Gastric cancer patients treated by a general or gastric cancer surgical team: a comparative study

BACKGROUND: Although gastric cancer has been decreasing in incidence in many countries, it is still the second most common cause of cancer deaths worldwide. Its prognosis is poor and depends, among other factors, on early diagnosis as well as on surgeon expertise. AIM: To compare the outcomes of gastric cancer patients treated at a university hospital by a general surgical team and later on by a gastric cancer surgical team. METHODS: Gastric cancer patients were separated into two groups according to whether they were treated by a general surgical team (group 1, n = 136; 1984 to 1993) or by gastric cancer team (group 2, n = 149; 1994 to 2003). Clinical and pathologic features and survival rates were assessed. RESULTS: During a 20-year period, a decreased number of patients underwent surgical resection in the second period (94% vs 86%), a greater number of upper gastrointestinal endoscopies were performed resulting in an increased number of tumors diagnosed as stage I (5% vs 22%). Also, D2 gastrectomies were more frequently performed instead of D0 gastrectomies and negative surgical margins were adequate. Mortality decreased from 9% to 6% in group 1 and 2, respectively and adjuvant therapy has been considered. CONCLUSION: Surgical specialized units for gastric cancer are necessary if better results are to be expected since this approach definitely provides better patient care.

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Docetaxel plus FOLFOX4 compared with FOLFOX4 as adjuvant chemotherapy for gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.181 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 181-181

Author(s):

Chun-Xia Du ◽

Xiao-Yan Liu ◽

Hong-Gang Zhang ◽

Ai-Ping Zhou

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Survival Rates ◽

Subtotal Gastrectomy ◽

Disease Free Survival ◽

Adjuvant Radiation ◽

Ptnm Stage ◽

Gastric Cancer Patients

181 Background: To compare the efficacy of docetaxel plus FOLFOX4 to FOLFOX4 as adjuvant chemotherapy for gastric cancer patients. Methods: 320 patients with stage IB-IV (M0) gastric cancer were enrolled into the retrospective study. All patients received a total or subtotal gastrectomy with at least D1 lymph nodes dissection. 193 patients received FOLFOX4 as adjuvant chemotherapy. 127 patients received biweekly docetaxel plus FOLFOX4 (DOF regimen) as adjuvant chemotherapy. Docetaxel was administered at 40 mg/m2 on day 1, followed by FOLFOX4 regimen. Both of the regimens were repeated every 2 weeks for a maximum of 12 cycles. Results: In comparison with patients in FOLFOX4 group, patients in DOF group were relatively younger (p=.001), with more advanced disease in pN stage (p=.035) and pTNM stage (p=.031), received more cycles of adjuvant chemotherapy (p=.004), and had a higher percentage of adjuvant radiation (p =.002). After adjustment of unbalanced variables as mentioned above, no statistical difference was observed between DOF group and FOLFOX4 group in terms of 3-year disease-free survival (54% vs 69%, p = 0.100, HR 1.362, 95% CI (0.943-1.967)) and 3-year overall survival(70% vs 72%, p = 0.810, HR 1.049, 95% CI (0.711-1.548)). Stratified analysis according to clinicopathologic characters showed that there were almost no statistical differences of 3-year overall survival rates between two groups, except the primary site (middle 1/3) (p =.025) and pTNM stage (IIb stage) (p =.035) in favor of FOLFOX4 group. The incidences of grade 3/4 adverse events were obviously higher in DOF group than in FOLFOX4 group,including decreased appetite (18.1% V 10.4%, P = 0.046), diarrhea (4.7% V 0%, p=0.004 ), hypersensitivity reactions to oxaliplatin (3.1% V 0%, p=0.024) and neutropenia (47.3% V 31.6%, p=0.004). Conclusions: Compared to FOLFOX4 regimen, adjuvant docetaxel plus FOLFOX4 did not show significant survival advantages in gastric cancer patients. However, a more serious toxicity profile was observed in docetaxel plus FOLFOX4 arm. Further studies are needed to decide whether triplet regimen is appropriate as adjuvant chemotherapy of gastric cancer.

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Akt-mediated YB-1 phosphorylation induces resistance for chemotherapy of gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4554 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4554-4554

Author(s):

E. Oki ◽

Y. Kakeji ◽

E. Tokunaga ◽

R. Yoshida ◽

A. Egashira ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Binding Protein ◽

Chemotherapeutic Agents ◽

University Hospital ◽

Akt Activation ◽

Nuclear Expression ◽

Signal Transduction Inhibitors ◽

Phosphorylated Akt ◽

Gastric Cancer Patients

4554 Background: Y-box-binding protein 1 (YB-1), a member of the DNA-binding protein family which contains a cold-shock domain, has pleiotropic functions in response to stimuli of the AKT/PI3K signal pathway. We have previously described a pathway that involves PTEN/AKT/PI3K, thereby mediating chemoresistance in gastric cancer patients. We studied the Akt-mediated YB-1 phosphorylation and resistance to anti-cancer drugs for the treatment of gastric cancer. Methods: Primary gastric carcinoma tissue and the corresponding normal mucosa were both obtained from 81 gastric cancer patients who underwent surgery in the Department of Surgery II at Kyushu University Hospital from the years 1996 to 2000. YB-1 nuclear expression was investigated by immunostaining while AKT activation was investigated by immunostaining with a phosphorylation-specific antibody. The chemotherapeutic sensibilities of these patients were investigated using an MTT assay. LOH of PTEN was studied using a DNA sequencer with D10S796 and D10S1173 microsatellite markers in the same samples. Results: We found the activated AKT to be associated with an increased resistance to multiple chemotherapeutic agents, including those currently used on gastric cancer patients (5-fluorouracil, adriamycin, mitomycin C, and cis-platinum). The YB-1 nuclear expression was recognized in some patients and they closely correlated with a high expression of phosphorylated AKT. A high level of AKT phosphorylation (activated AKT) correlated closely with the LOH of PTEN (p < 0.0008), and the prognosis of patients who had LOH of PTEN was significantly poor in comparison to the other patients. Conclusions: The results of this study indicate that AKT activation and LOH of PTEN mediated the YB-1 activation, thus suggesting that they play an important role in conferring broad-spectrum chemoresistance in gastric cancer patients. These findings thus support the carrying out of new clinical trials for investigations of combination chemotherapy using conventional drugs with a new generation of signal transduction inhibitors. No significant financial relationships to disclose.

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Use of perioperative therapy in gastric cancer: A retrospective comparison of ECF and chemoradiation.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.112 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 112-112

Author(s):

V. Siripurapu ◽

J. C. Watson ◽

J. P. Hoffman

Keyword(s):

Gastric Cancer ◽

Median Survival ◽

Locally Advanced ◽

Survival Rates ◽

Pathologic Complete Response ◽

Preoperative Treatment ◽

Perioperative Therapy ◽

Significant Group ◽

Group 2 ◽

Group 1

112 Background: Gastric Cancer (GC) remains a major cause of cancer related morbidity and mortality in Western Countries with five year survival rates between 30%-40%. Preoperative therapy has been championed by groups extrapolating data from the Intergroup 0116 and the MAGIC trials, with a view to enhancing completion of therapy and improving survival in locally advanced tumors. Methods: Patients with preoperative treatment of GC were reviewed from our tumor registry. Stages were assigned by AJCC 7th edition. A comparison between the ECF regimen and non-ECF chemoradiation regimens was performed to view patterns of pathologic complete response (pCR), recurrence, toxicity and overall survival. Results: Forty-two patients were identified and stratified into two groups; Group 1 ECF treatment arm (n = 16) compared to group 2 non-ECF chemo-radiation arm (n = 26). No statistical difference was noted in age, ethnicity or stage stratification. All of Group 1 received their chemotherapy regimen after 2005. In contrast, 60% of Group 2 patients received their treatment pre-2005. Only 56% the ECF group completed their treatment course (19% received other postoperative therapy). Seventy percent of group 2 received adjuvant chemotherapy. A grade 2 or higher toxicity was noted in 16% of Group 1 compared to 60% in Group 2 (p = 0.035). Seven complications were noted in the group 1 compared to 10 in group 2 (p = NS). The differentiation of tumor between groups was not significant (p = 0.97). Length of stay was significant (Group 1:9 days, Group 2:12 days, p = 0.02). More nodes were retrieved from group 1 versus group 2 (20.2 versus 15.2, p = 0.03). Group 1 had 3 recurrences (19%) while Group 2 had 11 recurrences (42%, p = 0.94). In both groups 80% of recurrences were distant. Group 1 had a 19% pCR versus 23% in group 2 (p = 0.79). Two-year survival was 70% in both groups, with a median survival of 51 months for group 2. Median survival was not reached for group 1. Conclusions: No difference was noted in pCR, recurrences, or survival between these two regimens. If this can be confirmed in larger, prospective, randomized trials, use of radiation and its potential morbidity may be avoided. No significant financial relationships to disclose.

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Association of activin type II receptor mutation with microsatellite instability in gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e23191 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e23191-e23191 ◽

Cited By ~ 1

Author(s):

Kizuki Yuza ◽

Masayuki Nagahashi ◽

Hiroshi Ichikawa ◽

Masato Nakajima ◽

Takaaki Hanyu ◽

...

Keyword(s):

Gastric Cancer ◽

Microsatellite Instability ◽

Cancer Patients ◽

Strong Association ◽

High Status ◽

Type Ii ◽

Wild Type ◽

Number Of Patients ◽

Significant Difference ◽

Gastric Cancer Patients

e23191 Background: Microsatellite instability-high status (MSI-H) and alterations in the DNA mismatch repair pathway associate with the efficacy of 5-FU and immune checkpoint inhibitors in patients with gastrointestinal cancers. The activin type II receptor (ACVR2) that binds to the transforming growth factor beta superfamily of ligands is frequently mutated in MSI-H colorectal cancer. However, the incidence of ACVR2 mutations in gastric cancer patients remains unclear. The aim of this study is to reveal the incidence and to examine the association between the MSI-H and ACVR2A mutations in gastric cancer patients. Methods: 124 archived FFPE gastric cancer tissues (stage I-IV), who were operated at Niigata University Medical and Dental Hospital or Niigata Cancer Center Hospital, were analyzed for ACVR2A mutation and MSI status with the NGS-based comprehensive genomic test platform. Clinicopathological characteristics of the patients were also examined. Results: All 124 gastric cancer patients were successfully analyzed. 13 out of 124 patients (10.4%) showed MSI-H status. Interestingly, 10 of 13 MSI-H patients (76.9%) showed ACVR2A mutation, where none (0%) was found among patients with microsatellite stable status (P < 0.001), indicating the strong association between ACVR2A mutation and MSI status in gastric cancer patients. In the ACVR2A mutated group, there was a female predominance (P < 0.05), and cancers of the lower part of the stomach were more common (P < 0.05), compared with the wild type group. Only one of 10 patients with ACVR2A mutation died, and the patients with ACVR2A mutation show a 5-year overall survival rate of 90%. No statistically significant difference in survival was achieved between patients with ACVR2A mutation and wild type; this is probably due to the small number of patients. Conclusions: 10 of 13 MSI-H patients showed ACVR2A mutation. Our results indicate a strong association between ACVR2A mutation and MSI-H in gastric cancer patients.

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INNV-09. CLINICAL EFFICACY OF TUMOR TREATING FIELDS FOR NEWLY DIAGNOSED GLIOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noz175.552 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi132-vi132

Author(s):

Yang Liu ◽

Myla Strawderman ◽

Kwanza Warren ◽

Margie Richardson ◽

Jennifer Serventi ◽

...

Keyword(s):

Cox Model ◽

Performance Status ◽

Survival Rates ◽

Poisson Model ◽

Newly Diagnosed ◽

Tumor Treating Fields ◽

Number Of Patients ◽

Group 2 ◽

Stupp Protocol ◽

Group 1

Abstract Recent clinical trials demonstrated that adding tumor treating fields (TTF) to radiotherapy and temozolomide chemotherapy (the Stupp protocol) increased survival for glioblastoma (GBM) patients. However, data is lacking on the magnitude of this survival effect when the regimen is used outside of a clinical trial as part of routine clinical practice. In the present study, we retrospectively identified adult patients with newly diagnosed GBM (n = 240) treated with the Stupp protocol at our institution from January 2005 to July 2017. We grouped patients into two time periods for comparison: 2005–2013 (group 1, Stupp protocol) and 2014–2017 (group 2, TTF+ Stupp protocol). Thirty-six percent (37/104) of patients in group 2 received TTF in conjunction with the Stupp protocol. Within group 2, the 37-patients who received TTF + Stupp had increased 6-month and 1-year survival rates compared to the 67-patients who received Stupp alone (97.1% vs. 75.7%, p = 0.006; 67.6% vs. 53.7%, p = 0.170, respectively). The improvement of survival rate at 6-month was further confirmed by a modified Poisson model (RR: 1.23, p = 0.010) adjusting for sex, age, performance status and extent of resection. However, we did not observe improvements in overall survival (OS) with a Cox model with TTF treatment modeled as a time-dependent covariate (HR = 0.87, p = 0.599). Furthermore, we did not find that the addition of TTF as a treatment option in our center significantly improved OS for patients in group 2 when compared to those in group 1 (429.0 vs. 395.0 days, p = 0.138). Therefore, while adding TTF to the Stupp protocol appeared to benefit patients with newly diagnosed GBM, this effect may be largely due to selection bias. Comprehensive studies including large number of patients as well as longer follow-up time are needed to validate our results.

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Long-term clinicopathological prognosis on 609 cases after gastrectomy: A 10-year follow up single-institutional retrospective analysis

10.21203/rs.3.rs-15857/v1 ◽

2020 ◽

Author(s):

Guoxiao Liu ◽

Hao Cui ◽

Wang Zhang ◽

Bo Cao ◽

Zhida Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Cancer Patients ◽

Vascular Invasion ◽

Univariate Analysis ◽

Survival Rates ◽

Nerve Invasion ◽

Pn Stage ◽

Gastric Cancer Patients ◽

Degree Of Differentiation

Abstract Objective: This retrospective study focused on relevant factors about gastric cancer patients who underwent gastrectomy after 10 years, which showed great significance of prolonging survival time of gastric cancer patients. Methods: 609 gastric cancer patients after surgery were recruited from January, 2005 to December, 2007. They were perfectly followed and their clinicopathological data were collected. Univariate analysis was performed using Log-rank test in order to compare survival rates between or among groups. The outcomes with statistical significance (P<0.05) were screened out. Cox regression model was employed for survival multivariate analysis. Forward stepwise LR analysis was used to screen the factors influencing survival qualities of relevant patients after surgery. Results: Univariate analysis indicated that prognosis was correlated with age, pT stage, pN stage, pM stage, tumor size, location, type of gastrectomy, degree of differentiation, vascular invasion, nerve invasion, radical treatment, chemotherapy, radiotherapy, pTNM stage and BMI (P＜0.05). Multivariate analysis showed that pT stage, pN stage, pM stage, degree of differentiation, vascular invasion, nerve invasion, radical treatment, chemotherapy, radiotherapy, pTNM stage were independent prognostic factors of GC patients (P＜0.05). Conclusions: The 10-year survival rates of gastric cancer patients are primarily determined by tumor progression. Appropriate treatment can improve prognosis of patients. Early diagnosis of gastric cancer and prompt implementation of radical surgery and adjuvant chemotherapy are essential for increasing survival rates. This study provides a promising direction for future basic researches.

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Intervention Effect of Probiotics in Gastric Cancer Patients with Complications of Coronary Heart Disease and Heart Failure

Journal of Oncology ◽

10.1155/2021/1620891 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Hui Yu ◽

Anqin Dong ◽

Luosha Zhao ◽

Ping Li ◽

Qiujun Zhang ◽

...

Keyword(s):

Heart Failure ◽

Gastric Cancer ◽

Coronary Heart Disease ◽

Heart Disease ◽

Control Group ◽

Observation Group ◽

Group A ◽

Group 2 ◽

Gastric Cancer Patients ◽

Group 1

Objective. To investigate the characteristics of intestinal flora in patients with gastric cancer complicated by coronary heart disease and heart failure and the guiding value of probiotics intervention for clinical treatment. Methods. (1) One hundred and sixty-eight gastric cancer patients with complications of coronary heart disease and heart failure from August 2017 to December 2020 were selected as the observation group. A total of 125 patients with coronary heart disease treated at the same time were selected as control group 1, and 89 healthy subjects were selected as control group 2. Fecal samples were retained to extract the total RNA, and high-throughput sequencing was applied to complete the analysis of microbial diversity and structure differences, so as to obtain the biological species information of the specimens. (2) Patients in the observation group were randomly divided into two equal groups of 84 patients, namely, group A and group B. Group A was treated with conventional methods, and group B was combined with probiotics intervention on the basis of group A; then, the differences in the intestinal mucosal barrier between the two groups were compared. Results. The Chao, ACE, and Simpson index in the observation group were lower than those in control group 1 ( P < 0.05 ), and the Shannon index was higher than that in control group 1 ( P < 0.05 ). The Chao, ACE, and Shannon index in control group 1 were lower than those in control group 2 ( P < 0.05 ), whereas the Simpson index was higher than in control group 2 ( P < 0.05 ). The abundance of Bacteroidetes in the observation group was lower than that in control group 1 and control group 2 ( P < 0.05 ). The abundance of Firmicutes was higher than that of control group 1 and control group 2 ( P < 0.05 ). Four weeks after treatment, the levels of ET, D-lactic acid, and PCT in the group B were (0.10 ± 0.01), (3.99 ± 0.32), and (0.41 ± 0.10), respectively, which were lower than those in group A (0.19 ± 0.03), (4.51 ± 0.46), and (0.81 0.13). Conclusion. Gastric cancer patients with complications of coronary heart disease and heart failure are associated with intestinal flora disorder, which may be involved in the occurrence and development of the disease. Probiotics intervention is helpful to repair the intestinal mucosal barrier in patients, which is worthy of popularization and application.

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Diagnostic Significance of Serum Eotaxin-1 Level in Gastric Cancer Patients

Disease Markers ◽

10.1155/2013/274515 ◽

2013 ◽

Vol 35 ◽

pp. 363-367 ◽

Cited By ~ 10

Author(s):

Ümit Koç ◽

Erdinç Çetinkaya ◽

Erdal B. Bostanci ◽

Ahu S. Kemık ◽

Mesut Tez ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Inflammatory Diseases ◽

Prognostic Significance ◽

Delayed Diagnosis ◽

Positive Lymph Node ◽

Diagnostic Significance ◽

Number Of Patients ◽

Gastric Cancer Patients

Introduction. Gastric cancer is the second cause of cancer-related deaths worldwide. Delayed diagnosis leads to high mortality rates. Eotaxin-1 was originally discovered as an eosinophil-selective chemoattractant and may play a role in a number of chronic inflammatory diseases, cancer, and other gastrointestinal disorders. The aim of this study was to analyse diagnostic and prognostic significance of serum eotaxin-1 (s-eotaxin-1) levels in gastric cancer.Methods. Sixty gastric cancer patients and 69 healthy subjects were included into the study. S-eotaxin-1 levels were compared with clinicopathological features and outcomes in gastric cancer.Results. Serum levels of eotaxin-1 in gastric cancer patients were significantly higher than controls ( pg/mL versus pg/mL, respectively ()). The s-eotaxin-1 levels did not differ significantly with histopathological grade, tumor-node-metastasis (TNM) stage, tumor localization, lymph node metastases, positive lymph node ratio, size, perineural and perivascular invasion. So there is no relationship found between s-eotaxin-1 level and prognosis.Conclusion. S-eotaxin-1 levels may be used as an easily available biomarker for gastric cancer risk and may alert physicians for early diagnosis. Due to the limited number of patients included in this study, larger cohort studies are warranted to validate the diagnostic value of s-eotaxin-1 level in gastric cancer.

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Impact of PTEN/AKT/PI3K signal pathway on the chemotherapy for gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.4034 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 4034-4034 ◽

Cited By ~ 1

Author(s):

E. Oki ◽

Y. Kakeji ◽

E. Tokunaga ◽

K. Nishida ◽

T. Koga ◽

...

Keyword(s):

Gastric Cancer ◽

Signal Transduction ◽

Cancer Patients ◽

Mtt Assay ◽

Signal Transduction Pathway ◽

Chemotherapeutic Agents ◽

University Hospital ◽

Akt Activation ◽

Signal Transduction Inhibitors ◽

Gastric Cancer Patients

4034 Background: Growth factor receptor-mediated signal transduction has been recently implicated in conferring resistance to conventional chemotherapy on cancer cells. We have described a pathway that involves AKT/PI3K to mediate chemoresistance in gastric cancer patients. The phosphatase activity of PTEN is crucial in controlling the phosphatidylinositol-3 (PI-3) kinase signal transduction pathway and in the activation of the protein kinase B(PKB/Akt) proto-oncogene. This indicates that PTEN exerts its tumor-suppressor function by negatively regulating the anitapoptotic PI3-kinase/AKT signaling pathway. Methods: Primary gastric carcinoma tissues and corresponding normal mucosa were obtained from 119 gastric cancer patients who underwent surgery in the Department of Surgery II in Kyushu University Hospital from the years 1996 to 2000. Methylation of PTEN was studied with methylation-specific PCR and LOH (loss of heterozygosity) of PTEN was studied using a DNA sequencer with D10S796 and D10S1173 microsatellite marker in the same samples. AKT activation was investigated by immunostaining with a phosphorylation-specific antibody. The chemotherapeutic sensibilities of these patients were investigated using an MTT assay. Results: We found that methylation of PTEN was rarely recognized, However, the gastric cancer patients who had a higher AKT phosphorylation (activated AKT) appeared to have LOH of PTEN (p < 0.0008), and the prognosis of the patient who has LOH of PTEN was significantly poor. When the chemotherapeutic sensibilities of these patients were studied in an MTT assay, it was found that the activated AKT was associated with increased resistance to multiple chemotherapeutic agents, which included those currently used on gastric cancer patients (5-fluorouracil, adriamycin, mitomycin C, and cis-platinum). Conclusions: The results of this study indicate that AKT activation and LOH of PTEN plays an important role in conferring a broad-spectrum chemoresistance in gastric cancer patients. It also indicates that clinical trials for an appropriate chemotherapy combination with conventional drugs and a new generation of signal transduction inhibitors that inhibit the PTEN/AKT pathway should be considered in treating gastric cancer in the near future. No significant financial relationships to disclose.

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