Multidisciplinary Approach in Improving Survival Outcome of Early-Stage Gastric Cancer

Purpose: To compare postoperative opioid consumption, inflammatory response, survival/clinical outcomes and safety profile of epidural combined with general anesthesia (GA) versus GA in stage 1 gastric cancer patients undergoing surgical intervention by laparoscopy.Method: Chinese patients with early-stage gastric cancer undergoing laparoscopic-assisted tumor resection were enrolled and received either epidural combined with general anesthesia (group EA + GA) or general anesthesia only (group GA) in allocation ratio of 1:1. The following efficacy variables were assessed: 1) Pain score was measured on VAS scale; 2) post-operative consumption; 3) Quality of recovery; 4) inflammatory response; and 5) survival outcome. Safety was assessed throughout the study period.Results: Data for 200 subjects were analyzed. Compared to GA alone, combination of EA + GA demonstrate significantly greater reduction in post-operative pain with decrease postoperative opioid consumption. Also, the combination of GA and EA inhibited inflammatory response when compared to patients who received GA only. Moreover, the combination of GA and EA did not demonstrate any clinical benefit in survival outcome, when compared to patients who received GA alone, indicating that GA + EA has no role in improving survival outcome among patients undergoing gastric cancer surgery. Additionally, EA + GA was also associated with a shorter length of hospital stay, compared to GA.Conclusion: Overall, the results favor the use of GA + EA in Chinese patients with early-stage gastric cancer undergoing laparoscopic-assisted tumor resection. GA + EA combination improves immune response by inhibiting the inflammatory response but has no significant effect on survival outcome.

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SURVIVAL OUTCOME OF PATIENTS WITH EARLY STAGE AND LOCALLY ADVANCED CERVICAL CANCER WHO UNDERWENT RADICAL HYSTERECTOMY.

10.26226/morressier.5770e29ad462b80290b4ba02 ◽

2016 ◽

Author(s):

Jimmy Billod

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Locally Advanced ◽

Survival Outcome ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer

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IgG4-related gastric disease with plasma cell-rich obliterative arteritis accompanied by early-stage gastric cancer: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01126-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Masayoshi Obatake ◽

Koichi Sato ◽

Shigehiko Yagi ◽

Hiromi Ohtani ◽

Katsumi Kito

Keyword(s):

Gastric Cancer ◽

Plasma Cell ◽

Early Stage ◽

Vascular Lesions ◽

Gastric Disease ◽

Inflammatory Disorder ◽

Obliterative Phlebitis ◽

Regional Lymph Node Dissection ◽

Serum Igg4 ◽

Storiform Fibrosis

Abstract Background Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated inflammatory disorder that can involve multiple organs. It is characterized by IgG4-positive plasma cell-rich storiform fibrosis and obliterative phlebitis associated with a high serum IgG4 level. There are few reports of gastric IgG4-RD, especially those detected prior to systemic or other organ involvement. Case presentation: A 70-year-old man was diagnosed with type 0–IIc gastric cancer at the anterior wall of the gastric corpus by upper gastrointestinal endoscopy. In addition, a submucosal tumor (SMT) 7 mm in diameter was found at the greater curvature of the angulus. Laparoscopic distal gastrectomy with regional lymph node dissection was performed. Pathology revealed a poorly differentiated adenocarcinoma in the type 0–IIc lesion and storiform fibrosis with infiltration of a large number of IgG4-positive plasma cells in the SMT. Postoperative laboratory testing showed elevation of serum IgG4 levels; thus, we diagnosed the SMT as IgG4-RD. Intriguingly, the gastric IgG4-RD lesion demonstrated IgG4-positive plasma cell-rich arteritis as well as typical obstructive phlebitis. The patient has been followed for 2 years after surgery without recurrence of cancer, but skin lesions of IgG4-RD have appeared. Conclusion We report a rare case of IgG4-RD presenting as a gastric SMT, accompanied by early-stage gastric cancer. Our case may support a newly proposed relationship between IgG4-RD and malignancies. The gastric IgG4-RD lesion showed arteritis as well as obliterative phlebitis, potentially providing novel insight into IgG4-related vascular lesions.

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Microsatellite frameshift variants in SGO1 of gastric cancer are not always associated with MSI status

Journal of Clinical Pathology ◽

10.1136/jclinpath-2020-206934 ◽

2020 ◽

pp. jclinpath-2020-206934

Author(s):

Tomohiro Sugiyama ◽

Moriya Iwaizumi ◽

Terumi Taniguchi ◽

Satoshi Suzuki ◽

Shinya Tani ◽

...

Keyword(s):

Gastric Cancer ◽

Microsatellite Instability ◽

Mismatch Repair ◽

Gastrointestinal Cancer ◽

Early Stage ◽

Stage Iv ◽

Cancer Resection ◽

Deficient Mismatch Repair ◽

Gastric Cancer Resection ◽

Genemapper Software

AimsAlthough frameshift variants in the microsatellite area of shugoshin 1 (SGO1) have been reported in the context of microsatellite instability-high (MSI-H)/deficient mismatch repair gastrointestinal cancer, most have been evaluated only in early stage I–III patients, and only two of its five microsatellite regions have been evaluated. Therefore, we investigated the frequency and MSI status of microsatellite frameshift variants in gastric cancer cases, including stage IV.MethodsIn a total of 55 cases, 30 gastric cancer resection and 25 non-resection cases, DNA was extracted from both tumour and normal parts and PCR was performed. The variant was confirmed by TA cloning, and MSI was evaluated using GeneMapper software.ResultsA frameshift variant of c.973delA was observed in 16 of the 45 evaluable cases. Its frequency was 35.6%. Of the 25 cases that could be assessed for MSI status, two cases of MSI-H were associated with the c.973delA SGO1 variant. However, c.973delA SGO1 variant was also observed in four cases of microsatellite stable.ConclusionOur study shows that SGO1 frameshift variants are not always associated with MSI status.

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Abstract PS5-03: Celtil score and long-term survival outcome in early stage HER2-positive (HER2+) breast cancer treated with anti-HER2-based chemotherapy: A correlative analysis of neoALTTO trial

10.1158/1538-7445.sabcs20-ps5-03 ◽

2021 ◽

Author(s):

Nuria Chic ◽

Stephen Luen ◽

Paolo Nuciforo ◽

Roberto Salgado ◽

Debora Fumagalli ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Survival Outcome ◽

Her2 Positive ◽

Term Survival ◽

Long Term Survival ◽

Correlative Analysis ◽

Her2 Breast Cancer

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Racial disparities in stage-specific gastric cancer: analysis of results from the Surveillance Epidemiology and End Results (SEER) program database

Journal of Investigative Medicine ◽

10.1136/jim-2017-000413 ◽

2017 ◽

Vol 65 (6) ◽

pp. 991-998 ◽

Cited By ~ 7

Author(s):

Gang Zhang ◽

Xing Zhao ◽

Jie Li ◽

Yu Yuan ◽

Ming Wen ◽

...

Keyword(s):

Gastric Cancer ◽

Radiation Treatment ◽

Early Stage ◽

Ethnic Disparities ◽

Incidence Rates ◽

Pacific Islanders ◽

Seer Program ◽

Second Primary ◽

Data Set ◽

End Results

The incidence of gastric cancer is declining in western countries but continues to represent a serious health problem worldwide, especially in Asia and among Asian Americans. This study aimed to investigate ethnic disparities in stage-specific gastric cancer, including differences in incidence, treatment and survival. The cohort study was analyzed using the data set of patients with gastric cancer registered in the Surveillance, Epidemiology, and End Results (SEER) program from 2004 to 2013. Among 54,165 patients with gastric cancer, 38,308 were whites (70.7%), 7546 were blacks (13.9%), 494 were American Indian/Alaskan Natives (0.9%) and 7817 were Asians/Pacific Islanders (14.4%). Variables were patient demographics, disease characteristics, surgery/radiation treatment, overall survival (OS) and cause specific survival (CSS). Asians/Pacific Islanders demonstrated the highest incidence rates for gastric cancer compared with other groups and had the greatest decline in incidence during the study period (13.03 to 9.28 per 100,000/year), as well as the highest percentage of patients with American Joint Committee on Cancer (AJCC) early stage gastric cancer. There were significant differences between groups in treatment across stages I–IV (all p<0.001); Asians/Pacific Islanders had the highest rate of surgery plus radiation (45.1%). Significant differences were found in OS and CSS between groups (p<0.001); OS was highest among Asians/Pacific Islanders. Multivariate analysis revealed that age, race, grade, stage, location, and second primary cancer were valid prognostic factors for survival. Marked ethnic disparities exist in age-adjusted incidence of primary gastric cancer, with significant differences between races in age, gender, histological type, grade, AJCC stage, location, second cancer, treatment and survival.

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Geographic variation in surgical practice patterns and outcomes for resected nonmetastatic gastric cancer in Ontario

Current Oncology ◽

10.3747/co.25.3953 ◽

2018 ◽

Vol 25 (5) ◽

Cited By ~ 6

Author(s):

A. L. Mahar ◽

A. El-Sedfy ◽

M. Dixon ◽

M. Siddiqui ◽

M. Elmi ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Practice Patterns ◽

Early Stage ◽

Primary Tumour ◽

Disease Stage ◽

Resection Margins ◽

Local Health ◽

Surgical Practice ◽

Tumour Location

BackgroundGastrectomy with negative resection margins and adequate lymph node dissection is the cornerstone of curative treatment for gastric cancer (gc). However, gastrectomy is a complex and invasive operation with significant morbidity and mortality. Little is known about surgical practice patterns or short- and long-term outcomes in early-stage gc in Canada.MethodsWe undertook a population-based retrospective cohort study of patients with gc diagnosed between 1 April 2005 and 31 March 2008. Chart review provided clinical and operative details such as disease stage, primary tumour location, surgical approach, operation, lymph nodes, and resection margins. Administrative data provided patient demographics, geography, and vital status. Variations in treatment and outcomes were compared for 14 local health integration networks. Descriptive statistics and log-rank tests were used to examine geographic variation.ResultsWe identified 722 patients with nonmetastatic resected gc. We documented significant provincial variation in case mix, including primary tumour location, stage at diagnosis, and tumour grade. Short-term surgical outcomes varied across the province. The percentage of patients with 15 or fewer lymph nodes removed and examined varied from 41.8% to 73.8% (p = 0.02), and the rate of positive surgical margins ranged from 15.2% to 50.0% (p = 0.002). The 30-day surgical mortality rates did not vary statistically significantly across the province (p = 0.13); however, rates ranged from 0% to 16.7%. Overall 5-year survival was 44% and ranged from 31% to 55% across the province.ConclusionsThis cohort of patients with resected stages i–iii gc is the largest analyzed in Canada, providing important historical information about treatment outcomes. Understanding the causes of regional variation will support interventions aiming to improve gc operative outcomes in the cancer system.

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Isolated renal mucormycosis in a patient with Idiopathic CD4 lymphocytopenia

BMJ Case Reports ◽

10.1136/bcr-2018-225234 ◽

2018 ◽

pp. bcr-2018-225234

Author(s):

Jasmine Sethi ◽

Raja Ramachandran ◽

Harbir Singh Kohli ◽

Krishan Lal Gupta

Keyword(s):

Case Report ◽

Combination Therapy ◽

Autoimmune Hepatitis ◽

Lymphocyte Count ◽

Multidisciplinary Approach ◽

Early Stage ◽

Fatal Disease ◽

Cd4 Lymphocyte Count ◽

Cd4 Lymphocyte ◽

Idiopathic Cd4 Lymphocytopenia

Idiopathic CD4 lymphocytopenia (ICL) is characterised by a low CD4 +lymphocyte count in the absence of HIV or other underlying aetiologies. We report a case of a 17-year-old girl with ICL with autoimmune hepatitis who developed isolated renal mucormycosis, which, to our knowledge, is the first reported case described in literature. Combination therapy with antifungals and surgical resection was done, and the patient improved. This case report illustrates the importance of timely multidisciplinary approach to recognise this highly fatal disease at an early stage.

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Identification of Early Diagnostic and Prognostic Biomarkers via WGCNA in Stomach Adenocarcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.636461 ◽

2021 ◽

Vol 11 ◽

Author(s):

Ruoyue Tan ◽

Guanghui Zhang ◽

Ruochen Liu ◽

Jianbing Hou ◽

Zhen Dong ◽

...

Keyword(s):

Gastric Cancer ◽

Extracellular Matrix ◽

Early Detection ◽

Early Stage ◽

Gene Set Enrichment Analysis ◽

Stage I ◽

Tyrosine Kinase Receptor ◽

Stomach Adenocarcinoma ◽

Early Diagnostic ◽

Potential Biomarkers

Stomach adenocarcinoma (STAD) is a leading cause of cancer deaths, and the outcome of the patients remains dismal for the lack of effective biomarkers of early detection. Recent studies have elucidated the landscape of genomic alterations of gastric cancer and reveal some biomarkers of advanced-stage gastric cancer, however, information about early-stage biomarkers is limited. Here, we adopt Weighted Gene Co-expression Network Analysis (WGCNA) to screen potential biomarkers for early-stage STAD using RNA-Seq and clinical data from TCGA database. We find six gene clusters (or modules) are significantly correlated with the stage-I STADs. Among these, five hub genes, i.e., MS4A1, THBS2, VCAN, PDGFRB, and KCNA3 are identified and significantly de-regulated in the stage-I STADs compared with the normal stomach gland tissues, which suggests they can serve as potential early diagnostic biomarkers. Moreover, we show that high expression of VCAN and PDGFRB is associated with poor prognosis of STAD. VCAN encodes a large chondroitin sulfate proteoglycan that is the main component of the extracellular matrix, and PDGFRB encodes a cell surface tyrosine kinase receptor for members of the platelet-derived growth factor (PDGF) family. Consistently, Gene Ontology (GO) analysis of differentially expressed genes in the STADs indicates terms associated with extracellular matrix and receptor ligand activity are significantly enriched. Protein-protein network interaction analysis (PPI) and Gene Set Enrichment Analysis (GSEA) further support the core role of VCAN and PDGFRB in the tumorigenesis. Collectively, our study identifies the potential biomarkers for early detection and prognosis of STAD.

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