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 Long-term outcomes of omentum-preserving versus resecting gastrectomy for locally advanced gastric cancer with propensity score analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Sakimura ◽  
Noriyuki Inaki ◽  
Toshikatsu Tsuji ◽  
Shinichi Kadoya ◽  
Hiroyuki Bando
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Missing Values ◽  
Propensity Score Analysis ◽  
Locally Advanced ◽  
R0 Resection ◽  
Significant Difference ◽  
First Recurrence ◽  
The Impact

Abstract Omentectomy is conducted for advanced gastric cancer (AGC) patients as radical surgery without an adequate discussion of the effect. This study was conducted to reveal the impact of omentum-preserving gastrectomy on postoperative outcomes. AGC patients with cT3 and 4 disease who underwent total or distal gastrectomy with R0 resection were identified retrospectively. They were divided into the omentum-preserved group (OPG) and the omentum-resected group (ORG) and matched with propensity score matching with multiple imputation for missing values. Three-year overall survival (OS) and 3-year relapse-free survival (RFS) were compared, and the first recurrence site and complications were analysed. The numbers of eligible patients were 94 in the OPG and 144 in the ORG, and after matching, the number was 73 in each group. No significant difference was found in the 3-year OS rate (OPG: 78.9 vs. ORG: 78.9, P = 0.54) or the 3-year RFS rate (OPG: 77.8 vs. ORG: 68.2, P = 0.24). The proportions of peritoneal carcinomatosis and peritoneal dissemination as the first recurrence site and the rate and severity of complications were similar in the two groups. Omentectomy is not required for radical gastrectomy for AGC.

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.

scholarly journals Conversion Surgery for Patients With Stage IV HER2-Positive Gastric Cancer: A Report of 3 Patients

2017 ◽  
Vol 102 (3-4) ◽  
pp. 137-140 ◽  
Author(s):  
Shin Saito ◽  
Yoshinori Hosoya ◽  
Hirofumi Fujii ◽  
Hideyuki Ohzawa ◽  
Akira Tanaka ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Targeted Therapy ◽  
Advanced Gastric Cancer ◽  
Molecular Targeted Therapy ◽  
Stage Iv ◽  
Complete Response ◽  
Conversion Surgery ◽  
Her2 Positive ◽  
Stage Iv Gastric Cancer ◽  
Metastatic Lesions

Gastric cancer is a common malignancy and remains potentially lethal. The prognosis of patients with stage IV gastric cancer is thought to be poor, but new molecular targeted therapy may benefit patients with advanced gastric cancer. Currently, conversion surgery after chemotherapy with a trastuzumab-containing regimen is reported to be effective in these patients. We present 3 patients with human epidermal growth factor receptor 2 (HER2)–positive advanced gastric cancer who underwent conversion surgery after receiving a trastuzumab-containing chemotherapy regimen. Interestingly, the primary lesion acquired resistance to the trastuzumab-containing regimen, although the metastatic lesions maintained a complete response. The reason why the primary lesions became resistant to trastuzumab remains unclear. More studies are needed to clarify the mechanism of resistance. Conversion surgery, made possible by the use of molecular-targeted therapy, may improve the prognosis of patients with stage IV gastric cancer, particularly if metastatic lesions show a complete response to therapy.

scholarly journals A Study on Pertinence of Non-curative Gastric Resection for Stage IV Gastric Cancer.

2001 ◽  
Vol 62 (7) ◽  
pp. 1613-1618
Author(s):  
Yumi YAMAGUCHI ◽  
Keigo ASHIDA ◽  
Shunsuke SHIBATA ◽  
Minoru ISHIGURO ◽  
Eiichi YURUGI ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Resection ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer

scholarly journals Reporting patient characteristics and stratification factors in randomized trials of systemic chemotherapy for advanced gastric cancer

2011 ◽  
Vol 15 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Kohei Shitara ◽  
Junko Ikeda ◽  
Chihiro Kondo ◽  
Daisuke Takahari ◽  
Takashi Ura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Randomized Trials ◽  
Patient Characteristics

Efficacy of sequential use of docetaxel / 5-fluorouracil / cisplatin as first-line, and irinotecan/levofolinate/5-fluorouracil as second-line chemotherapy for advanced gastric cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15150-15150
Author(s):  
K. Sugiyama ◽  
A. Ishikawa ◽  
H. Sato
Keyword(s):  
Gastric Cancer ◽  
Disease Progression ◽  
Advanced Gastric Cancer ◽  
Objective Response ◽  
Stage Iv ◽  
Observation Time ◽  
Severe Toxicity ◽  
Survival Times ◽  
Line Therapy ◽  
Sequential Administration

15150 Background The prognosis for advanced gastric cancer (AGC) is extremely poor, and efficacy of chemotherapy is limited with median survival times of around 9 months. Recently docetaxel (DOC) and irinotecan (CPT-11) seem to be effective for AGC as well as 5-fluorouracil (5-FU) and cisplatin (CDDP). This study was performed to evaluate the efficacy of combination chemotherapy including sequential administration of these all key drugs. Methods Patients (pts) with AGC were treated with the chemotherapy consisted of DOC / 5-FU / CDDP (DOC 50mg/m2 d1 + 5-FU 330mg/m2/bolus d1–4 + CDDP 9mg/m2 d1–4; q4weeks or DOC 50mg/m2 d1 + 5-FU1320mg/m2/48-h infusion over d1–2 + CDDP 18mg/m2 d1–2; q3weeks) as 1st-line until disease progression and/or unacceptable toxicity. 2nd-line therapy was included CPT-11 / levofolinate (l-LV) / 5-FU combination (CPT-11 90mg/m2 d1 + l-LV 75mg/m2 d1 + 5-FU 330mg/m2/bolus d1 followed by 1400mg/m2/46-h infusion over d1–2; q2weeks or CPT-11 30mg/m2 + l-LV 35mg/m2 + 5-FU 330mg/m2/bolus d1,8,15,22; q6weeks). Toxicities and efficacy were evaluated according to the CTCAE v3.0 and the RECIST guidelines. Time to progression (TTP) and overall survival time (OS) was measured from the date of diagnosis. Results Ten pts (4 unresectable stage IV diseases, 6 postoperative metastatic diseases) were enrolled between May 2004 and October 2006. Median age was 72 years. Pts with ECOG PS 1/2 were 8, PS 3 were 2. Metastatic sites were liver 6, peritoneum 3, lymph nodes 5. Histological types were papillary/tubular 2, poorly/mucinous/signet ring 4, mixed 4. Median administered number of cycles were 4.5 for 1st-line, 3.5 for 2nd-line. Toxicities were tolerable, and all pts received 1st-line therapy until disease progression. Objective response rate was 20.0% (2PR, 8 SD). TTP ranges 4.4–14.0 months for 8pts (2pts remained SD). Median OS were not reached, and median observation time was 11.7 months (range; 2.9- 28.0 months) at the date of 31 Dec 2006. Conclusions DOC / 5-FU / CDDP combination as 1st-line, CPT-11 / l-LV / 5-FU combination as 2nd-line treatment appears active against AGC and improve the survival, without severe toxicity. No significant financial relationships to disclose.

Changing national trends and survival in stage IV gastric cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 81-81 ◽  
Author(s):  
Anna M. Leung ◽  
Connie G. Chiu ◽  
Danielle M. Hari ◽  
Myung-Shin Sim ◽  
Anton J. Bilchik
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Negative Impact ◽  
Survival Rates ◽  
Stage Iv ◽  
Rank Test ◽  
Treatment Pathways ◽  
Stage Iv Gastric Cancer ◽  
Cancer Data ◽  
Palliative Gastrectomy

81 Background: With more effective systemic chemotherapy, the role for palliative gastrectomy in patients with Stage IV gastric cancer has been questioned. Methods: Using the National Cancer Data Base we identified 29,655 patients with Stage IV gastric cancer over a 14 year period (1994-2008). Patient demographics, tumor related features, and treatments were analyzed. Overall survival rates were examined using log-rank test power analysis. Results: There was a decrease in surgical resection from 31.2% in 2000 to 22% in 2008 (p<0.0001), a decrease in radiation from 20% in 2000 to 18.5% in 2008 (p= 0.0009), and an increase in systemic therapy from 45.5% in 2000 to 55.1% in 2008 (p<0.001). There were no differences in gender, age, or histology, but there was a decreasing trend of Caucasians diagnosed (p<0.0001). Survival rates decreased significantly over time p<0.05 (see table below). Conclusions: Over the past 14 years there has been an increase in the use of systemic chemotherapy and a reduction in palliative gastrectomy for stage IV gastric cancer. The negative impact on survival suggests that treatment pathways be re-evaluated. [Table: see text]

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