scholarly journals Looking for a strategy in treating peritoneal gastric cancer carcinomatosis: an Italian multicenter Gastric Cancer Research group’s analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Luigina Graziosi ◽  
Elisabetta Marino ◽  
Maria Bencivenga ◽  
Alessia D’Ignazio ◽  
Leonardo Solaini ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Stage Iv ◽  
R0 Resection ◽  
Extended Lymphadenectomy ◽  
Multicentric Study ◽  
Factors Affecting ◽  
Aggressive Surgical Approach ◽  
Retrospective Nature

Abstract Background The present study provides a snapshot of Italian patients with peritoneal metastasis from gastric cancer treated by surgery in Italian centers belonging to the Italian Research Group on Gastric Cancer. Prognostic factors affecting survival in such cohort of patients were evaluated with the final aim to identify patients who may benefit from radical intent surgery. Methods It is a multicentric retrospective study based on a prospectively collected database including demographics, clinical, surgical, pathological, and follow-up data of patients with gastric cancer and synchronous macroscopic peritoneal metastases. Patients were surgically treated from January 2005 to January 2017. We focused on patients with macroscopic peritoneal carcinomatosis (PC) treated with upfront surgery in order to provide homogeneous evidences. Results Our results show that patients with peritoneal carcinomatosis cannot be considered all lost. Strictly selected cases (R0/R1 and P1 patients) could benefit from an aggressive surgical approach performing an extended lymphadenectomy and HIPEC treatment. Conclusion The main result of the study is that GC patients with limited peritoneal involvement can have a survival benefit from a surgery with “radical oncological intent”, that means extended lymphadenectomy and R0 resection. The retrospective nature of this study is an important bias, and for this reason, we have started a prospective multicentric study including Italian stage IV patients that hopefully will give us more answers.

scholarly journals Updated Analysis of SWOG-Directed Intergroup Study 0116: A Phase III Trial of Adjuvant Radiochemotherapy Versus Observation After Curative Gastric Cancer Resection

2012 ◽  
Vol 30 (19) ◽  
pp. 2327-2333 ◽  
Author(s):  
Stephen R. Smalley ◽  
Jacqueline K. Benedetti ◽  
Daniel G. Haller ◽  
Scott A. Hundahl ◽  
Norman C. Estes ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Substantial Reduction ◽  
Phase Iii ◽  
R0 Resection ◽  
Second Malignancies ◽  
Adjuvant Radiochemotherapy ◽  
Phase Iii Trial ◽  
Failure Patterns ◽  
Postoperative Radiochemotherapy

Purpose Surgical resection of gastric cancer has produced suboptimal survival despite multiple randomized trials that used postoperative chemotherapy or more aggressive surgical procedures. We performed a randomized phase III trial of postoperative radiochemotherapy in those at moderate risk of locoregional failure (LRF) following surgery. We originally reported results with 4-year median follow-up. This update, with a more than 10-year median follow-up, presents data on failure patterns and second malignancies and explores selected subset analyses. Patients and Methods In all, 559 patients with primaries ≥ T3 and/or node-positive gastric cancer were randomly assigned to observation versus radiochemotherapy after R0 resection. Fluorouracil and leucovorin were administered before, during, and after radiotherapy. Radiotherapy was given to all LRF sites to a dose of 45 Gy. Results Overall survival (OS) and relapse-free survival (RFS) data demonstrate continued strong benefit from postoperative radiochemotherapy. The hazard ratio (HR) for OS is 1.32 (95% CI, 1.10 to 1.60; P = .0046). The HR for RFS is 1.51 (95% CI, 1.25 to 1.83; P < .001). Adjuvant radiochemotherapy produced substantial reduction in both overall relapse and locoregional relapse. Second malignancies were observed in 21 patients with radiotherapy versus eight with observation (P = .21). Subset analyses show robust treatment benefit in most subsets, with the exception of patients with diffuse histology who exhibited minimal nonsignificant treatment effect. Conclusion Intergroup 0116 (INT-0116) demonstrates strong persistent benefit from adjuvant radiochemotherapy. Toxicities, including second malignancies, appear acceptable, given the magnitude of RFS and OS improvement. LRF reduction may account for the majority of overall relapse reduction. Adjuvant radiochemotherapy remains a rational standard therapy for curatively resected gastric cancer with primaries T3 or greater and/or positive nodes.

scholarly journals Prognostic benefit of conversion surgery for HER2 positive stage IV gastric cancer; a case series study of eleven patients treated with trastuzumab-based chemotherapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koichi Hayano ◽  
Hiroki Watanabe ◽  
Takahiro Ryuzaki ◽  
Naoto Sawada ◽  
Gaku Ohira ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
R0 Resection ◽  
Conversion Surgery ◽  
First Line ◽  
Her2 Positive ◽  
Stage Iv Gastric Cancer ◽  
Gastric Cancer Patients ◽  
First Line Treatment

Abstract Background Since the ToGA trial, trastuzumab-based chemotherapy is the standard treatment for HER2 positive stage IV gastric cancer. However, it is not yet clear whether surgical resection after trastuzumab-based chemotherapy (conversion surgery) can improve survival of HER2 positive stage IV gastric cancer. The purpose of this study is to evaluate the prognostic benefit of conversion surgery in HER2 positive stage IV gastric cancer patients. Case presentation We retrospectively investigated the medical records of the patients with HER2 positive (IHC3(+) or IHC2(+)/FISH(+)) stage IV gastric cancer treated with trastuzumab-based chemotherapy as the first line treatment. Overall survival (OS) was compared between patients with conversion surgery and without. Eleven HER2 positive stage IV gastric cancer patients treated with trastuzumab-based chemotherapy as the first line treatment were evaluated. Response rate was 63.6%, and 6 of 11 patients could receive conversion surgery. R0 resection was achieved in four patients. In Kaplan–Meier analysis, patients who received conversion surgery showed significantly better OS than those without surgery (3-year survival rate, 66.7% vs. 20%, P = 0.03). The median OS of patients who achieved R0 resection is 51.8 months. Conclusions Conversion surgery might have a survival benefit for HER2 positive stage IV gastric cancer patients. If curative surgery is technically possible, conversion surgery could be a treatment option for HER2 positive stage IV gastric cancer.

scholarly journals Survival Benefit of Adjuvant Radiation Therapy for Gastric Cancer following Gastrectomy and Extended Lymphadenectomy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
R. A. Snyder ◽  
E. T. Castaldo ◽  
C. E. Bailey ◽  
S. E. Phillips ◽  
A. B. Chakravarthy ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Radiation Therapy ◽  
Gastric Adenocarcinoma ◽  
Survival Benefit ◽  
Cox Regression ◽  
Population Based ◽  
Adjuvant Radiation ◽  
Extended Lymphadenectomy ◽  
Factors Affecting ◽  
Gastric Cancer Patients

Purpose. Although randomized trials suggest a survival benefit of adjuvant chemotherapy and radiation therapy (XRT) for gastric adenocarcinoma, its use in patients who undergo an extended lymphadenectomy is less clear. The purpose of this study was to determine if a survival benefit exists in gastric cancer patients who receive adjuvant XRT following resection with extended lymphadenectomy.Methods. The SEER registry was queried for records of patients with resected gastric adenocarcinoma from 1988 to 2007. Multivariable Cox regression models were used to assess independent prognostic factors affecting overall survival (OS) and disease-specific survival (DSS).Results. Of 15,060 patients identified, 3,208 (21%) received adjuvant XRT. Adjuvant XRT was independently associated with improved OS (HR 0.67, CI 0.64–0.71) and DSS (HR 0.69, CI 0.65–0.73) in stages IB through IV (M0). This OS and DSS benefit persisted regardless of the extent of lymphadenectomy. Furthermore, lymphadenectomy with >25 LN resected was associated with improved OS and DSS compared with <15 LN or 15–25 LN.Conclusion. This population-based study shows a survival benefit of adjuvant XRT following gastrectomy that persists in patients who have an extended lymphadenectomy. Furthermore, removal of >25 LNs results in improved OS and DSS compared with patients who have fewer LNs resected.

scholarly journals Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?

2010 ◽  
Vol 162 (6) ◽  
pp. 1147-1153 ◽  
Author(s):  
S Leboulleux ◽  
D Deandreis ◽  
A Al Ghuzlan ◽  
A Aupérin ◽  
D Goéré ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peritoneal Carcinomatosis ◽  
Surgical Approach ◽  
Tumor Size ◽  
Stage Iv ◽  
Distant Metastases ◽  
Adrenocortical Cancer ◽  
Increased Risk

ContextPeritoneal carcinomatosis (PC) is a rare site of distant metastases in patients with adrenocortical cancer (ACC). One preliminary study suggests an increased risk of PC after laparoscopic adrenalectomy (LA) for ACC.ObjectiveThe objective of the study was to search for risk factors of PC including surgical approach.DesignThis was a retrospective cohort study conducted in an institutional practice.PatientsSixty-four consecutive patients with ACC seen at our institution between 2003 and 2009 were included. Mean tumor size was 132 mm. Patients had stage I disease in 2 cases, stage II disease in 32 cases, stage III disease in 7 cases, stage IV disease in 21 cases, and unknown stage disease in 2 cases. Surgery was open in 58 cases and laparoscopic in 6 cases.Main outcomeThe main outcome was the risk factors of PC.ResultsPC occurred in 18 (28%) patients. It was present at initial diagnosis in three cases and occurred during follow-up in 15 cases. The only risk factor of PC occurring during follow-up was the surgical approach with a 4-year rate of PC of 67% (95% confidence interval (CI), 30–90%) for LA and 27% (95% CI, 15–44%) for open adrenalectomy (P=0.016). Neither tumor size, stage, functional status, completeness of surgery, nor plasma level of op'DDD was associated with the occurrence of PC.ConclusionWe found an increased risk of PC after LA for ACC. Whether this is related to an inappropriate surgical approach or to insufficient experience in ACC surgery should be clarified by a prospective program.

scholarly journals Epidemiology of Simultaneous Medullary and Papillary Thyroid Carcinomas (MTC/PTC): An Italian Multicenter Study

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1516 ◽  
Author(s):  
Marialuisa Appetecchia ◽  
Rosa Lauretta ◽  
Agnese Barnabei ◽  
Letizia Pieruzzi ◽  
Irene Terrenato ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Outcome ◽  
Stage Iv ◽  
Papillary Thyroid ◽  
Time To Progression ◽  
Cytological Examination ◽  
Multicentric Study ◽  
Epidemiological Characteristics ◽  
Disease Free

Background: The concomitant presence of papillary thyroid cancer (PTC) and medullary TC (MTC) is rare. In this multicentric study, we documented the epidemiological characteristics, disease conditions and clinical outcome of patients with simultaneous MTC/PTC. Methods: We collected data of patients with concomitant MTC/PTC at 14 Italian referral centers. Results: In total, 183 patients were enrolled. Diagnosis was mostly based on cytological examination (n = 58, 32%). At diagnosis, in the majority of cases, both PTC (n = 142, 78%) and MTC (n = 100, 54%) were at stage I. However, more cases of stage II–IV were reported with MTC (stage IV: n = 27, 15%) compared with PTC (n = 9, 5%). Information on survival was available for 165 patients: 109 patients (66%) were disease-free for both PTC and MTC at the last follow-up. Six patients died from MTC. Median time to progression was 123 months (95% confidence interval (CI): 89.3–156.7 months). Overall, 45% of patients were disease-free after >10 years from diagnosis (125 months); this figure was 72.5% for PTC and 51.1% for MTC. Conclusions: When MTC and PTC are concurrent, the priority should be given to the management of MTC since this entity appears associated with the most severe impact on prognosis.

The prognostic significance of IL-1-B and GST T1/M1 polymorphisms in non-metastatic gastric cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4084-4084
Author(s):  
M. S. Al-Moundhri ◽  
B. Al-Bahrani ◽  
M. Al-Nabhani ◽  
I. Burney ◽  
M. Al-Kindy ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Value ◽  
Prognostic Significance ◽  
Stage Iv ◽  
Metastatic Gastric Cancer ◽  
Signet Ring ◽  
Distal Gastric Cancer ◽  
Gastric Cancer Patients ◽  
Pathological Stages

4084 Background: Gastric cancer is the most common malignancy in Oman. The proinflammatory cytokine IL-1-B polymorphisms have been associated with increased gastric cancer risk and shown to be of a prognostic value in advanced gastric cancer. Our aim is to study the prognostic significance of IL-1B- 31, -3954, IL-1RN- and GST T1/M1 polymorphisms in non-metastatic gastric cancer and correlate it with clinicopthological features. Methods: Genomic DNA was extracted from peripheral blood of 40 gastric cancer patients treated with adjuvant chemotherapy or chemoradiotherapy. The DNA samples were analyzed using TaqMan real-time polymerase chain reaction and 5’ nuclease assay. The deletion of GST T1/M1 genes was assessed by PCR. Results: The pathological stages were stage I = 1, stage II = 13, stage III = 22, stage IV = 3. The median follow up was 17 months. There was no prognostic significance for all the above polymorphisms in isolation. However, IL-1RN 2/2 IL-31 C/C genotypes (n = 13) were associated with worst outcome compared with IL-1RN L/L or 2/L and IL-31 T/T and T/C genotypes (n = 27). The median survival of IL-1RN 2/2 IL-31 C/C genotype was 16 months versus 63 months for IL-1RN L/L or 2/L and IL-31 T/T and T/C genotypes (p = 0.035). The IL-1RN 2/2 IL-31 C/C genotype correlated with signet ring pathology (p = 0.01) and non-distal gastric cancer location (p = 0.01). There was no significant association with T, N, or overall stage. Conclusion: These preliminary results suggest a prognostic value for IL-1-B polymorphisms in non-metastatic gastric cancer. No significant financial relationships to disclose.

Predictive factors for metastasis in patients (pts) with gastric cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15056-15056
Author(s):  
S. Kilickap ◽  
O. Dizdar ◽  
H. Harputluoglu ◽  
S. Aksoy ◽  
S. Yalcin
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Early Stage ◽  
Stage Iv ◽  
Stage I ◽  
Early Stage Disease ◽  
Increased Risk ◽  
Metastasis Development ◽  
The Mean

15056 Background: Determination of patients (pts) with early stage disease who have a high risk for developing metastatic disease is crucial. We investigated the risk factors associated with metastases development in pts with operable gastric cancer. Patients and Methods: In this retrospective study, pts with stage I-III and non-metastatic stage IV gastric cancer diagnosed between 1990 and 2006 were evaluated. The medical records of all pts including patient characteristics, laboratory results, histopathological examinations, were reviewed. Logistic regression methods were used to determine the risk factors for developing metastasis and to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: 184 pts (70% male, 30% female) were analyzed. The mean age ± standard deviation was 56.5±11.9. The mean age of female were higher than male (p=0.014). At the time of diagnosis, 13.6% of the pts had stage I, 19.0% had stage II, 53.3% had stage III, and 14.1% had non-metastatic stage IV disease. The tumors were distally localized in 80% of the cases. Median follow-up period was 35 months. During follow up, 51 pts developed metastases. Median time to metastases development was 14 months. Overall survival was shorter in pts who developed metastasis than those who did not. (20 months vs. not reached, respectively, p=0.002). In univariate analyses, stage (p=0.020), tumor localization (p=0.006), extracapsular lymphatic extension (ELE) (p<0.001), the number of metastatic lymph nodes (p=0.001), CEA level (p<0.001), lymphovascular invasion (LVI) (p=0.001), and perineural invasion (p=0.007) were associated with metastasis development. In multivariate analysis, elevated CEA levels (p=0.009; OR: 2.8; CI 95%: 1.29–6.19), LVI (p=0.041; OR: 2.2; CI 95%: 1.03–4.64) and ELE (p=0.029; OR: 2.3; CI 95%: 1.09–4.78) were associated with increased risk of metastasis development while distal localization (p=0.038; OR: 0.42; CI%: 0.18–0.95) was associated with decreased risk in pts with gastric cancer. Discussion: In pts with early stage or locally advanced gastric cancer, elevated CEA levels, LVI, proximal localization and ELE were associated with increased risk of developing metastasis. Aggressive treatment options and closer follow up should be considered for pts with these risk factors. No significant financial relationships to disclose.

Conditional survival nomogram after an R0 resection for gastric cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 11-11
Author(s):  
J. L. Dikken ◽  
C. J. Van De Velde ◽  
M. Verheij ◽  
R. Baser ◽  
M. Gonen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Weight Loss ◽  
Predictive Accuracy ◽  
Performance Status ◽  
R0 Resection ◽  
Conditional Survival ◽  
Disease Free Interval ◽  
The Us ◽  
One Year

11 Background: The risk of dying of cancer is highest in the first two years after a curative resection for gastric cancer. Therefore, the prognosis of patients who did not recur in the first two years is improved because they survived this critical period, a phenomenon called conditional survival. The US-derived gastric cancer nomogram predicts disease-specific survival (DSS) based on pathological variables. However, a disease-free interval after surgery, which improves the prognosis, is not captured by the nomogram. Therefore, it has only been used directly after surgery and not in the follow-up setting. The purposes of this study were to develop a conditional survival nomogram for 1, 2 and 3-year survivors (step 1) and to test if the introduction of follow-up variables would improve predictive accuracy of the nomogram in the follow-up setting (step 2). Methods: In a combined US-Dutch population of 1642 patients who underwent an R0 resection for gastric cancer and for whom the old nomogram variables were available, a conditional survival nomogram based on the original variables was developed for one (N=1147), two (N=879) and three (N=721) year survivors (step 1). To improve predictive accuracy in the follow-up setting, weight loss, performance status (PS), hemoglobin (HGB), and albumin (ALB) at one year after resection were retrospectively collected and added to the baseline variables in a new nomogram (step 2). Results: The conditional survival nomograms for 1, 2 and 3-year survivors (step 1) showed a high predictive accuracy in the calibration plots. Surviving one, two and three years shows a median improvement of 5-year DSS of 4%, 9% and 14% respectively. The introduction of weight loss, PS, HGB, and ALB at one year after surgery (step 2) did not improve this nomogram, but availability of these variables was limited. Conclusions: A strongly predictive conditional survival nomogram was developed, giving an improved prognosis for 1, 2 and 3-year survivors of gastric cancer. Introduction of variables available at one year after resection did not further improve this nomogram. This might be caused by the limited availability of follow-up data, as well as the strong predictive accuracy of the original variables. No significant financial relationships to disclose.

Nodal downstaging in gastric cancer in relation to survival when ypN0 is achieved.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 93-93
Author(s):  
Naruhiko Ikoma ◽  
Jeannelyn Estrella ◽  
Wayne Lewis Hofstetter ◽  
Prajnan Das ◽  
Jaffer A. Ajani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariable Analysis ◽  
Chemoradiation Therapy ◽  
Preoperative Therapy ◽  
Sensitivity Analyses ◽  
R0 Resection ◽  
Nodal Disease ◽  
Preoperative Chemoradiation Therapy ◽  
Similar Survival

93 Background: The AJCC 8th edition introduced ypStage for patients with gastric cancer due to the increasing use of preoperative therapy. ypN0 patients have better survival than ypN+ patients; however, whether patients who had clinically positive nodal disease before preoperative therapy (cN+ ypN0) have similar survival to those who had “natural N0” (cN0 ypN0) disease is unknown. Methods: We reviewed an institutional database to identify patients with gastric adenocarcinoma who underwent potentially curative R0 resection after preoperative chemo- or chemoradiation therapy. Patients were categorized into 3 groups based on nodal status: natural N0 (cN0 ypN0), downstaged N0 (cN+ ypN0), and ypN+. Univariable and multivariable Cox regressions were performed to determine associations with overall survival (OS). Results: We identified 316 patients who met study criteria, including 74 (23%) patients with GEJ tumors; 56% were white and 62% were male. Preoperative chemoradiation therapy was given to 239 (76%). Ninety-four (30%) had natural N0, 93 (29%) had downstaged N0, and 129 (41%) had ypN+ disease. Of all patients, 136 (43%) patients died during a median follow-up of 3.1 y. Median OS was 7.7 y, and 5-year OS was 60.3%. OS did not differ in patients with natural N0 disease (5-y OS, 72%) and those with downstaged N0 disease (5-y OS, 69%) ( p = 0.776), even though the downstaged N0 group had more advanced baseline cT disease than did the natural N0 group ( p < 0.001). On multivariable analysis adjusting for other factors, including ypT category, OS did not differ between natural N0 and downstaged N0 patients (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.54-1.48; p = 0.666), but it was shorter in ypN+ patients (HR, 1.82; 95% CI, 1.15-2.87; p = 0.010). Sensitivity analyses also showed equivalent OS in the natural N0 and downstaged N0 groups within the ypT0-2 group ( p = 0.936) and the ypT3-4 group ( p = 0.608). Conclusions: In patients with gastric cancer who underwent preoperative therapy, we found similar OS in patients with natural N0 and those with downstaged N0 disease. As ypN+ patients had poor OS, achieving ypN0 status is an important hallmark demonstrating the effectiveness of preoperative therapy.

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