Long Term Survival after Cytoreductive Surgery Combined with Perioperative Chemotherapy in Gastric Cancer Patients with Peritoneal Metastasis

The present study demonstrated prognostic factors for long-term survival in patients after a comprehensive treatment (CHT) for peritoneal metastasis (PM) from gastric cancer (GC). Materials and Methods: Among 419 patients treated with neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), 266 (63.5%) patients received complete resection (CC-0) of the macroscopic tumors. In total, 184 (43.9%) patients were treated with postoperative systemic chemotherapy. Results: All patients treated who received incomplete cytoreduction (CC-1) died of GC within 6 years. In contrast, 10- year survival rates (-YSR) of CC-0 resection were 8.3% with median survival time (MST) of 20.5 months. Post-NIPS peritoneal cancer index (PCI) ≤11, and pre-NIPS PCI ≤13 were the significant favorable prognostic factors. Patients with numbers of involved peritoneal sectors ≤5 survived significant longer than those with ≥6. Both negative pre- and post-NIPS cytology was associated with significant favorable prognosis. Multivariate analyses identified pre-PCI (≤13 vs. ≥14), and cytology after NIPS (negative cytology vs. positive cytology) as independent prognostic factors. Ten year-survivors were found in patients with involvement of the greater omentum (9%), pelvic peritoneum (3%), para-colic gutter (13.9%), upper jejunum (5.6%), lower jejunum (5.5%), spermatic cord (21.9%), rectum (9.5%), ureter (6.3%), ovary (6.7%), and diaphragm (7.0%) at the time of cytoreduction. Twenty-one patients survived longer than 5 years, and 17 patients are still alive without recurrence. Conclusions: GC-PM should be removed aggressively, in patients with PCI after NIPS ≤11, PCI before NIPS ≤13, mall bowel PCI ≤2, and complete cytoreduction should be performed for metastasis in ≤5 peritoneal sectors.

Download Full-text

Long-Term Survival of Two Patients with Liver Metastases from Advanced Gastric Cancer Treated with Radiofrequency Ablation and Chemotherapy

Case Reports in Oncology ◽

10.1159/000507849 ◽

2021 ◽

pp. 67-72

Author(s):

Sung Jin Oh

Keyword(s):

Gastric Cancer ◽

Radiofrequency Ablation ◽

Liver Metastases ◽

Advanced Gastric Cancer ◽

Systemic Chemotherapy ◽

Subtotal Gastrectomy ◽

Hepatic Metastases ◽

Term Survival ◽

Long Term Survival

Liver metastasis from gastric cancer has a very poor prognosis. Herein, we present two cases of liver metastases (synchronous and metachronous) from advanced gastric cancer. In the first case, the patient underwent radical subtotal gastrectomy. Liver metastases occurred 6 months after surgery while the patient was receiving adjuvant chemotherapy, but two hepatic tumors were successfully removed by radiofrequency ablation (RFA). In the second case, liver metastases occurred 15 months after surgery for gastric cancer. The patient also received RFA for one hepatic tumor, and other suspicious metastatic tumors were treated with systemic chemotherapy. Although these case presentations are limited for the efficacy of RFA treatment with systemic chemotherapy for hepatic metastases from gastric cancer, our findings showed long-term survival (overall survival for 108 and 67 months, respectively) of the affected patients, without recurrence. Therefore, we suggest that RFA treatment with systemic chemotherapy could be an effective alternative treatment modality for hepatic metastases from gastric cancer.

Download Full-text

Long-term survival of 5 years following initial surgery for gastric cancer and simultaneous disseminated peritoneal metastasis: Report of a case

Surgery Today ◽

10.1007/bf00312381 ◽

1995 ◽

Vol 25 (11) ◽

pp. 959-961 ◽

Cited By ~ 6

Author(s):

Shinji Otani ◽

Michio Maeta ◽

Atsuo Oka ◽

Yasuaki Hirooka ◽

Shunichi Tsujitani ◽

...

Keyword(s):

Gastric Cancer ◽

Peritoneal Metastasis ◽

Term Survival ◽

Long Term Survival ◽

Initial Surgery

Download Full-text

Application value of nomogram and prognostic factors of gastric cancer patients who underwent D2 radical lymphadenectomy

BMC Gastroenterology ◽

10.1186/s12876-019-1098-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Guang-Chuan Mu ◽

Yuan Huang ◽

Zhi-Ming Liu ◽

Xiang-Hua Wu ◽

Xin-Gan Qin ◽

...

Keyword(s):

Gastric Cancer ◽

Regression Analysis ◽

Prognostic Factors ◽

Cancer Patients ◽

Cox Regression ◽

Term Survival ◽

Long Term Survival ◽

Cox Regression Analysis ◽

Gastric Cancer Patients

Abstract Background The aim of this study was to explore the prognostic factors and establish a nomogram to predict the long-term survival of gastric cancer patients. Methods The clinicopathological data of 421 gastric cancer patients, who were treated with radical D2 lymphadenectomy by the same surgical team between January 2009 and March 2017, were collected. The analysis of long-term survival was performed using Cox regression analysis. Based on the multivariate analysis results, a prognostic nomogram was formulated to predict the 5-year survival rate probability. Results In the present study, the total overall 3-year and 5-year survival rates were 58.7 and 45.8%, respectively. The results of the univariate Cox regression analysis revealed that tumor staging, tumor location, Borrmann type, the number of lymph nodes dissected, the number of lymph node metastases, positive lymph nodes ratio, lymphocyte count, serum albumin, CEA, CA153, CA199, BMI, tumor size, nerve invasion, and vascular invasion were prognostic factors for gastric cancer (all, P < 0.05). However, merely tumor staging, tumor location, positive lymph node ratio, CA199, BMI, tumor size, nerve invasion, and vascular invasion were independent risk factors, based on the results of the multivariate Cox regression analysis (all, P < 0.05). The nomogram based on eight independent prognostic factors revealed a well-degree of differentiation with a concordance index of 0.76 (95% CI: 0.72–0.79, P < 0.001), which was better than the AJCC-7 staging system (concordance index = 0.68). Conclusion The present study established a nomogram based on eight independent prognostic factors to predict long-term survival in gastric cancer patients. The nomogram would be beneficial for more accurately predicting the prognosis of gastric cancer, and provide important basis for making individualized treatment plans following surgery.

Download Full-text

Long-term survival in patients with peritoneal metastasized gastric cancer treated with cytoreductive surgery and HIPEC: A multi-institutional cohort from PSOGI.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.390 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 390-390

Author(s):

Andreas Brandl ◽

Yutaka Yonemura ◽

Olivier Glehen ◽

Paul H. Sugarbaker ◽

Beate Rau

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Median Survival ◽

Cytoreductive Surgery ◽

Peritoneal Metastasis ◽

Tumor Recurrence ◽

Term Survival ◽

Long Term Survival ◽

Crs And Hipec

390 Background: Peritoneal metastasis of gastric cancer is relatively common (17%) and is associated with poor survival. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is still controversially discussed, as it has proven an increase in median survival in selected patients, but only a small subgroup reached long-term survival. The aim of this study was to collect and analyze a worldwide cohort of patients treated with CRS and HIPEC with long-term survival in order to explore relevant patient characteristics. Methods: We conducted a questionnaire, which was distributed to all collaborators of the Peritoneal Surface Oncology Group International (PSOGI). Inclusion criteria were: histopathologic proven peritoneal metastasis of gastric cancer, treated with CRS and HIPEC, and overall survival > 5 years. Patient, tumor, and therapeutic details were collected and analyzed. Results: A total of 29 patients with a mean age of 52.5 years and a mean PCI of 3.2 were included. The overall median survival was 11.0 years (min 5.0; max 27.9). The predictors completeness of cytoreduction (CC-0) and low PCI (PCI < 6) were present in 23/29 patients. 13/29 patients developed at a median of 82.2 months tumor recurrence. Tumor recurrence was associated with inferior median overall survival compared to patients without tumor recurrence (8.8 years vs. not reached; p = 0.002). Conclusions: Long-term survival and even cure are possible in patients with peritoneal metastasis of gastric cancer treated with CRS and HIPEC. Completeness of cytoreduction (CC-0) and low PCI seemed to be crucial. Further studies are needed in order to improve existing selection criteria.

Download Full-text

Curative-Intent Surgery for Stage IV Advanced Gastric Cancer: Who Can Undergo Surgery and What Are the Prognostic Factors for Long-Term Survival?

Annals of Surgical Oncology ◽

10.1245/s10434-019-07790-1 ◽

2019 ◽

Vol 26 (13) ◽

pp. 4452-4463 ◽

Cited By ~ 1

Author(s):

Sho Sato ◽

Chikara Kunisaki ◽

Yusaku Tanaka ◽

Kei Sato ◽

Hiroshi Miyamoto ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factors ◽

Advanced Gastric Cancer ◽

Stage Iv ◽

Curative Intent ◽

Term Survival ◽

Long Term Survival

Download Full-text

Thirty-three long-term survivors after cytoreductive surgery in patients with peritoneal metastases from colorectal cancer: a retrospective descriptive study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02145-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yasuyuki Kamada ◽

Koya Hida ◽

Haruaki Ishibashi ◽

Shouzou Sako ◽

Akiyoshi Mizumoto ◽

...

Keyword(s):

Colorectal Cancer ◽

Cytoreductive Surgery ◽

Peritoneal Cancer Index ◽

Signet Ring Cell ◽

Clinicopathological Parameters ◽

Comprehensive Treatment ◽

Term Survival ◽

Long Term Survival ◽

Long Term Survivors

Abstract Background Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in selected patients with peritoneal metastasis (PM) from colorectal cancer (CRC). However, little has been reported on characteristics and clinical course of long-term survivors with CRC-PM beyond 5 years. The objective of this study was to identify the clinical and oncological features affecting long-term survival of CRC-PM after comprehensive treatment. Methods Between January 1990 and April 2015, CRC-PM patients who underwent CRS with or without HIPEC in two Japanese tertiary hospitals were analyzed. Clinicopathological parameters and therapeutic details for long-term survivors (patients surviving ≥ 5 years after CRS) were described and compared with those for non-survivors (patients surviving < 5 years). Results The study identified 236 patients with CRC-PM who underwent CRS, with a median follow-up period of 2.5 years. Thirty-three patients (14.0%) were considered as long-term survivors. Compared with non-survivors, long-term survivors had a lower median peritoneal cancer index (PCI) [4 (1–27) vs 9 (0–39), p < 0.001]. Complete cytoreduction (CCR-0) was achieved in all long-term survivors, with a significantly higher rate [33/33 (100%) vs 141/203 (69.8%), p < 0.001]. Metachronous onsets of PM were more frequently observed in the long-term survivor group [26/33 (78.8%) vs 103/203 (50.3%), p = 0.018]. Regarding histopathology, long-term survivors more frequently had mucinous adenocarcinoma than non-survivors [8/33 (24.2%) vs 27/203 (13.3%)] and less likely exhibited poorly differentiated or signet ring cell carcinoma [2/33 (6.1%) vs 48/203 (23.7%)] (p < 0.001). Conclusions One in seven patients with CRC-PM achieved the long-term milestone after CRS. A long-term survival was associated with the presence of low PCI, CCR-0, metachronous onset, and mucinous histology.

Download Full-text