the Osaka Medical and Pharmaceutical University Hospital, Japan. The Kaplan–Meier method was used to create survival curves, and differences in survival were compared between the groups (clinical factors, pathological factors, and surgical factors) using the log-rank test. Multivariate analyses using the Cox proportional hazard model were used to identify factors associated with long-term survival. Results No significant differences were noted in the survival rate based on clinical factors (age, body mass index, diabetes mellitus, hypertension, cardiovascular disease, pulmonary complications, liver disease, diet, history of alcohol drinking, and history of smoking) or the type of remnant gastrectomy. Significant differences were noted in the survival rate based on pathological factors and surgical characteristics (intraoperative blood loss, operation time, and the number of positive lymph nodes). Multivariate analysis revealed that the T stage (hazard ratio, 5.593; 95% confidence interval [CI], 1.183–26.452; p = 0.030) and venous invasion (hazard ratio, 3.351; 95% CI, 1.030–10.903; p = 0.045) were significant independent risk factors for long-term survival in patients who underwent radical resection for RGC. Conclusions T stage and venous invasion are important prognostic factors of long-term survival after remnant gastrectomy for RGC and may be keys to managing and identifying therapeutic strategies for improving prognosis in RGC.

Download Full-text

Long-term survival and prognosis associated with conversion surgery in patients with metastatic gastric cancer

Molecular and Clinical Oncology ◽

10.3892/mco.2017.1128 ◽

2017 ◽

Vol 6 (2) ◽

pp. 163-166 ◽

Cited By ~ 12

Author(s):

Takahiro Einama ◽

Hironori Abe ◽

Shunsuke Shichi ◽

Hiroki Matsui ◽

Ryo Kanazawa ◽

...

Keyword(s):

Gastric Cancer ◽

Metastatic Gastric Cancer ◽

Conversion Surgery ◽

Term Survival ◽

Long Term Survival

Download Full-text

Predictive factors for long-term survival after conversion surgery for unresectable gastric cancer: A retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.205 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 205-205

Author(s):

Tamotsu Sagawa ◽

Kyoko Hamaguchi ◽

Akira Sakurada ◽

Fumito Tamura ◽

Tsuyoshi Hayashi ◽

...

Keyword(s):

Gastric Cancer ◽

Residual Tumor ◽

R0 Resection ◽

Conversion Surgery ◽

Tumor Depth ◽

Term Survival ◽

Long Term Survival ◽

Line Therapy ◽

Unresectable Gastric Cancer

205 Background: Chemotherapy occasionally converts an initially unresectable gastric cancer to a resectable cancer. However, the association between clinical factors and long-term prognosis after conversion surgery for unresectable gastric cancer has not been investigated. Methods: We retrospective reviewed 36 gastric cancer patients who underwent conversion surgery at our institute between 2005 and 2015. Clinicopathologic characteristics and patient outcomes were analyzed, with particular focus on the potential to predict long-term survival. Results: The number of incurable factors was one in 31 patients and two in 5, including metastases to non-regional lymph node in 22, peritoneum in 10, liver in 6, and lung in 3. The regimen of chemotherapy was Docetaxel/CDDP/S-1 in 23 patients, Docetaxel/CDDP/S-1+Trastuzmab in 7, S-1/CDDP in 2, Docetaxel/S-1 in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. Complete resection with no residual tumor (R0) was achieved in 25 of 36 patients, microscopic residual tumor status (R1) in 10, and macroscopic residual tumor (R2) in 1. The 3-year overall survival (OS) rate among the 36 patients who underwent conversion surgery was 60.3 % (median survival time, 1200 days). The 3-year OS rate among patients who underwent R0 resection was 70.8 % (median survival time, 1503 days). Patients who underwent R0 resection had significantly longer OS times than those who underwent R1 and R2 resection ( p=0.0124). We selected 16 variables in addition to residual tumor for Kaplan–Meier analysis. According to the log rank test, the following four variables were significantly associated with a better OS: clinical response to 1st line therapy (CR or PR vs. SD or PD)( p=0.0283), pathological response grade (1b-3 vs. 0-1a) ( p=0.0304), pathological tumor depth (CR or T1~T3 vs. T4) ( p=0.0261), and pathological nodal stage (N0〜2 vs. N3) ( p=0.0086). Conclusions: Our data indicates that clinical response to 1st line therapy in preoperative characteristics, R0 resection, pathological response grade, pathological tumor depth, pathological nodal stage in postoperative characteristics are predictive factors that can be expected to long-term survival.

Download Full-text

Curative-Intent Surgery for Stage IV Advanced Gastric Cancer: Who Can Undergo Surgery and What Are the Prognostic Factors for Long-Term Survival?

Annals of Surgical Oncology ◽

10.1245/s10434-019-07790-1 ◽

2019 ◽

Vol 26 (13) ◽

pp. 4452-4463 ◽

Cited By ~ 1

Author(s):

Sho Sato ◽

Chikara Kunisaki ◽

Yusaku Tanaka ◽

Kei Sato ◽

Hiroshi Miyamoto ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factors ◽

Advanced Gastric Cancer ◽

Stage Iv ◽

Curative Intent ◽

Term Survival ◽

Long Term Survival

Download Full-text

Surgical Outcome and Long-Term Survival of Conversion Surgery for Advanced Gastric Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-020-08559-7 ◽

2020 ◽

Vol 27 (11) ◽

pp. 4250-4260 ◽

Cited By ~ 1

Author(s):

Guo-Ming Chen ◽

Shu-Qiang Yuan ◽

Run-Cong Nie ◽

Tian-Qi Luo ◽

Kai-Ming Jiang ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Surgical Outcome ◽

Conversion Surgery ◽

Term Survival ◽

Long Term Survival

Download Full-text

Long-Term Survival of Two Patients with Liver Metastases from Advanced Gastric Cancer Treated with Radiofrequency Ablation and Chemotherapy

Case Reports in Oncology ◽

10.1159/000507849 ◽

2021 ◽

pp. 67-72

Author(s):

Sung Jin Oh

Keyword(s):

Gastric Cancer ◽

Radiofrequency Ablation ◽

Liver Metastases ◽

Advanced Gastric Cancer ◽

Systemic Chemotherapy ◽

Subtotal Gastrectomy ◽

Hepatic Metastases ◽

Term Survival ◽

Long Term Survival

Liver metastasis from gastric cancer has a very poor prognosis. Herein, we present two cases of liver metastases (synchronous and metachronous) from advanced gastric cancer. In the first case, the patient underwent radical subtotal gastrectomy. Liver metastases occurred 6 months after surgery while the patient was receiving adjuvant chemotherapy, but two hepatic tumors were successfully removed by radiofrequency ablation (RFA). In the second case, liver metastases occurred 15 months after surgery for gastric cancer. The patient also received RFA for one hepatic tumor, and other suspicious metastatic tumors were treated with systemic chemotherapy. Although these case presentations are limited for the efficacy of RFA treatment with systemic chemotherapy for hepatic metastases from gastric cancer, our findings showed long-term survival (overall survival for 108 and 67 months, respectively) of the affected patients, without recurrence. Therefore, we suggest that RFA treatment with systemic chemotherapy could be an effective alternative treatment modality for hepatic metastases from gastric cancer.

Download Full-text

The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

Cancer Control ◽

10.1177/1073274821997430 ◽

2021 ◽

Vol 28 ◽

pp. 107327482199743

Author(s):

Ke Chen ◽

Xiao Wang ◽

Liu Yang ◽

Zheling Chen

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Survival Rate ◽

Meta Analysis ◽

Response Rates ◽

Control Group ◽

Term Survival ◽

Long Term Survival ◽

And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

Download Full-text