scholarly journals Gastric cancer with positive peritoneal cytology: survival benefit after induction chemotherapy and conversion to negative peritoneal cytology

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Massimiliano Valletti ◽  
Dilmurodjon Eshmuminov ◽  
Nicola Gnecco ◽  
Christian Alexander Gutschow ◽  
Paul Magnus Schneider ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Neoadjuvant Chemotherapy ◽  
Peritoneal Metastasis ◽  
Median Overall Survival ◽  
Peritoneal Cytology ◽  
Significant Prognostic Factor ◽  
Peritoneal Disease ◽  
Lavage Cytology

Abstract Background The optimal treatment in patients with gastric cancer and peritoneal disease remains controversial. Some guidelines indicate palliative treatment only, while others consider surgical treatment in case of positive lavage cytology (CY+) or limited peritoneal disease. Here, we analyzed the role of peritoneal disease in patients with gastric cancer, and the prognostic relevance of response to neoadjuvant therapy. Methods In this retrospective cohort analysis, we analyzed patients with adenocarcinoma of the stomach or esophago-gastric junction from a single center operated between 2011 and 2019. According to histology and lavage cytology, patients were classified into four risk groups: (A) no peritoneal disease, (B) CY+ who converted to negative lavage cytology (CY−) after neoadjuvant chemotherapy, (C) CY+ without conversion after chemotherapy, and (D) patients with visible peritoneal metastasis. Results Overall, n = 172 patients were included. At initial presentation, n = 125 (73%) had no peritoneal disease, and about a third of patients (n = 47, 27%) had microscopic or macroscopic peritoneal disease. Among them, n = 14 (8%) were CY+ without visible peritoneal metastasis, n = 9 converted to CY− after chemotherapy, and in n = 5 no conversion was observed. Median overall survival was not reached in patients who had initially no peritoneal disease and in patients who converted after chemotherapy, resulting in 3-year survival rates of 65% and 53%. In contrast, median overall survival was reduced to 13 months (95% CI 8.7–16.7) in patients without conversion and was 16 months (95% CI 12–20.5) in patients with peritoneal metastasis without difference between the two groups (p = .364). The conversion rate from CY+ to CY− was significantly higher after neoadjuvant treatment with FLOT (5-fluorouracil plus leucovorin, oxaliplatin, and docetaxel) compared to ECF (epirubicin, cisplatin, and 5-fluorouracil) (p = 0.027). Conclusion Conversion of CY+ to CY− after neoadjuvant chemotherapy with FLOT is a significant prognostic factor for a better overall survival. Surgical treatment in well-selected patients should therefore be considered. However, peritoneal recurrence remains frequent despite conversion, urging for a better local control.

Survival and prognosticators of gastric cancer patients with only positive peritoneal lavage cytology.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 16-16
Author(s):  
Kazuki Kano ◽  
Tsutomu Sato ◽  
Yukio Maezawa ◽  
Kenki Segami ◽  
Tetsushi Nakajima ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Proportional Hazards Model ◽  
Peritoneal Lavage ◽  
Multivariate Analyses ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Peritoneal Cytology ◽  
Peritoneal Lavage Cytology ◽  
Lavage Cytology

16 Background: Treatment strategies for only positive peritoneal lavage cytology findings have not yet been established. The objective of this retrospective study was to clarify the survival and prognosticators in these patients. Methods: Overall survival (OS) rates were examined in 39 patients with gastric cancer who underwent a curative resection and had positive peritoneal cytology in the absence of overt peritoneal metastases between January 2000 and June 2015. Univariate and multivariate analyses were performed to identify risk factors using a Cox proportional hazards model. Results: A total of 39 patients were evaluated. The median overall survival was significantly longer in the 34 patients who received chemotherapy after surgery than that in the 5 who did not (19.1 vs 5.9 months, p < 0.01). Among the patients who received chemotherapy after surgery, univariate and multivariate analyses showed that pN3b was an independent significant prognosticator (hazard ratio of 4.169 with 95% CI: 1.108-15.684, p = 0.035). The median OS was 15.8 months when the patients diagnosed with N3b was 33.1 months when the patients diagnosed with N3a or lower. Conclusions: The prognosis of gastric carcinoma with positive peritoneal lavage cytology without peritoneal metastasis is still poor and need more aggressive treatment. The lymph node metastasis was a significant prognosticator in these patients.

scholarly journals Prognostic Role of Gastrectomy in Patients With Gastric Cancer With Positive Peritoneal Cytology

2014 ◽  
Vol 99 (6) ◽  
pp. 830-834 ◽  
Author(s):  
Okihide Suzuki ◽  
Minoru Fukuchi ◽  
Erito Mochiki ◽  
Toru Ishiguro ◽  
Jun Sobajima ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Metastatic Disease ◽  
Survival Data ◽  
Median Overall Survival ◽  
Peritoneal Cytology ◽  
Prognostic Effect ◽  
Positive Peritoneal Cytology ◽  
Optimal Treatment Strategy

Abstract This retrospective study identified the optimal treatment strategy for patients with gastric cancer with positive peritoneal cytology. We analyzed clinicopathologic and survival data for 54 patients who had undergone gastrectomy and/or chemotherapy for treatment of gastric cancer with positive peritoneal cytology with (n = 40) or without (n = 14) metastatic disease. The median overall survival did not differ significantly between patients with gastric cancer with positive peritoneal cytology with and without metastatic disease (19 versus 13 months, respectively). Among 14 clinicopathologic variables, the lack of gastrectomy was the only significant independent unfavorable factor for survival (odds ratio, 1.64; 95% confidence interval, 1.04–2.57; P = 0.03). The median overall survival significantly differed among patients who had undergone gastrectomy plus chemotherapy, chemotherapy alone, and gastrectomy alone (25, 10, and 17 months, respectively; P &lt; 0.01). Gastrectomy may be optimal for patients with (gastric cancer with positive peritoneal cytology), considering its favorable prognostic effect with respect to perioperative chemotherapy.

The real-world practiсe of surgery in patients with metastatic gastric cancer (mGC).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 363-363
Author(s):  
Ekaterina Obarevich ◽  
Natalia Besova ◽  
Tatiana Titova ◽  
Elena Trusilova ◽  
Mikhail Davydov ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Median Overall Survival ◽  
Optimal Time ◽  
Modern Trend ◽  
Curative Intent ◽  
Ongoing Research ◽  
Free Interval ◽  
Metastatic Sites

363 Background: According to recent studies the results of treatment patients with initially mGC are still not sufficient: median overall survival varies between 6.1 and 12.4 months. The triplet-chemotherapy regimens demonstrate high efficacy and allow to downstage the disease and perform surgical treatment. Conversion treatment in stage IV GC is a modern trend and still an area of ongoing research. Methods: We analyzed the efficacy of first line chemotherapy (6-9 courses) for patients with mGC (n = 55) including the following regimens: 1) mFOLFIRINOX; 2) douplet: oxaliplatin/irinotecan + fluoropyrimidine; 3) triplet variations: docetaxel, platinum and fluoropyrimidine. 27/55 patients had > 2 metastatic sites, 2/55 patient - 5 metastatic sites. The most common localizations of metastases were peritoneum (n = 34) and retroperitoneal lymph nodes (n = 11). Unlike in REGATTA trial all patients underwent surgical treatment with curative intent followed by complete response of distant metastases after chemotherapy. For patients with ovarian metastases ovariectomy was also perfomed. Results: Median progression-free survival and median overall survival were 18.5 and 33.27 months, respectively and the 3-year survival rate was 43.5%. Multivariate analysis showed that clinically determined ascites (p = 0.023), linitis plastica (p = 0.022), tumor grade 3 (p = 0.014), present of lymphovascular invasion (p = 0.037), absence of grade III-IV pathomorphosis (p = 0.037) and treatment free interval before surgery < 3.4 month (p = 0.046) were poor independent prognostic factors. Conclusions: Surgery after effective combination chemotherapy may have significant clinical efficacy for selected patients with initially unresectable gastric cancer. According to our data the optimal time for surgery is a 3.4 and more months treatment-free interval in the absence of disease progression.

scholarly journals Intraperitoneal Chemotherapy as Adjuvant or Perioperative Chemotherapy for Patients with Type 4 Scirrhous Gastric Cancer: PHOENIX-GC2 Trial

2021 ◽  
Vol 10 (23) ◽  
pp. 5666
Author(s):  
Hironori Ishigami ◽  
Yasushi Tsuji ◽  
Hisashi Shinohara ◽  
Yasuhiro Kodera ◽  
Mitsuro Kanda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Metastasis ◽  
Systemic Chemotherapy ◽  
Disease Free Survival ◽  
Phase Iii ◽  
Peritoneal Cytology ◽  
Scirrhous Gastric Cancer ◽  
Peritoneal Lavage Cytology ◽  
Lavage Cytology ◽  
Gastric Cancer Patients

The prognosis of patients with type 4 scirrhous gastric cancer remains poor due to a high risk of peritoneal metastasis. We have previously developed combined chemotherapy regimens of intraperitoneal (IP) paclitaxel (PTX) and systemic chemotherapy, and promising clinical efficacy was reported in gastric cancer with peritoneal metastasis. Herein, a randomized, phase III study is proposed to verify the efficacy of IP PTX to prevent peritoneal recurrence. Gastric cancer patients with type 4 tumors and without apparent distant metastasis, including peritoneal metastasis, will be randomized for standard systemic chemotherapy or combined IP and systemic chemotherapy based on peritoneal lavage cytology findings. Those with negative peritoneal cytology will receive radical gastrectomy and adjuvant chemotherapy of S-1 plus docetaxel (control arm), or S-1 plus intravenous and IP PTX (experimental arm). Those with positive peritoneal cytology will receive three courses of S-1 plus oxaliplatin (control arm), or S-1 plus oxaliplatin and IP PTX (experimental arm). Subsequently, they undergo gastrectomy and receive postoperative chemotherapy of S-1 plus docetaxel (control arm), or S-1 plus intravenous and IP PTX (experimental arm). The primary endpoint is disease free survival after a 3-year follow-up period. Secondary endpoints are overall survival, survival without peritoneal metastasis, safety, completion rate, curative resection rate, and histological response of preoperative chemotherapy. A total of 300 patients are to be enrolled.

Role of thrombospondin 1 (THBS1) expression in peritoneal metastasis of gastric cancer treated with taxanes.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 57-57
Author(s):  
N. Kurita ◽  
M. Shimada ◽  
T. Iwata ◽  
M. Nishioka ◽  
S. Morimoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Metastasis ◽  
Survival Rates ◽  
Peritoneal Cytology ◽  
Responder Analysis ◽  
Adenocarcinoma Cells ◽  
Clinical Benefits ◽  
Negative Role

57 Background: To clarify the utility of taxanes and to pick up the prognostic factors in the treatment with 5FU- based chemotherapy for peritoneal metastasis of gastric cancer. Methods: Responder analysis: 18 patients with peritoneal metastasis of gastric cancer were enrolled in phase I study. The regimen consists of S-1 (80-120 mg) for 14 days and intraperitoneal infusion of PTX (dose escalation: 40 - 100 mg/m2) at day 1 and 14, which was repeated 2 cycles. To pick up the predictive factors, the 137 genes, which were selected in the viewpoint of sensitivity of 5FU, CPT11 and taxanes, were analyzed using focused DNA microarray for the 12 patients. Role of THBS1 expression: THBS1 expressions were evaluated in immunohistochemical (IHC) staining of surgical specimens of 59 patients with peritoneal metastasis of gastric cancer who were administered 5FU-based chemotherapy. THBS1 positive was defined > 30% of the population stained moderate to strong. Results: Responder analysis: Expressions of THBS1 gene of the 6 patients who had clinical benefits (2: partial response, 2: positive adenocarcinoma cells in peritoneal cytology became negative, 2: remarkable decrease of ascites) were more than 2 folds higher than those of no responders. THBS1 expression was confirmed in 5 (83.3%) using IHC staining, who had significantly higher survival rate compared with that of the negative. Role of THBS1 expression: 17 patients (28.8%) was THBS1 positive and had significantly better prognosis compared with negative patients (1year survival: 64.7% vs 34.7%). 38 patients treated with regimes including taxanes revealed a tendency of improved overall survival rates (p=0.05). Overall survival of 15 patients with THBS1 positive administered taxanes was significantly higher than that of the negative patients. (1 year survival: 66.7% vs 42.4%) Conclusions: PTX could improve the survival of peritoneal metastasis of gastric cancer. THBS1 is a prognostic factor especially in the patients treated with taxanes, which leads to tailor-made therapy. [Table: see text]

scholarly journals The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases

2021 ◽  
Vol 11 ◽  
Author(s):  
Patrick Schuss ◽  
Niklas Schäfer ◽  
Christian Bode ◽  
Valeri Borger ◽  
Lars Eichhorn ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Brain Metastases ◽  
Prolonged Mechanical Ventilation ◽  
Postoperative Phase ◽  
Significant Prognostic Factor ◽  
Cancer Disease ◽  
Definition Of ◽  
The Impact

ObjectiveSurgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases.Methods360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed.Results14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p&lt;0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p&lt;0.0001).ConclusionsThe present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.

scholarly journals The FIGO Stage IVA Versus IVB of Ovarian Cancer: Prognostic Value and Predictive Value for Neoadjuvant Chemotherapy

2018 ◽  
Vol 28 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Parvin Tajik ◽  
Roelien van de Vrie ◽  
Mohammad H. Zafarmand ◽  
Corneel Coens ◽  
Marrije R. Buist ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Prognostic Value ◽  
Median Overall Survival ◽  
Stage Iv ◽  
Figo Stage ◽  
Figo Staging ◽  
Stage Ivb

ObjectiveThe revised version of the International Federation of Gynaecology and Obstetrics (FIGO) staging system (2014) for epithelial ovarian cancer includes a number of changes. One of these is the division of stage IV into 2 subgroups. Data on the prognostic and predictive significance of this classification are scarce. The effect of neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) in relation to the subclassification of FIGO stage IV is also unknown.MethodsWe used data of the EORTC 55971 trial, in which 670 patients with previous stage IIIC or IV epithelial ovarian cancer were randomly assigned to PDS or NACT; 160 patients had previous stage IV. Information on previous FIGO staging and presence of pleural effusion with positive cytology were used to classify tumors as either stage IVA or IVB. We tested the association between stage IVA/IVB and survival to evaluate the prognostic value and interactions between stage, treatment, and survival to evaluate the predictive performance.ResultsAmong the 160 participants with previous stage IV disease, 103 (64%) were categorized as stage IVA and 57 (36%) as stage IVB tumors. Median overall survival was 24 months in FIGO stage IVA and 31 months in stage IVB patients (P = 0.044). Stage IVB patients treated with NACT had 9 months longer median overall survival compared with IVB patients undergoing PDS (P = 0.025), whereas in IVA patients, no significant difference was observed (24 vs 26 months, P = 0.48).ConclusionsThe reclassification of FIGO stage IV into stage IVA or IVB was not prognostic as expected. Compared with stage IVA patients, stage IVB patients have a better overall survival and may benefit more from NACT.

Race Influences Stage-specific Survival in Gastric Cancer

2015 ◽  
Vol 81 (3) ◽  
pp. 259-267 ◽  
Author(s):  
J. Harrison Howard ◽  
Jason M. Hiles ◽  
Anna M. Leung ◽  
Stacey L. Stern ◽  
Anton J. Bilchik
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Surgical Patients ◽  
Disease Specific Survival ◽  
Stage Number ◽  
Survival Differences ◽  
Disease Specific

Gastric adenocarcinoma studies show improved survival for Asians but have not reported stage-specific overall survival (OS) or disease-specific survival (DSS) by race. The Surveillance, Epidemiology and End Results database was queried for cases of gastric adenocarcinoma between 1998 and 2008. We evaluated OS and DSS by race and stage. Number of assessed lymph nodes was compared among surgical patients. Of 49,058 patients with complete staging data, 35,300 were white, 7709 were Asian, and 6049 were black. Asians had significantly better OS for all stages ( P < 0.001) and significantly better DSS for Stages I ( P < 0.0001) and II ( P = 0.0006). As compared with blacks, whites had significantly better DSS for Stages I ( P < 0.0001), II ( P = 0.0055), III ( P = 0.0165), and IV ( P < 0.0001). Among the 28,133 (57%) surgical patients, average number of evaluated lymph nodes was highest for Asians ( P < 0.0001). Among surgical patients with 15 or more nodes evaluated, DSS was worse in blacks with Stage I disease ( P < 0.05). Blacks with gastric adenocarcinoma have a worse DSS, which disappears when surgical treatment includes adequate lymphadenectomy. Race-associated survival differences for gastric adenocarcinoma might simply reflect variations in surgical staging techniques and socioeconomic factors.

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