The clinicopathological characteristics of understaging and overstaging of the preoperative assessment for gastric cancer by endoscopic ultrasonography and computed tomography.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 34-34
Author(s):  
Ae-Ra Lee ◽  
Dong Ho Lee ◽  
Jae Jin Hwang ◽  
Cheol Min Shin ◽  
Hyuk Yoon ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Preoperative Staging ◽  
Preoperative Assessment ◽  
Clinicopathological Characteristics ◽  
T Stage ◽  
Cancer Group ◽  
Lower Accuracy ◽  
Ulcerative Lesions ◽  
N Staging

34 Background: Despite the development of EUS and CT technology, there are no clinically relevant imaging tools to detect accurate preoperative staging such as lymph node (LN) metastases. The aim of this study was to elucidate of the clinicopathological characteristics of understaging and overstaging of the preoperative assessment for the gastric cancer by EUS and CT. Methods: In total, 180 patients who underwent EUS and CT, followed by gastrectomy at Bundang Hospital, Seoul National University, from July 2012 to June 2014, were analyzed. The results from the preoperative EUS and CT were compared to the postoperative pathological findings. Results: For T staging, a total of 180 patients who underwent CT and EUS have been recruited and 99 patients with visualized primary lesions on CT were analyzed. For N staging, 180 patients who underwent EUS and CT were analyzed. The overall accuracy of EUS and CT for T staging was 63.7% and 69%, respectively. The overall accuracy for N staging was 74.3% and 69.6%, respectively. Compared with variables of under and over staging group with accurate staging group, Accuracy of T staging for lesions at the cardia (36.4% vs. 63.6%, P = 0.021), advanced gastric cancer group (55% vs. 90.9%, P = 0.005) and advanced T stage group (24.4% vs. 5.2 %, P = 0.001) was higher than that non-cardia lesions and EGC group. Ulcerative lesion (38.5% vs. 61.5%, P < 0.001) and histologically undifferentiated type (3.8% vs. 93.8%, P = 0.002) had significantly lower accuracy in N staging than non-ulcerative lesions and the differentiated cancer. Conclusions: Caution is required in interpreting the T staging of the advanced T stage (T3 and T4) lesions, lesions at the cardia and advanced gastric cancer lesions. The ulcerative and undifferentiated lesions needed careful interpretation for N staging. However, there seemed to be no significant differences of clinicopathological characteristics between EUS and CT. The accuracy of CT was close to that of EUS and both modalities were useful and complementary for the locoregional staging of gastric cancer.

The actual accuracy of endoscopic ultrasound for detailed tumor depth determination in nonserosal exposed gastric cancer: What should we do to increase the accuracy of endoscopic ultrasound?

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 20-20
Author(s):  
H. Lee ◽  
J. H. Lee
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Ultrasound ◽  
Preoperative Staging ◽  
Exposed Group ◽  
Tumor Depth ◽  
Factors Affecting ◽  
T Stage ◽  
Staging Of Gastric Cancer ◽  
Gastric Cancer Patients ◽  
N Staging

20 Background: The accuracy of endoscopic ultrasound (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS T and N staging in all and non-serosal exposed cases and identify the histopathological factors influencing accuracy. Methods: A total of 309 gastric cancer patients with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary's Hospital, Korea, between January and December 2009. Of these, 262 patients were diagnosed with non-serosal exposed gastric cancer. Results: Overall accuracies of EUS for T stage, the detailed T stages of all cases, and the detailed T stage in the non-serosal exposed group were 70.2%, 43.0%, and 41.2%, respectively. In the non-serosal exposed group, tumors greater than 5 cm in diameter were significantly associated with T overstaging (odds ratio [OR], 2.583). The overall accuracies of EUS for N staging in all cases and in the non-serosal exposed group were 71.2% and 76.7%, respectively. Tumor size (2 cm ≤ size < 5 cm; OR, 4.467; and 5 cm ≤ size; OR, 8.668) and tumor depth (submucosa; OR, 3.267; muscular propria; OR, 6.675 and subserosa; OR, 4.831) were significant factors affecting incorrect nodal detection in non-serosal exposed gastric cancer cases. Conclusions: Careful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging. No significant financial relationships to disclose.

Is tumor size a predictor of preoperative N staging in T2–T4a stage advanced gastric cancer?

2014 ◽  
Vol 23 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Chang-Ming Huang ◽  
Mu Xu ◽  
Jia-Bin Wang ◽  
Chao-Hui Zheng ◽  
Ping Li ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Tumor Size ◽  
N Staging

Prognostic factors after R2 surgery in patients with advanced gastric cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 140-140
Author(s):  
Masanori Tokunaga ◽  
Hironobu Goto ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Advanced Gastric Cancer ◽  
Operation Time ◽  
Clinicopathological Characteristics ◽  
Infectious Complications ◽  
Hazard Ratio ◽  
Postoperative Chemotherapy ◽  
Safe Procedure ◽  
Confidential Interval

140 Background: In patients with advanced gastric cancer, chemotherapy is a standard treatment if they have non-curable factors. However, gastrectomy is sometimes performed even in patients having non-curable factors, particularly when they have tumor associated symptoms. The aim of this study is to investigate clinicopathological characteristics of patients who underwent R2 surgery, and to identify prognostic factors. Methods: This study included 157 patients who underwent gastrectomy with macroscopic residual disease (R2 surgery) between September 2002 and June 2011 at the Shizuoka Cancer Center. Clinicopathological characteristics and surgical outcomes were investigated. In addition, we conducted Cox-proportional Hazards model which included age, sex, number of non-curable factors, chemotherapy, macroscopic type, histology, and postoperative intraabdominal infectious complications as covariates, to identify independent prognostic factors after R2 surgery. Results: There were 103 male and 54 female patients with median age of 69 years. The reasons why R2 surgery was performed were low oral intake due to stenosis in 120 patients and bleeding in 54 patients. Total gastrectmy was the most frequently performed procedure (93 patients) followed by distal gastrectomy (61 patients) Median operation time and intraoperative blood loss were 193 minutes and 337 mg, respectively, and intraabdominal infectious complications (Clavien-Dindo classification grade II or more severe) were observed in 24 patients (15.3%). Chemotherapy was given after surgery in 112 patients (71.3%) with median survival time of all patients being 8.7 months. Multivariate analysis identified postoperative chemotherapy (Hazard ratio, 0.34; 95% confidential interval, 0.24 – 0.65) and postoperative intraabdominal infectious complications (Hazard ratio, 1.74; 95% confidential interval, 1.06 – 2.88) as independent prognostic factors. Conclusions: The incidence of postoperative infectious complications after R2 surgery was thought to be higher than that after curative gastrectomy reported before. Safe procedure and administration of postoperative chemotherapy would be necessary to offer improved overall survival after R2 surgery.

Predictors of pathological response and tumor regression following neoadjuvant therapy in advanced gastric cancer patients.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 206-206 ◽  
Author(s):  
Ulysses Ribeiro ◽  
Marcus Fernando Kodama Pertille Ramos ◽  
Marina Alessandra Pereira ◽  
André Roncon Dias ◽  
Osmar Kenji Yagi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Advanced Gastric Cancer ◽  
Tumor Response ◽  
Tumor Regression ◽  
Clinicopathological Characteristics ◽  
R0 Resection ◽  
Histopathological Response ◽  
Neutrophil Lymphocyte Ratio ◽  
Significant Difference

206 Background: Neoadjuvant chemotherapy (NACT) has became the standard approach for patients with advanced gastric cancer. Clinicopathological characteristics can be utilized to evaluate the effect of NACT, and may be a useful tool to identify responsive patients. Methods: We retrospectively reviewed all patients with GC treated with NACT and R0 resection between 2009 and 2015 from a prospective collected database. Histopathological response to the treatment was graded from 0% to 100% and the clinicopathological characteristics assessed to identify predictors of tumor response. A threshold of 50% histopathological response was used for the analysis. Results: NACT was performed in 45 patients. Cisplatin-irinotecan therapy was used in 64.4% of patients and 11 (24.4%) tumors were located in the proximal stomach. Ten (22.2%) patients demonstrated a tumor regression of at least 50% and one patient had complete response. The mean number of lymph node retrieved was 38.1 and 66.7% patients had lymph node metastasis (LNM). Factors associated with > 50% of response by univariate analyses included lower neutrophil-lymphocyte ratio (NLR) ( p = 0.035), diffuse/mixed Lauren type ( p = 0.007), lower depth of tumor invasion ( p = 0.043) and non cisplatin-irinotecan therapy (p = 0.01). A slight tendency of poorly differentiated tumors respond better to NACT than differentiated type was observed ( p = 0.05). There was no significant difference regarding the presence of mucin, calcification and/or necrosis and the tumor response. Multivariate analysis identified NLR and diffuse/mixed tumors as independent predictors of pathologic response. Median follow-up for all patients was 26.5 months and recurrence-free survival (RFS) rate was 74.3% and 60% for patients with > 50% and < 50% of response, respectively ( p= 0.08). RFS was significantly different in patients without LNM compared to patients who have LNM (100% vs. 55.2%, p = 0.01), and in patients with fibroinflammatory/inflammatory stroma infiltration compared to patients with only fibrotic stroma (80% vs. 53.3%, p = 0.015). Conclusions: Diffuse/mixed histopathological type and lower NLR are independently predictors of tumor response after NACT.

Clinical Outcome and Clinicopathological Characteristics of Recurrence after Laparoscopic Gastrectomy for Advanced Gastric Cancer

Digestion ◽  
2011 ◽  
Vol 83 (3) ◽  
pp. 184-190 ◽  
Author(s):  
Fumihiro Yoshimura ◽  
Kazuki Inaba ◽  
Yuichiro Kawamura ◽  
Yoshinori Ishida ◽  
Keizo Taniguchi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Outcome ◽  
Advanced Gastric Cancer ◽  
Laparoscopic Gastrectomy ◽  
Clinicopathological Characteristics

scholarly journals Evaluation of preoperative staging in advanced gastric cancer with MRI

2011 ◽  
Vol 3 (2) ◽  
pp. 95
Author(s):  
Guang-Yu Tang ◽  
Qing-Lu Guo ◽  
Ping-Ping Xin
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Preoperative Staging

scholarly journals MAGNETIC RESONANCE IMAGING WITH DIFFUSE WEIGHTED IMAGING AND COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST IN STAGING OF DISSEMINATED OVARIAN, STOMACH, COLORECTAL CANCER

2019 ◽  
Vol 6 ◽  
pp. 59-65
Author(s):  
Sergiy Chetverikov ◽  
Svitlana Zavoloka ◽  
Viacheslav Onyshchenko ◽  
Mykhailo Chetverikov ◽  
Valeriia Chetverikova-Ovchynnyk
Keyword(s):  
Colorectal Cancer ◽  
Gastric Cancer ◽  
Ovarian Cancer ◽  
Patient Selection ◽  
Preoperative Staging ◽  
Advanced Ovarian Cancer ◽  
Preoperative Assessment ◽  
Distant Metastases ◽  
Peritoneal Carcinoma ◽  
Intravenous Contrast

The aim of the research. Development and implementation of new methods for pre-operative staging of advanced ovarian, gastric and colorectal cancer to improve patient selection for cytoreductive surgery and increase its radicality. Materials and methods. Data from 120 patients with advanced ovarian cancer, 28 with advanced gastric cancer and 119 with advanced colorectal cancer were analyzed. Preoperative detection of the incidence of peritoneal carcinoma and the possibility of surgery in radical or cytoreductive volume performed by CT with intravenous contrast (72 patients with ovarian cancer, 17 patients with gastric cancer, and 69 patients with colorectal cancer), and MR T1 and T2, contrast-enhanced T1, and diffuse-weighted sequences (48 patients with ovarian cancer, 11 patients with gastric cancer, and 50 patients with colorectal cancer). Subsequently, preoperative and intraoperative assessment of the prevalence of the tumour process with peritoneal carcinoma index (PCI) by Sugarbaker was performed. Results. A statistically significant increase in the informativeness of the preoperative assessment of the incidence of tumour process in peritoneum and the presence of distant metastases using DWI / MRI compared with CT with intravenous contrast was determined. Patients from all groups were categorized according to the completeness index of cytoreduction achieved by preoperative staging and patient selection using DWI / MRI and CT. The use of DWI / MRI allowed to significantly reduce the number of suboptimal and non-optimal cytoreductive interventions. Conclusions. DWI / MRI has made it possible to significantly improve the preoperative incidence of advanced ovarian, gastric, and colorectal cancer compared to CT, predict the radicality of future surgery, and detect inoperable cases.

Survival analysis of linitis plastica advanced gastric cancer patients receiving S-1 plus cisplatin.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15105-e15105
Author(s):  
Yosuke Kumekawa ◽  
Keisho Chin ◽  
Hiroki Osumi ◽  
Mariko Ogura ◽  
Masato Ozaka ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Disease Status ◽  
Linitis Plastica ◽  
Clinicopathological Characteristics ◽  
Clinical Feature ◽  
Diffuse Type ◽  
First Line ◽  
Gastric Cancer Patients ◽  
Line Chemotherapy

e15105 Background: Linitis plastica gastric cancer (LPGC) has been known to have worse prognosis than non-LPGC. Clinical trial using molecular targeting agent has been ongoing for LPGC. However it remains unknown whether to be better to change the chemotherapy for the patients. S-1 plus cisplatin (SP) is the standard chemotherapy for previously untreated Japanese advanced gastric cancer (AGC). Methods: To clarify the clinical feature and outcome of LPGC treated with chemotherapy, we retrospectively compared the patients with unresectable or metastatic LPGC and non-LPGC who received SP as the first-line chemotherapy in Cancer Institute Hospital of JFCR between 2007 and 2011. Results: In the period there were 687 patients with AGC who received systemic chemotherapy and 223 (LPGC 63 and non- LPGC 160) patients received SP as first-line chemotherapy. LPGC patients were more frequent in female (44.0% vs. 26.9%; P=0.016). LPGC was more likely to have non-measurable disease (39.7% vs. 14.4%; P<0.001), peritoneal metastasis (73% vs. 35.6% P<0.001), and diffuse type histology (diffuse type 85.7% vs. 56.3%, intestinal type 7.9% vs. 27.5%; P<0.001). LPGC was less likely to have liver metastasis (7.9% vs. 27.5%; P<0.001), and no evaluable distant metastasis in computed tomography (81.0% vs. 93.8%; P=0.010). Other clinicopathological characteristics were follows (LPGC patients vs. non-LPGC patients): median age (57 vs. 62 years), disease status (recurrent 11.1% vs. 18.8%), ECOG PS 0 (81.0% vs. 81.9%), number of metastatic sites (1: 52.4% vs. 46.9, 2: 39.7% vs. 46.9%, ³a3: 7.9% vs. 6.2%), lymph node metastasis (63.5% vs. 70.6%), prior gastrectomy (31.7% vs. 35.6%). They were not significantly different. Median overall survival time is 383 days (95% CI 332-564) in LPGC patients and 473 days (95% CI 412-555) in non-LPGC patients (P=0.363). Median time to treatment failure is 229 days (95% CI 155 - 280) in LPGC patients and 189 days (95% CI 156 -219) in non-LPGC patients (P=0.245). Conclusions: Although clinicopathological backgrounds were not identical, it was suggested that the prognosis of the patients treated with SP was not different between advanced or metastatic LPGC and non-LPGC.

Phase II study of docetaxel (DTX) and S-1 as neoadjuvant chemotherapy for potentially R0 advanced gastric cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 74-74
Author(s):  
Yasunori Emi ◽  
Eiji Oki ◽  
Hiroshi Saeki ◽  
Masaru Morita ◽  
Tetsuya Kusumoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Preoperative Chemotherapy ◽  
Curative Resection ◽  
Response Rate ◽  
Clinical Stage ◽  
Preoperative Staging ◽  
Peritoneal Cytology ◽  
Eligibility Criteria

74 Background: This trial sought to evaluate the efficacy and safety of preoperative chemotherapy with DTX plus S-1 for advanced gastric cancer with poor prognosis even after R0 curative resection. We show the 2 years follow-up data. Methods: Preoperative staging was confirmed by laparoscopy. Eligibility criteria included 1) negative peritoneal cytology, H0, P0 and M0, 2) possible curative resection, and 3) ECOG PS 0-1. Patients received DTX (35 mg/m2) on days 1 and 15, and daily oral administration of S-1 (80 mg/m2/day) for days 1–14 every 4 weeks of 2 courses, followed by gastrectomy with D2 lymphadenectomy. The primary endpoint was pathological response rate (pRR). A sample size of 45 was planned for the expected pRR of 40% and threshold value of 20%, with one-sided alpha of 0.05 and beta of approximately 0.1. Results: A total of 47 patients were centrally registered between November 2007 and November 2009 from 14 centers. All patients were eligible for analysis. The median age was 63 (range 37–79); male/female: 36/11; PS0/1:41/6; and clinical stage IIIA/IIIB: 31/16. The target pRR was 47% (90%CI, 34–60%; p<0.0001). Forty six patients (98%) underwent surgery, in whom curative resection was performed in 44 patients, and 37 patients completed the protocol treatment. The response to preoperative chemotherapy was PR/SD/PD/NE in 16/24/2/5 with a response rate of 34%. The rate of 2 years and 3 years DFS were 53.9%, and 49.3%, respectively. The rate of 2 years and 3 years Overall survival were 69.6%, and 55.1%, respectively. The most common toxicities of neoadjuvant chemotherapy were grade 3/4 neutropenia (42%), febrile neutropenia (4%), grade 2 anorexia (21%), and fatigue (15%). Major operative morbidity included pancreatic fistula (9%), abdominal abscess (11%), pneumonia (2%), and anastomotic leakage (0%). No patients died due to surgical complications. Conclusions: The combination of DTX and S-1 was well tolerated and promising as a preoperative chemotherapy regimen for patients with potentially resectable advanced gastric cancer. Clinical trial information: UMIN000000875.

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