Conversion gastrectomy for stage IV unresectable gastric cancer: A retrospective cohort study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 298-298
Author(s):  
Tamotsu Sagawa ◽  
Yasushi Sato ◽  
Kyoko Hamaguchi ◽  
Masahiro Hirakawa ◽  
Hiroyuki Nagashima ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Distant Metastases ◽  
Metastatic Gastric Cancer ◽  
Cancer Center ◽  
R0 Resection ◽  
Stage Iv Gastric Cancer ◽  
Gastric Cancer Patients

298 Background: Stage IV Gastric cancer (GC) is a heterogeneous biological condition with a mixture of distant metastases, including hematologic, lymph nodal and/or peritoneal. In the recent classification introduced by Yoshida et al with the proposal to identify objective principles for conversion surgery, stage IV GC patients were subdivided into 4 new categories. In this study, we retrospectively investigated the efficacy of conversion gastrectomy for stage IV GC patients, with particular focus on the Yoshida’s classification. Methods: A retrospective, single center cohort study was performed in patients who had undergone conversion gastrectomy between 2005 and 2018. Data were extracted from Hokkaido Cancer Center database including all metastatic gastric cancer patients submitted to surgery. Only stage IV unresectable tumors/metastases which became resectable after chemotherapy were included in this analysis. Results: Forty-two resected stage IV GC patients were included in this analysis. Median overall survival (OS) was 40.0 months and 1-, 3- and 5-year survivals were 92.9, 70.7 and 57.7%, respectively. Univariate analysis among the patients with conversion gastrectomy identified macroscopic type, clinical response to 1st line therapy, pathological tumor depth, pathological nodal stage, R0 resection as significant prognostic factors. The MSTs of the patients with conversion gastrectomy for each category were 50.1 months for category 1, 46.6 months for category 2, 22.7 months for category 3 and 17.2 months for category 4. Conclusions: Unresectable stage IV GC patients could benefit from radical surgery after chemotherapy and achieve long survivals. Adequate selection of stage IV GC patients for conversion therapy may be an important role.

CONVERSION SURGERY FOR STAGE IV GASTRIC CANCER. LITERATURE REVIEW AND OWN EXPERIENCE

2020 ◽  
Vol 66 (1) ◽  
pp. 50-57
Author(s):  
Vladimir Khomyakov ◽  
Dmitriy Sobolev ◽  
Ilya Kolobaev ◽  
Anna Chayka ◽  
A. Utkina ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Metastatic Gastric Cancer ◽  
Complete Resection ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer ◽  
Paraaortic Lymph Nodes ◽  
Gastric Cancer Patients

Metastatic gastric cancer is associated with poor prognosis despite of advances in chemotherapy and surgery. According to current clinical guidelines surgical treatment for stage IV gastric cancer patients is indicated only for urgent complications. New approach for the management of patients with initially unresectable or metastatic gastric cancer includes primary systemic chemotherapy and following surgical resection if the patients are able to undergo complete resection. This approach is known as conversion surgery. In the review with presentation of own experience the results of conversion surgery for gastric cancer with distant metastases of various localization (liver, paraaortic lymph nodes and peritoneum) were reported. These results allow to define indications for this treatment strategy. 15 conversion surgery cases are presented, 12 of them were combined with HIPEC or PIPAC. Median progression-free survival was 18 months. Conclusion: literature analysis and own experience have shown that conversion surgery after chemotherapy increases the overall survival of patients with oligometastatic gastric cancer who underwent complete resection as compared with palliative chemotherapy. However the clear selection criteria for conversion surgery are needed from randomized controlled trials.

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.

Outcomes of locoregional therapy for metastatic gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 143-143
Author(s):  
Ravi Shridhar ◽  
Jamie Huston ◽  
Kenneth L Meredith
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Metastatic Gastric Cancer ◽  
Tumor Location ◽  
Peritoneal Metastases ◽  
Locoregional Therapy ◽  
Stage Iv Gastric Cancer ◽  
Rank Analysis ◽  
Signet Ring ◽  
Gastric Cancer Patients

143 Background: Patients with metastatic gastric cancer have poor survival. The purpose of this study was to compare outcomes of metastatic gastric cancer patients with or without surgery and radiation therapy (RT). Methods: The National Cancer Database (NCDB) was accessed to identify patients with stage IV gastric cancer between 2004 and 2013 and stratified by surgery. Propensity score matching was performed against age, metastatic site, radiation, and signet ring histology. Overall survival (OS) analysis was determined by Kaplan-Meier and log-rank analysis. Multivariate analysis (MVA) was analyzed by the Cox proportional hazard ratio model. Results: A total of 1808 patients were identified. Surgery was associated with an OS benefit. Median and 5-year OS for surgery and no surgery was 16 months and 16% and 10 months and 2%, respectively (p < 0.001). Median and 5 year OS for patients treated with surgery and RT was 22.4 months and 26%. Median and 5 year OS for surgery patients treated with or without preoperative RT was 27.2 months and 28% and 15.2 months and 12%, respectively (p < 0.001). There was no OS benefit with postoperative RT. MVA for all patients revealed that surgery and tumor location were associated with decreased mortality while peritoneal metastases were associated with increased mortality. In surgical patients, MVA showed that RT, partial esophagectomy, and tumor location were associated with decreased mortality, while positive margins, signet ring histology, and peritoneal metastases were associated with increased mortality. In nonsurgical patients, only carcinomatosis was prognostic on MVA. Conclusions: Surgery and radiation are associated with increased survival in a subset of patients with metastatic gastric cancer. Prospective trials will be needed to address the role and sequence of surgery and radiation in metastatic gastric cancer.

Comparison between S-1 monotherapy and S-1 plus cisplatin as postoperative chemotherapy after R0 resection for stage IV gastric cancer patients with oligometastasis: A multicenter retrospective study.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 123-123
Author(s):  
Koshi Kumagai ◽  
Toshifumi Yamaguchi ◽  
Atsuo Takashima ◽  
Kengo Nagashima ◽  
Yosuke Kano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Retrospective Study ◽  
Treatment Guidelines ◽  
Stage Iv ◽  
R0 Resection ◽  
Poor Prognostic Factor ◽  
Stage Iv Gastric Cancer ◽  
Cancer Group ◽  
Gastric Cancer Patients ◽  
Histological Confirmation

123 Background: Gastric cancer (GC) with liver metastasis (M1: HEP) and para-aortic lymph node metastasis (M1: LYM) is categorized as stage IV. Based on the retrospective reports, surgical resection is weakly recommended for oligo-metastasis (O-Meta), if resectable, in the Japanese GC Treatment Guidelines 2018. Whereas S-1 monotherapy as adjuvant chemotherapy after surgery for stage II/III GC and S-1 plus cisplatin (SP) as palliative chemotherapy for unresectable stage IV GC are standard treatments, there is no consensus about post-operative chemotherapy (Post-Cx) after R0 resection of stage IV GC with O-Meta. Methods: The criteria for this retrospective study were: 1) no prior treatment for GC, 2) R0 resection including O-Meta (HEP or LYM) at 20 institutions in the Stomach Cancer Group of the Japan Clinical Oncology Group between 2007 and 2012, 3) histological confirmation of adenocarcinoma for primary tumor and O-Meta (M1: HEP or LYM), 4) no other distant metastasis such as peritoneal metastasis. Results: A total of 110 patients were collected. Of the 94 eligible patients, 84 patients underwent gastrectomy followed by Post-Cx with S-1 (S-1 group: n = 55), SP (SP group: n = 22) or others (Others group: n = 7), and 10 patients did not receive post-Cx (non-Cx group). Median age for the S-1, SP, Others and non-Cx groups were 66, 60, 61, and 79 years old. Sites of oligo-metastasis (HEP/LYM) was 21/34, 9/13, 2/5, and 7/3 in the S-1, SP, Others and non-Cx groups. The 3- / 5-year overall and relapse free survival (OS and PFS) rates of all the patients were 45.6/31.4% and 24.5/21.3%, respectively. Median OS was 28.5 and 36.5 months in the S-1 and SP groups (HR 0.99; 95% CI 0.54-1.82, p = 0.986). In multivariate analysis, no Post-Cx, over 70 years old were identified as the independent poor prognostic factor for OS (p < 0.05). Conclusions: R0 resection followed by Post-Cx for GC patients with O-Meta showed favorable survival, while there seems no additional benefit of cisplatin to S-1 alone.

Prognostic Indicators in Stage IV Surgically Treated Gastric Cancer Patients: A Retrospective Multi-Institutional Study

2018 ◽  
Vol 36 (4) ◽  
pp. 331-339
Author(s):  
Alberto Biondi ◽  
Domenico D’Ugo ◽  
Ferdinando Cananzi ◽  
Stefano Rausei ◽  
Federico Sicoli ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Residual Disease ◽  
Stage Iv ◽  
Long Term Results ◽  
Stage Iv Gastric Cancer ◽  
Short And Long Term ◽  
Gastric Cancer Patients

Introduction: The role of gastric resection in treating metastatic gastric adenocarcinoma is controversial. In the present study, we reviewed the short- and long-term outcomes of stage IV patients undergoing surgery. Methods: A retrospective review was conducted that assessed patients undergoing elective surgery for incurable gastric carcinoma. Short- and long-term results were evaluated. Results: A total of 122 stage IV gastric cancer patients were assessed. Postoperative mortality was 5.7%, and the overall rate of complications was 35.2%. The overall survival rate at 1 and 3 years was 58 and 19% respectively; the median survival was 14 months. Improved survival was observed for the factors age less than 60 years (p = 0.015), site of metastases (p = 0.022), extended lymph node dissection (p = 0.044), absence of residual disease after surgery (p = 0.001), and administration of adjuvant chemotherapy (p = 0.016). Multivariate analysis showed that residual disease and adjuvant chemotherapy were independent prognostic factors. Conclusions: The results of this study suggest that surgery combined with systemic chemotherapy in selected patients with stage IV gastric cancer can improve survival.

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.

The prognostic factor and the optimal timing of conversion surgery in unresectable stage IV gastric cancer: A retrospective analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 78-78
Author(s):  
Tamotsu Sagawa ◽  
Yutaka Okagawa ◽  
Fumito Tamura ◽  
Tsuyoshi Hayashi ◽  
Koshi Fujikawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Residual Tumor ◽  
Optimal Timing ◽  
Conversion Surgery ◽  
Stage Iv Gastric Cancer ◽  
Metastatic Lesions ◽  
Unresectable Stage

78 Background: Conversion surgery could be an option for unresectable stage IV gastric cancer when distant metastasis (M1) is disappeared by chemotherapy. However, the indication and the optimal timing of conversion surgery in stage IV gastric cancer remain unclear, even if metastatic lesions disappear with chemotherapy. Guideline of National Comprehensive Cancer Network also shows no principle after down-staging. Methods: This retrospective study examined 34 gastric cancer patients who underwent curative conversion surgery at our institute between 2005 and 2014. Clinicopathologic characteristics and patient outcomes were analyzed, with particular focus on the potential to select patients who might benefit from surgical resection. Results: The number of M1 factors was one in 31 patients and two in 3, including metastases to non-regional lymph node in 21, peritoneum in 8, liver in 5, and lung in 3. The regimen of chemotherapy was Docetaxel/CDDP/S-1 in 23 patients, Docetaxel/CDDP/S-1+Trastuzmab in 6, S-1/CDDP in 2, Docetaxel/S-1 in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. The median duration from initiation of chemotherapy to the operation was 114 days (range 37-653 days). Total gastrectomy was performed in 27 patients and distal gastrectomy was performed in 7 patients. Complete resection with no residual tumor (R0) was achieved in 23 of 34 patients, microscopic residual tumor status (R1) in 10, and macroscopic residual tumor (R2) in 1. The 3-year overall survival (OS) rate among the patients who underwent conversion therapy was 58.0% with MST of 1190 days. Univariate analysis among the patents with conversion surgery identified intestinal differentiation, pathological response grade≧1b, R0 resection as significant prognostic factors. Patients operated on more than 91 days from initiation of chemotherapy had the 3-year survival rate of 68.2%, compared to 40.0% for patients operated on less than 90 days. Conclusions: Our data demonstrate the increased 3-year survival rate associated with delayed conversion surgery for stage IV gastric cancer. Delayed conversion surgery should be considered for patients, even if metastatic lesions disappear with chemotherapy.

Prognostic value of baseline complete blood count components in advanced gastric cancer patients: A multicenter retrospective study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16528-e16528
Author(s):  
Shereef Ahmed Elsamany ◽  
Ahmed Zeeneldin ◽  
Emad Tashkandi ◽  
Ayman Ahamd Rasmy ◽  
Waleed Abozeed ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Serum Albumin ◽  
Cancer Patients ◽  
Eosinophil Count ◽  
Univariate Analysis ◽  
Metastatic Gastric Cancer ◽  
Neutrophil Percentage ◽  
Gastric Cancer Patients ◽  
Doublet Chemotherapy

e16528 Background: Gastric cancer (GC) is one of the most prevalent malignant types in the world and an aggressive disease with a poor 5-year survival. Pretreatment CBC-based biomarkers, including blood neutrophil, lymphocyte, monocyte, and platelet counts; hemoglobin (Hb) levels; and their combinations, such as the neutrophil-lymphocyte ratio(NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio (PLR), have been reported to reflect systemic and local inflammation associated with cancer progression and prognosis. There has been growing interest in using CBC-based measures as biomarkers for GC. Methods: This chart-review study aimed to evaluate the effect of baseline levels of different components of routine CBC examination as well as other patients and disease characteristics on progression free survival (PFS) and overall survival (OS) in metastatic gastric cancer patients. Total 135 metastatic gastric cancer patients who had diagnosed and treated in three oncology centers in Saudi Arabia from 2011 to 2016 were incorporated. Various potential prognostic factors had measured in univariate and multivariate analysis. Results: After a median follow up of 21.4 months, the median OS / PFS were 11.0 and 6.1 months, respectively. Higher albumin level ( > 3g/dl), low neutrophil percentage ≤ 75%, high lymphocyte percentage > 15%, neutrophil /lymphocyte ≤ 2.5, high eosinophil count > 0.4 k/ml, and EOX/EOF chemotherapy vs. doublet chemotherapy were associated with better PFS in univariate analysis. Conversely, in multivariate analysis, only serum albumin and eosinophil levels were related to PFS. In univariate analysis, higher serum albumin (3 g/dl), low neutrophil percentage ≤ 75%, high lymphocyte percentage > 15%, neutrophil/lymphocyte ≤2.5, high eosinophil count > 0.4 k/ml, receiving 1st line chemotherapy vs. no chemotherapy, receiving > 6 cycles of chemotherapy, receiving EOX/EOF chemotherapy vs. doublet chemotherapy, platelet count ≤450 k/ml, male gender were associated with better OS. In multivariate analysis, lower neutrophil percentage, higher serum albumin, male sex and higher number of chemotherapy cycles were independently associated with OS. Conclusions: Higher eosinophil level was associated with improved PFS while lower neutrophil percentage and higher number of chemotherapy cycles were independent predictors of OS. Higher albumin levels independently predicted better OS and PFS.

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