A Case of Multidisciplinary Treatment for Metastatic Gastric Cancer from Ovarian Cancer

Abstract Background: The multidisciplinary treatment including induction chemotherapy plus conversion surgery (CS) has attracted attention as a new strategy to improve the outcome of metastatic gastric cancer (MGC). However, it is unclear which patients achieve a good response to chemotherapy and successful CS. Tumor-infiltrating immune cells (TIICs) have been reported to be both prognostic and predictive biomarkers not only in immunotherapy but also in chemotherapy in many cancer types. However, there have been no reports on the usefulness of TIICs as biomarkers in conversion surgery for MGC. The aim of the present study was to evaluate the association between the TIICs and treatment outcome for the multidisciplinary treatment in MGC.Methods: We retrospectively analyzed 68 MGC patients who received docetaxel plus cisplatin plus S-1 (DCS) therapy between April 2006 and March 2019 in our institute. The number of tumor-infiltrating CD4+, CD8+, Foxp3+lymphocytes, CD68+, CD163+macrophages in pre-treatment endoscopic biopsy samples were evaluated to investigate their predictive value for multidisciplinary treatment.Results: 50 patients underwent CS following DCS therapy (CS group), whereas 18 patients underwent DCS therapy alone (non-CS group). The MST of CS group was 33.3 months, which was significantly longer than the MST of 9.0 months in non-CS group (p<0.01). The number of CD163+macrophages was extracted as an independent prognostic factor for overall survival in all patients. There were more cases of high infiltration of CD 163+macrophages in non-CS group than in CS group. Furthermore, in CS group, pathological responders to DCS therapy showed low infiltration of CD 163+ macrophages, and high infiltration of CD8+lymphocyte. CD 163 low group showed a significant prolonged survival compared with CD163 high group in patients who underwent CS (p=0.02).Conclusions: The pre-treatment CD163+macrophages infiltration would be a pivotal biomarker for predicting prognosis and pathological response to multidisciplinary treatment among TIICs in MGC.Thus, for patients with low CD163+macrophage infiltration in pre-treatment biopsy sample, diagnostic imaging should be performed frequently during chemotherapy to avoid missing the optimal timing for CS, and CS should be aggressively considered as a treatment option if curative resection is deemed feasible.

Download Full-text

An open-label, multicenter phase II trial of SUNITINIB for patients with chemorefractory metastatic gastric cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0030-1263569 ◽

2010 ◽

Vol 48 (08) ◽

Cited By ~ 1

Author(s):

M Moehler ◽

J Hartmann ◽

F Lordick ◽

S Al-Batran ◽

P Reimer ◽

...

Keyword(s):

Gastric Cancer ◽

Phase Ii ◽

Phase Ii Trial ◽

Metastatic Gastric Cancer ◽

Open Label ◽

Multicenter Phase

Download Full-text

Severe Loss of Visceral Fat and Skeletal Muscle After Chemotherapy Predict Poor Prognosis in Metastatic Gastric Cancer Patients Without Gastrectomy

SSRN Electronic Journal ◽

10.2139/ssrn.3391371 ◽

2019 ◽

Author(s):

Wanjing Feng ◽

Mingzhu Huang ◽

Xiaoying Zhao ◽

Siyuan Chen ◽

Chenchen Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Cancer Patients ◽

Visceral Fat ◽

Poor Prognosis ◽

Metastatic Gastric Cancer ◽

Severe Loss ◽

Gastric Cancer Patients

Download Full-text

Trifluridine/tipiracil versus placebo for third or later lines of treatment in metastatic gastric cancer: an exploratory subgroup analysis from the TAGS study

ESMO Open ◽

10.1016/j.esmoop.2021.100200 ◽

2021 ◽

Vol 6 (4) ◽

pp. 100200

Author(s):

J. Tabernero ◽

K. Shitara ◽

A. Zaanan ◽

T. Doi ◽

S. Lorenzen ◽

...

Keyword(s):

Gastric Cancer ◽

Subgroup Analysis ◽

Metastatic Gastric Cancer

Download Full-text

Lymph node metastasis-derived gastric cancer cells educate bone marrow-derived mesenchymal stem cells via YAP signaling activation by exosomal Wnt5a

Oncogene ◽

10.1038/s41388-021-01722-8 ◽

2021 ◽

Vol 40 (12) ◽

pp. 2296-2308

Author(s):

Mei Wang ◽

Xinxin Zhao ◽

Rong Qiu ◽

Zheng Gong ◽

Feng Huang ◽

...

Keyword(s):

Gastric Cancer ◽

Stem Cells ◽

Bone Marrow ◽

Mesenchymal Stem Cells ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Metastatic Gastric Cancer ◽

Gastric Cancer Cells ◽

Node Metastasis ◽

Signaling Activation

AbstractLymph node metastasis (LNM), a common metastatic gastric-cancer (GC) route, is closely related to poor prognosis in GC patients. Bone marrow-derived mesenchymal stem cells (BM-MSCs) preferentially engraft at metastatic lesions. Whether BM-MSCs are specifically reprogrammed by LNM-derived GC cells (LNM-GCs) and incorporated into metastatic LN microenvironment to prompt GC malignant progression remains unknown. Herein, we found that LNM-GCs specifically educated BM-MSCs via secretory exosomes. Exosomal Wnt5a was identified as key protein mediating LNM-GCs education of BM-MSCs, which was verified by analysis of serum exosomes collected from GC patients with LNM. Wnt5a-enriched exosomes induced YAP dephosphorylation in BM-MSCs, whereas Wnt5a-deficient exosomes exerted the opposite effect. Inhibition of YAP signaling by verteporfin blocked LNM-GC exosome- and serum exosome-mediated reprogramming in BM-MSCs. Analysis of MSC-like cells obtained from metastatic LN tissues of GC patients (GLN-MSCs) confirmed that BM-MSCs incorporated into metastatic LN microenvironment, and that YAP activation participated in maintaining their tumor-promoting phenotype and function. Collectively, our results show that LNM-GCs specifically educated BM-MSCs via exosomal Wnt5a-elicited activation of YAP signaling. This study provides new insights into the mechanisms of LNM in GC and BM-MSC reprogramming, and will provide potential therapeutic targets and detection indicators for GC patients with LNM.

Download Full-text

Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors

Journal of Clinical Medicine ◽

10.3390/jcm10051141 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1141

Author(s):

Gianpaolo Marte ◽

Andrea Tufo ◽

Francesca Steccanella ◽

Ester Marra ◽

Piera Federico ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Prognostic Factors ◽

Liver Metastases ◽

Meta Analysis ◽

Multidisciplinary Treatment ◽

Review Of The Literature ◽

Term Survival ◽

The Impact

Background: In the last 10 years, the management of patients with gastric cancer liver metastases (GCLM) has changed from chemotherapy alone, towards a multidisciplinary treatment with liver surgery playing a leading role. The aim of this systematic review and meta-analysis is to assess the efficacy of hepatectomy for GCLM and to analyze the impact of related prognostic factors on long-term outcomes. Methods: The databases PubMed (Medline), EMBASE, and Google Scholar were searched for relevant articles from January 2010 to September 2020. We included prospective and retrospective studies that reported the outcomes after hepatectomy for GCLM. A systematic review of the literature and meta-analysis of prognostic factors was performed. Results: We included 40 studies, including 1573 participants who underwent hepatic resection for GCLM. Post-operative morbidity and 30-day mortality rates were 24.7% and 1.6%, respectively. One-year, 3-years, and 5-years overall survival (OS) were 72%, 37%, and 26%, respectively. The 1-year, 3-years, and 5-years disease-free survival (DFS) were 44%, 24%, and 22%, respectively. Well-moderately differentiated tumors, pT1–2 and pN0–1 adenocarcinoma, R0 resection, the presence of solitary metastasis, unilobar metastases, metachronous metastasis, and chemotherapy were all strongly positively associated to better OS and DFS. Conclusion: In the present study, we demonstrated that hepatectomy for GCLM is feasible and provides benefits in terms of long-term survival. Identification of patient subgroups that could benefit from surgical treatment is mandatory in a multidisciplinary setting.

Download Full-text