scholarly journals EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

2013 ◽  
Vol 50 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Wilson Luiz da COSTA JUNIOR ◽  
Felipe José Fernández COIMBRA ◽  
Thales Paulo BATISTA ◽  
Héber Salvador de Castro RIBEIRO ◽  
Alessandro Landskron DINIZ
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Continuous Variable ◽  
Lymphatic Spread ◽  
Adjuvant Chemoradiotherapy ◽  
D2 Gastrectomy ◽  
C Statistic ◽  
Cox's Regression ◽  
Area Under Roc Curve ◽  
Gastric Cancer Patients

ContextWhether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial.ObjectiveTo explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy.MethodsA retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol) at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis.ResultsOur analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable) presented “area under ROC curve” (AUC) of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092).ConclusionsThis study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%).

scholarly journals D2‐resected stage IIIc gastric cancer patients benefit from adjuvant chemoradiotherapy

2016 ◽  
Vol 5 (10) ◽  
pp. 2773-2780 ◽  
Author(s):  
Jin Peng ◽  
Yuehua Wei ◽  
Fuxiang Zhou ◽  
Jing Dai ◽  
Yahua Zhong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Adjuvant Chemoradiotherapy ◽  
Stage Iiic ◽  
Resected Stage ◽  
Gastric Cancer Patients

scholarly journals Competing risk nomogram predicting initial loco-regional recurrence in gastric cancer patients after D2 gastrectomy

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Shu-Bei Wang ◽  
Wei-Xiang Qi ◽  
Jia-Yi Chen ◽  
Cheng Xu ◽  
Youlia M. Kirova ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Competing Risk ◽  
Regional Recurrence ◽  
D2 Gastrectomy ◽  
Gastric Cancer Patients

Phase II feasibility study of adjuvant S-1 plus docetaxel for stage III gastric cancer patients after curative D2 gastrectomy (OGSG 1002).

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e15032-e15032
Author(s):  
Jin Matsuyama ◽  
Kazumasa Fujitani ◽  
Shigeyuki Tamura ◽  
Yutaka Kimura ◽  
Hiroshi Imamura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Feasibility Study ◽  
Phase Ii ◽  
Stage Iii ◽  
D2 Gastrectomy ◽  
Gastric Cancer Patients

scholarly journals Tumor Size Is a Critical Factor in Adjuvant Chemotherapy for T3-4aN0M0 Gastric Cancer Patients after D2 Gastrectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Shi Chen ◽  
Li-Ying Ou-Yang ◽  
Run-Cong Nie ◽  
Yuan-Fang Li ◽  
Jun Xiang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Tumor Size ◽  
Critical Factor ◽  
Tumor Location ◽  
D2 Gastrectomy ◽  
T Stage ◽  
Gastric Cancer Patients

Aim.To investigate whether tumor size is a reasonable indication for adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy.Method. We performed a retrospective study of 269 patients with a histological diagnosis of T3-4aN0M0 stage gastric cancer who underwent D2 radical surgery at the Sun Yat-sen University Cancer Center or the Sixth Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2010. The follow-up lasted until June of 2015. Chi-square tests and Kaplan-Meier methods were employed to compare the clinicopathological variables and prognoses.Result. For this group of patients, univariate analyses revealed that tumor size (p<0.001), pathological T stage (p<0.001), and tumor location (p=0.025) were significant prognostic factors. Adjuvant chemotherapy did not exhibit prognostic benefits. For patients with tumors larger than 5 cm, univariate analysis revealed that tumor location (p=0.007), Borrmann type (p=0.039), postoperative chemotherapy (p=0.003), and pathological T stage (p<0.001) were significant prognostic factors. Multivariate analysis revealed that postoperative chemotherapy and pathological T stage were independent prognostic factors.Conclusion. Our results imply that tumor size should be a critical factor in the decision to utilize adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy. Additional randomized controlled trials are required before this conclusion can be considered definitive.

Risk Factors for Peritoneal Recurrence in Stage II/III Gastric Cancer Patients Who Received S-1 Adjuvant Chemotherapy After D2 Gastrectomy

2011 ◽  
Vol 19 (5) ◽  
pp. 1568-1574 ◽  
Author(s):  
Toru Aoyama ◽  
Takaki Yoshikawa ◽  
Tsutomu Hayashi ◽  
Hiroshi Kuwabara ◽  
Yo Mikayama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Peritoneal Recurrence ◽  
Stage Ii ◽  
D2 Gastrectomy ◽  
Gastric Cancer Patients

Surgery-induced peritoneal metastasis and its intraoperative treatment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4092-4092
Author(s):  
Satoshi Murata ◽  
Katsushi Takebayashi ◽  
Masatsugu Kojima ◽  
Hiroshi Yamamoto ◽  
Tsuyoshi Yamaguchi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Cells ◽  
Advanced Gastric Cancer ◽  
Cancer Patients ◽  
Peritoneal Cavity ◽  
Peritoneal Metastasis ◽  
Curative Gastrectomy ◽  
Ki 67 ◽  
D2 Gastrectomy ◽  
Gastric Cancer Patients

4092 Background: A large number of advanced gastric cancer patients undergoing curative gastrectomy with D2 lymph node dissection (D2 gastrectomy) show peritoneal metastasis. The source of these metastatic cells and their treatment remain unclear. We examined the mechanism of surgery-induced peritoneal metastasis and determined the appropriate intraoperative treatment. Methods: (1) Curative gastrectomy was performed for 102 gastric cancer patients. Peritoneal lavage fluid was collected before and after gastrectomy. Cytology, RT-PCR, and cell culture were used to determine the presence of cancer cells. Proliferative potential of tumor cells was evaluated using Ki-67 staining. Tumorigenic capacity was assessed by cell injection into the peritoneal cavity of NOD/ShiJic-scid mice. (2) Fifty clinical T3(SE) or T4(SI) advanced gastric cancer patients undergoing curative D2 gastrectomy prospectively received intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in a phase II trial. HIPEC comprised 50 mg CDDP, 10 mg MMC, and 1000 mg 5-FU in 5 L saline maintained at 42–43C° for 30 min. Results: (1) Of 102 peritoneal lavage fluid samples obtained before gastrectomy, 57 from both early and advanced cancer patients did not contain CEA or CK20 mRNA amplification products or cancer cells. Of these 57 samples, CEA or CK20 mRNA was detected in 35 and viable cancer cells were identified in 24 after gastrectomy. Viable cancer cells in all 24 cases showed Ki-67 positivity, indicating proliferative activity. Cultured viable cancer cells developed into peritoneal tumor nodules after spill over into the peritoneal cavity in NOD/ShiJic-scid mice. (2) Fifty patients were eligible for the phase II clinical trial. The overall 5-year survival rate for all patients was 92.4%. This rate in patients with pT2(ss) (n = 12), pT3(se) (n = 35), and pT4(si) (n = 3) disease was 90.0%, 92.3%, and 100%, respectively. Only 2 patients (4%) showed peritoneal relapse. Conclusions: Viable tumorigenic cancer cells spilled over the peritoneal cavity during curative gastrectomy. Intraoperative HIPEC following curative D2 gastrectomy effectively prevented peritoneal metastasis, thereby potentially improving the prognosis of patients with advanced gastric cancer.

A western validation of a novel gastric cancer prognostic model using American data.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 2-2
Author(s):  
Bryan S. Goldner ◽  
Ki Jun Song ◽  
Taeil Son ◽  
Hyoung-Il Kim ◽  
Laleh Melstrom ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Prediction Model ◽  
Cancer Patients ◽  
Staging System ◽  
Tnm Staging ◽  
Prediction Tool ◽  
C Statistic ◽  
Tnm Staging System ◽  
Gastric Cancer Patients

2 Background: A novel prediction model, the Yonsei University Gastric Cancer Prediction Tool was developed by an international collaborative group (G6+) for accurate determination of 5-year overall survival of gastric cancer patients. This prediction model was created using a prospectively maintained single institution database of 12,399 patients and included clinically relevant factors not accounted for in the TNM staging system. This prediction model was validated using external data sets from Asia; its’ applicability in the American population has yet to be determined through a validated data set. Methods: Using the SEER dataset, 2014 release, all patients with gastric adenocarcinoma diagnosed between the years 2002 –2012 who underwent resection were selected. The following characteristics were selected for analysis: age, sex, gender, depth of tumor invasion, number of positive lymph nodes, total lymph nodes retrieved, presence of distant metastasis, extent of resection, and histology. These data were processed through a recently published prognostic nomogram to obtain concordance index (C-statistic) using the bootstrap method and calibration was assessed. This was compared to the current prognostic index, the TNM staging system. Results: A total of 26,019 possible patients were identified from the SEER database, years 2002-2012. Of these, 11,765 had complete datasets. Validation of the prognostication model revealed a C-statistic of 0.762 (95% CI 0.754-0.769). This is compared to the 7thTNM staging model, C-statistic 0.683 (95% CI 0.677-0.689). The new nomogram was found to be significantly more accurate with a p-value of < 0.001. Conclusions: Our study validates a novel prediction model for gastric cancer in the American patient population. Using this model, superior accuracy in prognosticating the 5-year survival of gastric cancer patients was confirmed in the western cohort strongly supporting its global applicability. This model also allows for inclusion of those who did not undergo adequate lymphadenectomy or who underwent a non-curative resection and can be a useful prediction tool for an increasing number of gastric cancer patients world-wide.

The Prognostic Significance of an R1 Resection in Gastric Cancer Patients Treated with Adjuvant Chemoradiotherapy

2013 ◽  
Vol 21 (4) ◽  
pp. 1107-1114 ◽  
Author(s):  
Jurriën Stiekema ◽  
Anouk K. Trip ◽  
Edwin P. M. Jansen ◽  
Henk Boot ◽  
Annemieke Cats ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Prognostic Significance ◽  
Adjuvant Chemoradiotherapy ◽  
R1 Resection ◽  
Gastric Cancer Patients
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