scholarly journals Mismatch Repair Deficiency, Chemotherapy and Survival for Resectable Gastric Cancer: an Observational Study from the German staR Cohort and a Meta-Analysis

2021 ◽  
Author(s):  
Thilo Stolze ◽  
Sabine Franke ◽  
Johannes Haybaeck ◽  
Markus Moehler ◽  
Peter P. Grimminger ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Mismatch Repair ◽  
Survival Data ◽  
Meta Analysis ◽  
Predictive Biomarker ◽  
Perioperative Chemotherapy ◽  
Medline Search ◽  
Siewert Type Ii ◽  
Prognostic Effect ◽  
Chemotherapy Patients

Abstract Purpose. In a post hoc analysis of the MAGIC trial, patients with curatively resected gastric cancer (GC) and mismatch repair (MMR) deficiency (MMRd) had better median overall survival (OS) when treated with surgery alone but worse median OS when treated with additional chemotherapy. Further data are required to corroborate these findings.Methods. Between April 2013 and December 2018, 458 patients with curatively resected GC, including cancers of the esophagogastric junction Siewert type II and III, were identified in the German centers of the staR consortium. Tumor sections were assessed for expression of MLH1, MSH2, MSH6 and PMS2 by immunohistochemistry. The association between MMR status and survival was assessed. Similar studies published up to January 2021 were then identified in a MEDLINE search for a meta-analysis. Results. MMR-status and survival data were available for 223 patients (median age 66 years, 62.8% male), 23 patients were MMRd (10.3%). After matching for baseline clinical characteristics, median OS was not reached in any subgroup. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd and MMRp had a HR of 0.67 (95% CI: 0.13-3.37, P=0.63) and 1.44 (95% CI: 0.66-3.13, P=0.36), respectively. The meta-analysis included pooled data from 385 patients. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd had an improved OS with a HR of 0.36 (95% CI: 0.14-0.91, P=0.03), whereas those with MMRp had a HR of 1.18 (95% CI: 0.89-1.58, P=0.26).Conclusion. Our data support a positive prognostic effect for MMRd in GC patients treated with surgery only and a differentially negative prognostic effect in patients treated with perioperative chemotherapy. MMR status determined by preoperative biopsies may be used as a predictive biomarker to select patients for perioperative chemotherapy in curatively resectable GC.

scholarly journals Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Joseph Cowling ◽  
Bethany Gorman ◽  
Afrah Riaz ◽  
James R. Bundred ◽  
Sivesh K. Kamarajah ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Survival Data ◽  
Meta Analysis ◽  
Outlet Obstruction ◽  
Survival Outcomes ◽  
Operative Outcomes ◽  
Palliative Gastrectomy ◽  
Resectional Surgery ◽  
Improvement In Survival

Abstract Background Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding. Methods We conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136). Results One hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent non-resectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus non-resectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar peri-operative mortality rates to non-resectional surgery. Conclusion Palliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications.

scholarly journals The Efficacy and Safety of (Neo)Adjuvant Therapy for Gastric Cancer: A Network Meta-analysis

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 80 ◽  
Author(s):  
Tom van den Ende ◽  
Emil ter Veer ◽  
Mélanie Machiels ◽  
Rosa Mali ◽  
Frank Abe Nijenhuis ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Curative Resection ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Perioperative Chemotherapy ◽  
Curative Intent ◽  
Radio Therapy ◽  
Credible Intervals ◽  
Resectable Gastric Cancer

Background: Alternatives in treatment-strategies exist for resectable gastric cancer. Our aims were: (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to August 2017 for randomized-controlled-trials on the curative treatment of resectable gastric cancer. We performed two network-meta-analyses (NMA). NMA-1 compared perioperative, neoadjuvant and adjuvant strategies only if there was a direct comparison. NMA-2 compared different adjuvant chemo(radio)therapy regimens, after curative resection. Overall-survival (OS) and disease-free-survival (DFS) were analyzed using random-effects NMA on the hazard ratio (HR)-scale and calculated as combined HRs and 95% credible intervals (95% CrIs). Results: NMA-1 consisted of 9 direct comparisons between strategies for OS (14 studies, n = 4187 patients). NMA-2 consisted of 16 direct comparisons between adjuvant chemotherapy/chemoradiotherapy regimens for OS (37 studies, n = 10,761) and 14 for DFS (30 studies, n = 9714 patients). Compared to taxane-based-perioperative-chemotherapy, surgery-alone (HR = 0.58, 95% CrI = 0.38–0.91) and perioperative-chemotherapy regimens without a taxane (HR = 0.79, 95% CrI = 0.58–1.15) were inferior in OS. After curative-resection, the doublet oxaliplatin-fluoropyrimidine (for one-year) was the most efficacious adjuvant regimen in OS (HR = 0.47, 95% CrI = 0.28–0.80). Conclusions: For resectable gastric cancer, (1) taxane-based perioperative-chemotherapy was the most promising treatment strategy; and (2) adjuvant oxaliplatin-fluoropyrimidine was the most promising regimen after curative resection. More research is warranted to confirm or reproach these findings.

scholarly journals Prognostic Role of Gastrectomy in Patients With Gastric Cancer With Positive Peritoneal Cytology

2014 ◽  
Vol 99 (6) ◽  
pp. 830-834 ◽  
Author(s):  
Okihide Suzuki ◽  
Minoru Fukuchi ◽  
Erito Mochiki ◽  
Toru Ishiguro ◽  
Jun Sobajima ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Metastatic Disease ◽  
Survival Data ◽  
Median Overall Survival ◽  
Peritoneal Cytology ◽  
Prognostic Effect ◽  
Positive Peritoneal Cytology ◽  
Optimal Treatment Strategy

Abstract This retrospective study identified the optimal treatment strategy for patients with gastric cancer with positive peritoneal cytology. We analyzed clinicopathologic and survival data for 54 patients who had undergone gastrectomy and/or chemotherapy for treatment of gastric cancer with positive peritoneal cytology with (n = 40) or without (n = 14) metastatic disease. The median overall survival did not differ significantly between patients with gastric cancer with positive peritoneal cytology with and without metastatic disease (19 versus 13 months, respectively). Among 14 clinicopathologic variables, the lack of gastrectomy was the only significant independent unfavorable factor for survival (odds ratio, 1.64; 95% confidence interval, 1.04–2.57; P = 0.03). The median overall survival significantly differed among patients who had undergone gastrectomy plus chemotherapy, chemotherapy alone, and gastrectomy alone (25, 10, and 17 months, respectively; P &lt; 0.01). Gastrectomy may be optimal for patients with (gastric cancer with positive peritoneal cytology), considering its favorable prognostic effect with respect to perioperative chemotherapy.

scholarly journals Adjuvant Chemotherapy for Gastric Cancer Patients with Mismatch Repair Deficiency or Microsatellite Instability: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Runcong Nie ◽  
Shuqiang Yuan ◽  
Jin Won Kim ◽  
Yun Wang ◽  
Guoming Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Microsatellite Instability ◽  
Cancer Patients ◽  
Mismatch Repair ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Poor Response ◽  
Cox Models ◽  
Level Data

Abstract Background: Mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H) serves as a predictor poor response to adjuvant chemotherapy in stage II colon cancer patients. Our objective was to investigate the efficacy of adjuvant chemotherapy in dMMR/MSI-H gastric cancer (GC). Methods: We searched literatures through December, 2020 to identify clinical studies that reported survival comparing adjuvant chemotherapy with surgery alone in dMMR/MSI-H GCs. Two approaches were used to pool the hazard ratio (HR) of survival: (1) If Kaplan-Meier curves and number at risk were provided, individual patient data were extracted. Cox models were used to calculate the HR with 95% confidence interval (CI); (2) for study-level data, pooled HR was estimated using fixed/random-effects models. Results: Six clinical studies were identified. For dMMR/MSI-H versus mismatch repair proficient (pMMR)/microsatellite stable (MSS)/microsatellite instability-low (MSI-L), the estimated 5-years DFS were 74.2% versus 51.5% (HR, 0.44; 95% CI, 0.32-0.62; P < 0.001); the estimated 5-years OS were 60.8% versus 50.1% (HR, 0.72; 95% CI, 0.60-0.88; P = 0.001). At study-level data, the pooled HRs were 0.42 for DFS (95% CI, 0.31-0.57; P < 0.001) and 0.66 for OS (95% CI, 0.32-1.38; P = 0.268). For adjuvant chemotherapy versus observation in dMMR/MSI-H, the estimated 5-years DFS were 76.1% versus 73.3% (HR, 0.72; 95% CI, 0.45-1.15; P = 0.171); the estimated 5-years OS were 74.9% versus 60.2% (HR, 0.60; 95% CI, 0.44-0.83; P = 0.001). Significant survival differences were also observed at study-level. Conclusions: This study further suggested adjuvant chemotherapy could be beneficial even in dMMR/MSI-H GC patients.

scholarly journals Prognostic Value of lncRNA PVT1 for Patients with Gastric Cancer: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jinyong Hao ◽  
Bo Yuan ◽  
Yani Gou ◽  
Jichun Ma ◽  
Xiaojun Huang
Keyword(s):  
Gastric Cancer ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Predictive Biomarker ◽  
Clinicopathological Characteristics ◽  
Expression Level ◽  
Cochrane Library ◽  
Human Gastric Cancer ◽  
Invasion Depth ◽  
Study Results

Objective. To evaluate the prognostic value of lncRNA PVT1 for patients with gastric cancer. Methods. A comprehensive literature searching was performed in PubMed, Cochrane Library, Web of Science, Embase, CNKI, CBM, and Wanfang Database to identify published studies on the expression level of lncRNA PVT1 in human gastric cancer. STATA 12.0 was conducted to perform the meta-analysis. Clinical outcomes including patients’ age, genders, TNM stage, OS, and DFS were assessed in the study. Results. A total of 8 studies involving 747 patients were included in this meta-analysis. The results of meta-analysis showed that higher expression level of lncRNA PVT1 was associated with GC patients’ gender (for male: OR = 2.27 , 95% CI: 1.67~3.07, P = 0.000 ), invasion depth (for T3~4: OR = 3.98 , 95% CI: 2.85~5.56, P = 0.000 ), poorer OS ( HR = 1.68 , 95% CI: 1.43~1.97, P = 0.000 ), and DFS ( HR = 1.74 , 95% CI: 1.44~2.08, P = 0.000 ). Conclusion. Higher expression level of lncRNA PVT1 is significantly associated with GC patients’ gender, invasion depth, poorer OS, and worse DFS. lncRNA PVT1 might act as a novel predictive biomarker of poor prognosis and clinicopathological characteristics for gastric cancer.

Prognostic role of tumor-inflating lymphocytes in gastric cancer: A systematic review and meta-analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15578-e15578
Author(s):  
Der Sheng Sun ◽  
Jung Soo Lee ◽  
Soon Auck Hong ◽  
Hye Sung Won ◽  
Yoon Ho Ko
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Foxp3 Expression ◽  
Survival Outcome ◽  
Cancer Prognosis ◽  
Infiltrating Lymphocytes

e15578 Background: Tumor-infiltrating lymphocytes(TILs) may act as major determinants of the host immune response to tumor cells. However, the potential prognostic value of TILs in gastric cancer remains controversial. This meta-analysis analyzed the associations between TILs and survival outcomes in gastric cancer. Methods: Eligible 24 published studies were identified by searching the PubMed and Google scholar databases. The primary clinical outcome was defined as overall survival (OS) or disease-free survival (DFS), which were analyzed by subgroups such as TILs subtype. The total of the study sample sizes in eligible 24 published studies was 3,229, which ranged from 52 to 273 (median, 120) patients. All studies were non-randomized and retrospective study. The only multivariate hazard ratio(HR) among patient survival data were pooled, and pooled multivariate HR with 95% confidence intervals (95% CI) were used to calculate the strength of this association between TILs expression and survival outcome. Results: The pooled multivariate hazard ratios suggested that high expression of TILs was associated with better overall survival outcome (pooled HR = 0.69, 95% CI 0.57–0.82), compared to low TILs expression in twenty-three eligible studies, particularly in CD8(+) lymphocytes (pooled HR = 0.63, 95% CI 0.48 –0.83). In contrast, a pooled analysis of the FOXP3 (+) T cells or Treg subgroup showed that high FOXP3 (+) expression was negatively correlated with OS (pooled HR = 1.88, 95% CI 1.34 –2.63). In an analysis of seven studies on DFS, the infiltration by TILs, CD4(+) or CD8(+) lymphocytes (pooled HR = 0.59, 95% CI 0.42 –0.81), not by the infiltration of FOXP3 (+) T lymphocytes (pooled HR = 1.82, 95% CI 1.30 – 2.53), was significantly associated with better survival outcome. Conclusions: The results from this meta-analysis suggest that TILs and TILs subsets expression can be a potential prognostic biomarker in patients with gastric cancer. Key Words: Tumor-infiltrating lymphocytes, gastric cancer, prognosis, meta-analysis

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