Clinical features and the role of surgery in stage IV gastric cancer: A single center experience.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 212-212
Author(s):  
Narjust Perez-Florez ◽  
Larysa Jessica Gromko ◽  
Eric Yoon ◽  
Andrew Jennis ◽  
Zubin M. Bamboat ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Survival Benefit ◽  
Cox Regression ◽  
Stage Iv ◽  
Treatment Modalities ◽  
Stage Iv Gastric Cancer ◽  
Significant Difference ◽  
To Receive

212 Background: Gastric cancer is a prevalent global disease with significant mortality. Nearly 22,220 patients are diagnosed annually in the US, with approximately 50% of them presenting with disease that extends beyond loco-regional confines, and only a small percentage undergoing curative resection. We aim to study the clinical characteristics and survival benefit of surgery in stage IV gastric cancer. Methods: We reviewed the records of all patients diagnosed with gastric cancer in our cancer center from 1999 to 2013. A total of 272 stage IV cases were identified. Demographics, tumor characteristics, treatment modalities (surgical vs. non-surgical) and survival rate were analyzed. Kaplan-Meier was used for survival analysis and Cox regression for univariate and multivariate analysis. Results: Within the cohort 70 (26%) patients received surgery and 202 (74%) were treated with chemotherapy ± radiation. Mean age at diagnosis was 64 years in the surgical (S) patients and 66 years in the non-surgical (NS). Non-Hispanics whites were more likely to receive surgery vs. all other ethnic groups combined, representing 77% vs. 23% of the S subgroup (p<0.0001). Patients with proximal tumors were more likely to receive surgery when compared with distal tumors (37 (53%) vs. 14 (20%), p<0.0001). Total gastrectomy was the most common surgical procedure 33 (47%). There was a significant difference in disease specific survival between the two groups, being 17.3 months for S (95%CI: 11.1-23.4) and 5.3 months for NS (95%CI: 3.8-6.7) (p<0.0001). Age > 70 years (OR: 1.74, p<0.02), proximal tumor location (OR: 0.75, p<0.04), surgery (OR: 0.37, p<0.0001) and extended lymphadenectomy (D2) (OR: 0.26, p<0.02) were independent and significant predictors of survival by multivariate analysis. Conclusions: In our cohort, non-Hispanic whites and patients with proximal tumors were more likely to undergo surgery. A major survival benefit was observed for the surgical subgroup when compared to non-surgical treatment for stage IV gastric cancer. Future research should aim to further elucidate the specific role of surgery, as this could potentially impact management and transform the standard of care in stage IV gastric cancer.

Gastrectomy after chemotherapy: A new paradigm for the treatment of stage IV gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 127-127 ◽  
Author(s):  
Ho Seok Seo ◽  
Cho Hyun Park ◽  
Kyo Young Song ◽  
Yoon Ju Jung
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Supportive Care ◽  
Stage Iv ◽  
Best Supportive Care ◽  
Treatment Modalities ◽  
Care Group ◽  
R0 Resection ◽  
Stage Iv Gastric Cancer ◽  
Response To Chemotherapy

127 Background: Although there are several traditional treatment modalities for stage IV gastric cancer including chemotherapy, radiation therapy, palliative surgery, or best supportive care, survival result is unsatisfactory. Recently, gastrectomy after chemotherapy which is called conversion surgery or adjuvant surgery was introduced. Methods: In total, 419 patients who were diagnosed stage IV gastric cancer from 2010 to 2015 in eight Catholic Medical Center affiliated hospitals were divided into four groups; 212 for chemotherapy only group (G1), 124 for chemotherapy after primary gastrectomy group (G2), 23 for gastrectomy after chemotherapy group (G3), and 60 for best supportive care group (G4). To compensate chemotherapy effects, cases of complete remission, partial response, and stable disease were selectively analyzed. To identify the factors that affected survival rate, the result of surgery and the intent of surgery of the G3 were analyzed. Results: Three-year survival rate of the G3 was significantly higher than that of the G1 (42.8% vs 12.0%, p = 0.001). In case of the patients with a response to chemotherapy, three-year survival rate showed similar result (G3 vs G1, 46.1% vs 18.4%, p = 0.011). In the G3, R0 resection and curative intent of resection showed better three-year survival rate (R0 vs R1 or R2, 61.1% vs 16.2%, p = 0.003, curative vs palliative, 62.3% vs 23.8%, p = 0.031). Conclusions: The present study showed that gastrectomy after chemotherapy might improve the survival rate for the patients with stage IV gastric cancer, especially who could undergo R0 resection.

scholarly journals Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1884 ◽  
Author(s):  
Kota Shigeto ◽  
Takumi Kawaguchi ◽  
Shunji Koya ◽  
Keisuke Hirota ◽  
Toshimitsu Tanaka ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Regression Analysis ◽  
Muscle Atrophy ◽  
Cox Regression ◽  
Stage Iv ◽  
Decision Tree Analysis ◽  
Tree Analysis ◽  
Cox Regression Analysis ◽  
Stage Iv Gastric Cancer ◽  
Prognostic Profile

We aimed to investigate the impact of muscle atrophy and the neutrophil-to-lymphocyte ratio (NLR), a sub-clinical biomarker of inflammation and nutrition, on the prognosis of patients with unresectable advanced gastric cancer. We retrospectively enrolled 109 patients with stage IV gastric cancer (median age 69 years; female/male 22%/78%; median observational period 261 days). Independent factors and profiles for overall survival (OS) were determined by Cox regression analysis and decision-tree analysis, respectively. OS was calculated using the Kaplan–Meier method. The prevalence of muscle atrophy was 82.6% and the median NLR was 3.15. In Cox regression analysis, none of factors were identified as an independent factor for survival. The decision-tree analysis revealed that the most favorable prognostic profile was non-muscle atrophy (OS rate 36.8%). The most unfavorable prognostic profile was the combination of muscle atrophy and high NLR (OS rate 19.6%). The OS rate was significantly lower in patients with muscle atrophy and high NLR than in patients with non-muscle atrophy (1-year survival rate 28.5% vs. 54.7%; log-rank test p = 0.0014). In conclusion, “muscle atrophy and high NLR” was a prognostic profile for patients with stage IV gastric cancer. Thus, the assessment of muscle mass, subclinical inflammation, and malnutrition may be important for the management of patients with stage IV gastric cancer.

Stage IV Gastric Cancer: Role of Conversion Surgery in Indian Scenario

2021 ◽  
Vol 47 (2) ◽  
pp. e51-e52
Author(s):  
Mohammed Imaduddin ◽  
Lalchhandami Colney ◽  
Dillip Muduly ◽  
Mahesh Sultania ◽  
Jyoti Ranjan Swain ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer ◽  
Indian Scenario

Carcinoembryonic antigen (CEA) in stage IV gastric cancer as a risk factor for liver metastasis: A univariate and multivariate analysis

1993 ◽  
Vol 53 (4) ◽  
pp. 235-238 ◽  
Author(s):  
Yoichi Ikeda ◽  
Masaki Mori ◽  
Yosuke Adachi ◽  
Tetsuya Matsushima ◽  
Keizo Sugimachi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Liver Metastasis ◽  
Carcinoembryonic Antigen ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer

The impact of the extent of gastric resection on advanced gastric cancer treated with systemic chemotherapy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 194-194
Author(s):  
Yusuke Sasaki ◽  
Yutaka Watanabe ◽  
Ichiro Ohkita ◽  
Jojo Hirota ◽  
Jun Konno
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Gastric Resection ◽  
Stage Iv ◽  
Patient Characteristics ◽  
Severe Toxicity ◽  
Stage Iv Gastric Cancer ◽  
Significant Difference ◽  
The Impact

194 Background: In previous clinical trials of adjuvant chemotherapy for gastric cancer, severe toxicity and discontinuation of chemotherapy was more common in patients receiving total gastrectomy (TG) than in those with distal gastrectomy (DG). However, data on the significance of the extent of gastric resection for stage IV gastric cancer treated with systemic chemotherapy are not available. Methods: This is a retrospective review of patients who were received chemotherapy with S-1 and cisplatin for stage IV gastric cancer at our institution between June 2009 and August 2015. The patients were classified into three groups according to the extent of gastrectomy (TG, DG and no gastric resection (NG)) before chemotherapy. Patient characteristics, survival and toxicities of chemotherapy were compared between three groups. Results: Among the 83 patients, 24 underwent TG, 19 DG, and 40 NG. Patient characteristics were well balanced between three groups. There was no significant difference in the requirement for dose reduction between TG, DG and NG patients (29% vs 11% vs 20%, respectively, p= 0.32). However, the rate of discontinuation because of toxicity was significantly higher in TG than in DG or NG patients (46% vs 16% vs 25%, respectively, p= 0.04). The main reasons of discontinuation were anorexia (43%), myelosuppression (23%), nausea (18%) and diarrhea (16%). The median progression-free survival was 8.9, 6.1 and 5.3 months ( p= 0.25), and the median overall survival was 16.0, 16.0 and 9.8 months ( p= 0.40) in the patients with TG, DG and NG, respectively. Conclusions: There was a high frequency of discontinuation of systemic chemotherapy in the advanced gastric cancer patients who underwent TG, but it was not associated with prognosis.

scholarly journals Multidisciplinary treatment for patients with stage IV gastric cancer: the role of conversion surgery following chemotherapy

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Seung-Hoon Beom ◽  
Yoon Young Choi ◽  
Song-Ee Baek ◽  
Shuang-Xi Li ◽  
Joon Seok Lim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multidisciplinary Treatment ◽  
Stage Iv ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer

The Role of Surgical Resection for Stage IV Gastric Cancer With Synchronous Hepatic Metastasis

2018 ◽  
Vol 232 ◽  
pp. 422-429 ◽  
Author(s):  
Omar Picado ◽  
Levi Dygert ◽  
Francisco Igor Macedo ◽  
Dido Franceschi ◽  
Danny Sleeman ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Resection ◽  
Hepatic Metastasis ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer

Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy

2016 ◽  
Vol 25 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Kunihiko Izuishi ◽  
Hirohito Mori
Keyword(s):  
Gastric Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer ◽  
Palliative Gastrectomy ◽  
Advanced Tumor ◽  
Esophagogastric Cancer ◽  
Previously Treated

Recently, many strategies have been reported for the effective treatment of gastric cancer. However, the strategy for treating stage IV gastric cancer remains controversial. Conducting a prospective phase III study in stage IV cancer patients is difficult because of heterogeneous performance status, age, and degree of cancer metastasis or extension. Due to poor prognosis, the variance in physical status, and severe symptoms, it is important to determine the optimal strategy for treating each individual stage IV patient. In the past decade, many reports have addressed topics related to stage IV gastric cancer: the 7th Union for International Cancer Control (UICC) TNM staging system has altered its stage IV classification; new chemotherapy regimens have been developed through the randomized ECF for advanced and locally advanced esophagogastric cancer (REAL)-II, S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer (SPIRITS), trastuzumab for gastric cancer (ToGA), ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD), and ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW) trials; and the survival efficacy of palliative gastrectomy has been denied by the reductive gastrectomy for advanced tumor in three Asian countries (REGATTA) trial. Current strategies for treating stage IV patients can be roughly divided into the following five categories: palliative gastrectomy, chemotherapy, radiotherapy, gastric stent, or bypass. In this article, we review recent publications and guidelines along with above categories in the light of individual symptoms and prognosis. Abbreviations: APC: argon plasma coagulation; AVAGAST: anti-angiogenic antibody bevacizumab, the avastin in gastric cancer; BSC: best supportive care; CF: cisplatin and fluorouracil; CRP: C-reactive protein; DCF: docetaxel, cisplatin, and 5-FU; FISH: fluorescent in-situ hybridization; GJ: gastrojejunostomy; GPS: Glasgow Prognostic Score; HER: human epidermal growth factor receptor; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; OS: overall survival; PS: performance status; QOL: quality of life; RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; RCTs: randomized controlled trials; REAL: randomized ECF for advanced and locally advanced esophagogastric cancer; REGARD: ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; REGATTA: reductive gastrectomy for advanced tumor in three Asian countries; SEER: Surveillance Epidemiology and End Results; SEMS: self-expandable metal stents; SPIRITS: S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer; ToGA: trastuzumab for gastric cancer; TTP: time-to-progression; VEGFR: vascular endothelial growth factor receptor.

scholarly journals Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 169-174
Author(s):  
Lei Lei ◽  
Liu Yang ◽  
Yang-yang Xu ◽  
Hua-fei Chen ◽  
Ping Zhan ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Features ◽  
Survival Benefit ◽  
Stage Iv ◽  
Primary Lesion ◽  
Hepatoid Adenocarcinoma ◽  
Seer Database ◽  
Primary Tumor Size ◽  
Adenocarcinoma Of The Lung ◽  
To Receive

Abstract Hepatoid adenocarcinoma of the lung (HAL) is a rare malignant tumor that is defined as a primary alpha-fetoprotein (AFP)-producing lung carcinoma. We aimed to identify prognostic factors associated with the survival of patients with HAL using data from the Surveillance, Epidemiology, and End Results (SEER) database. We collected data from patients diagnosed with HAL, adenocarcinoma (ADC), and squamous cell carcinoma (SCC) of the lung between 1975 and 2016 from the SEER database. The clinical features of patients with ADC and SCC of the lung were also analyzed. The clinical features of HALs were compared to ADCs and SCCs. A chi-square test was used to calculate the correlations between categorical variables, and a t test or Mann–Whitney U test was used for continuous variables. The Kaplan–Meier method and Cox regression analysis were used to identify the prognostic factors for the overall survival (OS) of HALs. Two-tailed p values < 0.05 were considered statistically significant. Sixty-five patients with HAL, 2,84,379 patients with ADC, and 1,86,494 with SCC were identified from the SEER database. Fewer males, advanced stages, and more chemotherapy-treated HALs were found. Compared to patients with SCC, patients with HAL were less likely to be male, more likely to be in an advanced stage, and more likely to receive chemotherapy (p < 0.05). The American Joint Committee on Cancer staging was the only prognostic factor for OS in patients with HAL, and stage IV was significantly different from other stages (hazard ratio = 0.045, 95% confidence interval: 0.005–0.398, p = 0.005). Males with HAL were more likely to receive radiotherapy compared to females with HAL (61.8 vs 31.5%, p = 0.034). Younger patients with HAL were more likely to receive chemotherapy (59.4 + 10.2 years vs 69 + 11.3 years, p = 0.001). The primary tumor size of HAL was associated with the location of the primary lesion (p = 0.012). No conventional antitumor therapies, including surgery, chemotherapy, and radiotherapy, were shown to have a significant survival benefit in patients with HAL (p > 0.05). This study showed that stage IV was the only prognostic factor for OS in HALs compared to other clinicopathologic factors. Conventional antitumor therapies failed to show survival benefit; thus, a more effective method by which to treat HAL is needed. Interestingly, the clinical features and the location of the primary lesion were shown to be associated with primary tumor size and treatment in patients with HAL, which have not been reported before.

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