Surgery and metastases of stomach cancer in liver

Liver metastases of gastric cancer determine the poor prognosis. Until now The expediency of their surgical removal has been controversial. However, according to a number of studies, the removal of potentially operable isolated liver metastases allows a significant increase of overall and relapse-free survival in some cases. The review is dedicated to the analysis of prognostic factors that allow selecting patients for surgical removal of liver metastases of gastric cancer. The main criteria are: effective perioperative chemotherapy; stage under T4, N0, absence of lymphovascular invasion, absence of peritoneal dissemination, number less than 3, size up to 4 cm, localization of metastases in one lobe, low level of cancer markers CA 19-9 and CEA.

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Prognostic effect of postoperative duration until adjuvant chemotherapy and cumulative S-1 dose in gastric cancer

10.21203/rs.2.20067/v1 ◽

2020 ◽

Author(s):

Yusuke Takashima ◽

Shuhei Komatsu ◽

Keiji Nishibeppu ◽

Tomohiro Arita ◽

Toshiyuki Kosuga ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

C Reactive Protein ◽

Relapse Free Survival ◽

Curative Gastrectomy ◽

Free Survival ◽

Prognostic Effect ◽

Reactive Protein ◽

The Poor ◽

Grade Ii

Abstract BackgroundAdjuvant chemotherapy (AC) following curative gastrectomy for stage II/III gastric cancer (GC) is recommended in Japan. However, for various reasons, patients cannot always start AC at the appropriate time. This study was designed to investigate the effect of the postoperative duration until adjuvant chemotherapy (PDAC) and cumulative S-1 dose on prognosis.MethodsBetween 2008 and 2014, 76 consecutive GC patients who underwent postoperative S-1 monotherapy were enrolled in this study.ResultsPostoperative complications of Clavien–Dindo grade II or higher and postoperative peak C-reactive protein of 8 mg/dl or higher were significantly associated with delayed AC. The cut-off value of PDAC selected to most effectively stratify prognosis was 7 weeks. For relapse-free survival (RFS), patients with PDAC ≥ 7 weeks had an insignificantly poorer prognosis than those with PDAC < 7 weeks (p = 0.017, 5-year RFS: PDAC ≥ 7 weeks vs. PDAC < 7 weeks, 48.5% vs. 77.0%). A multivariate analysis showed that PDAC ≥ 7 weeks [p = 0.007; hazard ratio (HR) 3.99 (95% CI: 1.46–11.5)] and cumulative S-1 dose > 12,000 mg [p = 0.033; HR 0.38 (95% CI: 0.14–0.93)] were independent prognostic factors. In patients with a cumulative S-1 dose ≥ 12,000 mg, there were no prognostic differences between patients with and without PDAC ≥ 7 weeks.Conclusions7 weeks after surgery could be an indicator starting AC. A cumulative S-1 dose of more than 12,000 mg might be a key dose for diminishing the poor prognostic effects of delaying AC.

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Umbilical cord blood transplantation can overcome the poor prognosis of KMT2A-MLLT3 acute myeloid leukemia and can lead to good GVHD-free/relapse-free survival

Annals of Hematology ◽

10.1007/s00277-021-04413-2 ◽

2021 ◽

Author(s):

Juan Tong ◽

Lei Zhang ◽

Huilan Liu ◽

Xiucai Xu ◽

Changcheng Zheng ◽

...

Keyword(s):

Myeloid Leukemia ◽

Poor Prognosis ◽

Cord Blood Transplantation ◽

Chronic Gvhd ◽

Relapse Free Survival ◽

Free Survival ◽

Chemotherapy Group ◽

Blood Transplantation ◽

The Poor ◽

First Complete Remission

AbstractThis is a retrospective study comparing the effectiveness of umbilical cord blood transplantation (UCBT) and chemotherapy for patients in the first complete remission period for acute myeloid leukemia with KMT2A-MLLT3 rearrangements. A total of 22 patients were included, all of whom achieved first complete remission (CR1) through 1–2 rounds of induction chemotherapy, excluding patients with an early relapse. Twelve patients were treated with UCBT, and 10 patients were treated with chemotherapy after 2 to 4 courses of consolidation therapy. The 3-year overall survival (OS) of the UCBT group was 71.3% (95% CI, 34.4–89.8%), and that of the chemotherapy group was 10% (95% CI, 5.89–37.3%). The OS of the UCBT group was significantly higher than that of the chemotherapy group (P = 0.003). The disease-free survival (DFS) of the UCBT group was 60.8% (95% CI, 25.0–83.6%), which was significantly higher than the 10% (95% CI, 5.72–35.8%) of the chemotherapy group (P = 0.003). The relapse rate of the UCBT group was 23.6% (95% CI, 0–46.8%), and that of the chemotherapy group was 85.4% (95% CI, 35.8–98.4%), which was significantly higher than that of the UCBT group (P < 0.001). The non-relapse mortality (NRM) rate in the UCBT group was 19.8% (95% CI, 0–41.3%), and that in the chemotherapy group was 0.0%. The NRM rate in the UCBT group was higher than that in the chemotherapy group, but there was no significant difference between the two groups (P = 0.272). Two patients in the UCBT group relapsed, two died of acute and chronic GVHD, and one patient developed chronic GVHD 140 days after UCBT and is still alive, so the GVHD-free/relapse-free survival (GRFS) was 50% (95% CI, 17.2–76.1%). AML patients with KMT2A-MLLT3 rearrangements who receive chemotherapy as their consolidation therapy after CR1 have a very poor prognosis. UCBT can overcome the poor prognosis and significantly improve survival, and the GRFS for these patients is very good. We suggest that UCBT is a better choice than chemotherapy for KMT2A-MLLT3 patients.

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Randomized Trial of Adjuvant Chemotherapy With Mitomycin, Fluorouracil, and Cytosine Arabinoside Followed by Oral Fluorouracil in Serosa-Negative Gastric Cancer: Japan Clinical Oncology Group 9206–1

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.103 ◽

2003 ◽

Vol 21 (12) ◽

pp. 2282-2287 ◽

Cited By ~ 111

Author(s):

Atsushi Nashimoto ◽

Toshifusa Nakajima ◽

Hiroshi Furukawa ◽

Masatsugu Kitamura ◽

Taira Kinoshita ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Survival Benefit ◽

Curative Resection ◽

Cancer Recurrence ◽

Phase Iii ◽

Relapse Free Survival ◽

Free Survival ◽

Significant Difference

Purpose: To evaluate the survival benefit of adjuvant chemotherapy after curative resection in serosa-negative gastric cancer patients (excluding patients who were T1N0), we conducted a multicenter phase III clinical trial in which 13 cancer centers in Japan participated. Patients and Methods: From January 1993 to December 1994, 252 patients were enrolled into the study and allocated randomly to adjuvant chemotherapy or surgery alone. The chemotherapy comprised intravenous mitomycin 1.33 mg/m2, fluorouracil (FU) 166.7 mg/m2, and cytarabine 13.3 mg/m2 twice weekly for the first 3 weeks after surgery, and oral FU 134 mg/m2 daily for the next 18 months for a total dose of 67 g/m2. The primary end point was relapse-free survival. Overall survival and the site of recurrence were secondary end points. Results: Ninety-eight percent of patients underwent gastrectomy with D2 or greater lymph node dissection. There were no treatment-related deaths and few serious adverse events. There was no significant difference in relapse-free and overall survival between the arms (5-year relapse-free survival 88.8% chemotherapy v 83.7% surgery alone; P = .14 and 5-year survival 91.2% chemotherapy v 86.1% surgery alone; P = .13, respectively). Nine patients (7.1%) in the chemotherapy arm and 17 patients (13.8%) in the surgery-alone arm had cancer recurrence. Conclusion: There was no statistically significant relapse-free or overall survival benefit with this adjuvant chemotherapy for patients with macroscopically serosa-negative gastric cancer after curative resection, and there was no statistical difference between the two arms relating to the types of cancer recurrence. We do not recommend adjuvant chemotherapy with this regimen for this population in clinical practice.

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Genome-Wide Scan for Copy Number Alteration Association with Relapse-Free Survival in Colorectal Cancer with Liver Metastasis Patients

Journal of Clinical Medicine ◽

10.3390/jcm7110446 ◽

2018 ◽

Vol 7 (11) ◽

pp. 446 ◽

Cited By ~ 1

Author(s):

Po-Sheng Yang ◽

Hsi-Hsien Hsu ◽

Tzu-Chi Hsu ◽

Ming-Jen Chen ◽

Cin-Di Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastasis ◽

Liver Metastases ◽

Copy Number ◽

Copy Number Alteration ◽

Gene Signature ◽

Comparative Genomic ◽

Relapse Free Survival ◽

Cgh Array ◽

Free Survival

Predicting a patient’s risk of recurrence after the resection of liver metastases from colorectal cancer is critical for evaluating and selecting therapeutic approaches. Clinical and pathologic parameters have shown limited accuracy thus far. Therefore, we combined the clinical status with a genomic approach to stratify relapse-free survival in colorectal cancer liver metastases patients. To identify new molecular and genetic signatures specific to colorectal cancer with liver metastasis (CRCLM) patients, we conducted DNA copy number profiling on a cohort of 21 Taiwanese CRCLM patients using a comparative genomic hybridization (CGH) array. We identified a three-gene signature based on differential copy number alteration between patients with different statuses of (1) recurrence and (2) synchronous metastasis. In relapse hotspot regions, only three genes (S100PBP, CSMD2, and TGFBI) were significantly associated with the synchronous liver metastasis factor. A final set of three genes—S100PBP, CSMD2, TGFBI—significantly predicted relapse-free survival in our cohort (p = 0.04) and another CRCLM cohort (p = 0.02). This three-gene signature is the first genomic signature validated for relapse-free survival in post-hepatectomy CRCLM patients. Our three-gene signature was developed using a whole-genome CGH array and has a good prognostic position for the relapse-free survival of CRCLM patients after hepatectomy.

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COMPLETE REMISSION AFTER COMBINATION CHEMOTHERAPY FOR STAGE IV GASTRIC CANCER WITH PERITONEAL DISSEMINATION AND LIVER METASTASES

Annals of Cancer Research and Therapy ◽

10.4993/acrt1992.11.169 ◽

2003 ◽

Vol 11 (1-2) ◽

pp. 169-181 ◽

Cited By ~ 1

Author(s):

Masaya Mukai ◽

Tomoya Hinoki ◽

Takayuki Tajima ◽

Hisao Nakasaki ◽

Shinkichi Sato ◽

...

Keyword(s):

Gastric Cancer ◽

Complete Remission ◽

Liver Metastases ◽

Combination Chemotherapy ◽

Peritoneal Dissemination ◽

Stage Iv ◽

Stage Iv Gastric Cancer

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Laparoscopic Versus Open Distal Gastrectomy With D2 Lymph Node Dissection for cT2 Gastric Cancer: A Retrospective Cohort Study of Short- and Long-Term Outcomes

International Surgery ◽

10.9738/intsurg-d-15-00027.1 ◽

2015 ◽

Vol 100 (9-10) ◽

pp. 1315-1322 ◽

Cited By ~ 1

Author(s):

Kei Hosoda ◽

Shinichi Sakuramoto ◽

Natsuya Katada ◽

Keishi Yamashita ◽

Hiromitsu Moriya ◽

...

Keyword(s):

Gastric Cancer ◽

Distal Gastrectomy ◽

Survival Rates ◽

Controlled Study ◽

D2 Lymphadenectomy ◽

Open Distal Gastrectomy ◽

Long Term Outcomes ◽

Relapse Free Survival ◽

Free Survival

The purpose of this study was to determine whether laparoscopy-assisted distal gastrectomy (LDG) with D2 lymphadenectomy could be a standard treatment for cT2N0-1 gastric cancer. There have been few reports regarding the long-term outcomes of patients with advanced gastric cancer who underwent LDG with D2 lymphadenectomy. The study included 32 patients who underwent LDG with D2 lymphadenectomy and 44 patients who underwent open distal gastrectomy (ODG) with D2 lymphadenectomy. There was no clinicopathologic difference in patient background between the groups. Operative duration was significantly longer in the LDG group than in the ODG group (297 ± 12 minutes versus 226 ± 10 minutes; P < 0.001). However, blood loss was significantly less (90 ± 27 mL versus 314 ± 23 mL; P < 0.001) and the number of days to assisted ambulation significantly shorter (1.1 ± 0.1 days versus 1.5 ± 0.1 days; P = 0.010) in the LDG group than in the ODG group. Median follow-up period was 60 months. The 5-year overall survival rates for the LDG group and the ODG group were 89.5% and 97.1%, respectively. The 5-year relapse-free survival rates for the LDG group and the ODG group were 88.0% and 97.7%, respectively. There were no significant differences in overall and relapse-free survival rates between the groups. LDG with D2 lymphadenectomy for cT2N0-1 gastric cancer is oncologically and technically safe and feasible, and is an option in the surgeon's arsenal. Randomized controlled study including the investigation of cost-effectiveness should be conducted.

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EFFICACY OF PERFUSION THERMOCHEMOTHERAPY IN GASTRIC CANCE MANAGEMENT BASED ON RESULTS OF PROSPECTIVE RANDOMIZED STUDY

Medical Journal ◽

10.51922/1818-426x.2021.3.87 ◽

2021 ◽

pp. 87-91

Author(s):

М.Yu. Reiitovich ◽

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Peritoneal Dissemination ◽

Radical Surgery ◽

Randomized Study ◽

Progression Free Survival ◽

Prospective Randomized Study ◽

Free Survival ◽

Borrmann Type

The article analyses the results of a prospective randomized study of a cohort of 154 radically operated patients with stage IIB-IIIC gastric cancer (Borrmann type 111 IV). 76 patients were administered intraoperative perfusion thermochemotherapy (HIPEC). It was noted that enhancing radical surgery procedure by complementing it with HIPEC in managing this prognostically unfavorable group of patients resulted in a decrease in the frequency of progression cases (p = 0.009), metachronous peritoneal dissemination — (p < 0.001), and 5-year cumulative carcinomatosis incidence — 70.7 ± 6.8 % to 23.6 ± 5.2 % (p < 0.001) thereby building a groundwork for improving 5-year adjusted survival rate from 27.0 ± 6.7 % to 45.1 ±6.4 % (p = 0.05), progression-free survival — from 16.3 ± 5.5 % to 42.1 ± 6.3 % (p < 0.001), and dissemination-free survival — from 19.4 ± 5.9 % to 45.2 ± 6.3 % (p = 0.001).

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Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.20.01210 ◽

2020 ◽

Vol 38 (28) ◽

pp. 3304-3313 ◽

Cited By ~ 3

Author(s):

Woo Jin Hyung ◽

Han-Kwang Yang ◽

Young-Kyu Park ◽

Hyuk-Joon Lee ◽

Ji Yeong An ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Open Surgery ◽

Distal Gastrectomy ◽

Locally Advanced ◽

Laparoscopic Distal Gastrectomy ◽

D2 Lymphadenectomy ◽

Relapse Free Survival ◽

Free Survival ◽

Locally Advanced Gastric Cancer

PURPOSE It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated. PATIENTS AND METHODS A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups. RESULTS From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7% v 23.4%, respectively; P = .0027) and late complications (4.7% v 9.5%, respectively; P = .0038), particularly intestinal obstruction (2.0% v 4.4%, respectively; P = .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank P = .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank P = .827; P for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank P = .900; P for noninferiority = .030). CONCLUSION Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.

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