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Fonseca GM, Braghiroli MIFM, Pirola Kruger JA, Coelho FF, Herman P. Is There a Role for Locoregional Therapies for Non-colorectal Gastrointestinal Malignancies? Hematol Oncol Clin North Am 2025; 39:125-141. [PMID: 39510669 DOI: 10.1016/j.hoc.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
The liver is the most common site of metastases from solid gastrointestinal tract tumors. Over the past few decades, the role of locoregional therapies, resection and thermal ablation, for neuroendocrine and colorectal liver metastases has been widely studied. However, for liver metastases originating from other gastrointestinal organs, the role of locoregional treatment remains unclear. This review summarizes and discusses the available evidence regarding benefits, risks, and indications for locoregional therapies for non-colorectal and non-neuroendocrine gastrointestinal liver metastases, highlighting the importance of multidisciplinary approach and patient selection.
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Affiliation(s)
- Gilton Marques Fonseca
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Maria Ignez Freitas Melro Braghiroli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), University of Sao Paulo, and Rede D'Or Sao Paulo, Av. Dr. Arnaldo, 251 - São Paulo, SP, Brazil. CEP: 01246-000, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil.
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Sun W, Li X. Surgical Resection Enhances Survival in Patients With Liver Metastases From Gastric Cancer: A Population-Based, Case-Control Study. Health Sci Rep 2024; 7:e70220. [PMID: 39669188 PMCID: PMC11635178 DOI: 10.1002/hsr2.70220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 10/25/2024] [Accepted: 11/04/2024] [Indexed: 12/14/2024] Open
Abstract
Background and Aims Gastric cancer with liver metastases (GCLM) is a challenging condition that significantly reduces long-term survival rates, but recent advancements in surgical techniques have shown promise. This study aims to comprehensively evaluate the impact of surgical resection on survival rates in GCLM patients. Methods We conducted a population-based analysis utilizing the SEER database for patients diagnosed with GCLM between 2010 and 2015. Overall survival (OS) was compared between patients who underwent cancer-directed surgery (CDS) and those who did not. The overlap weighting method based on lasso regression with penalty factors was employed to minimize selection bias. Survival outcomes were compared using Kaplan-Meier curves and Cox proportional hazards models, with subgroup analyses to further explore the effects of surgery among patients. Results A total of 3694 patients with GCLM were identified. Of those, 354 (9.58%) patients underwent CDS. After propensity score adjustment, The median OS was significantly higher in the surgical resection group (12 months, 95% confidence interval (CI) 11-16) compared to the nonresection group (6 months, 95% CI: 5-6). Cox regression analysis revealed a substantial improvement in OS for the surgical resection group, with a hazard ratio (HR) of 0.562 (95% CI: 0.482-0.656), including patients with adverse conditions. Conclusions The analysis demonstrated a clear association between surgical resection and enhanced OS in GCLM patients. Nevertheless, further research endeavors should be undertaken to identify specific prognostic factors that aid in the selection of optimal candidates for surgical resection.
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Affiliation(s)
- Wuhui Sun
- Department of Thyroid SurgerySecond Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
| | - Xiawei Li
- Department of SurgerySecond Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer InstituteSecond Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
- Cancer CenterZhejiang UniversityHangzhouChina
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Cao ND, Zhu XH, Ma FQ, Xu Y, Dong JH, Qin MM, Liu TS, Zhu CC, Guo WJ, Ding HH, Guo YB, Liu LK, Song JJ, Wu JP, Cheng YL, Zeng L, Zhao AG. Chinese Medicine Prolongs Overall Survival of Chinese Patients with Advanced Gastric Cancer: Treatment Pattern and Survival Analysis of a 20-Year Real-World Study. Chin J Integr Med 2024; 30:489-498. [PMID: 38801641 DOI: 10.1007/s11655-024-4107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To describe the treatment patterns and survival status of advanced gastric cancer (AGC) in China in the past two decades, and objectively evaluate the impact of standardized Chinese medicine (CM) treatment on the survival of AGC patients. METHODS This multicenter registry designed and propensity score analysis study described the diagnosis characteristics, treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1, 2000 and July 31, 2021. Overall survival (OS) was evaluated between non-CM cohort (standard medical treatment) and CM cohort (integrated standard CM treatment ≥3 months). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to adjust any difference in average outcomes for bias. RESULTS A total of 2,001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled. Among them, 1,607 received systemic chemotherapy, 215 (10.74%) accepted molecular targeted therapy, 44 (2.2%) received checkpoint inhibitor therapy, and 769 (38.43%) received CM. Two-drug regimen was the main choice for first-line treatment, with fluoropyrimidine plus platinum as the most common regimen (530 cases, 60.09%). While 45.71% (16 cases) of patients with HER2 amplification received trastuzumab in first-line. The application of apatinib increased (33.33%) in third-line. The application of checkpoint inhibitors has increased since 2020. COX analysis showed that Lauren mixed type (P=0.017), cycles of first-line treatment >6 (P=0.000), CM (P=0.000), palliative gastrectomy (P=0.000), trastuzumab (P=0.011), and apatinib (P=0.008) were independent prognostic factors for the OS of AGC. After PSM and IPTW, the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months, respectively (P<0.001). CONCLUSIONS In real-world practice for AGC in China, therapy choices consisted with guidelines. Two-drug regimen was the main first-line choice. Standardized CM treatment was an independent prognostic factor and could prolong the OS of Chinese patients with AGC. (Registration No. NCT02781285).
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Affiliation(s)
- Ni-da Cao
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Xiao-Hong Zhu
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Fang-Qi Ma
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Yan Xu
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Jia-Huan Dong
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Meng-Meng Qin
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Tian-Shu Liu
- Oncology Department, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Chun-Chao Zhu
- Gastrointestinal Surgery Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Wei-Jian Guo
- Oncology Department, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Hong-Hua Ding
- Oncology Department, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China
| | - Yuan-Biao Guo
- Traditional Chinese Medicine Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Li-Kun Liu
- Oncology Department, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, 030012, China
| | - Jin-Jie Song
- Oncology Department, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 102445, China
| | - Ji-Ping Wu
- Oncology Department, Yunnan Province Hospital of Traditional Chinese Medicine, Kunming, 650021, China
| | - Yue-Lei Cheng
- Oncology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Lin Zeng
- Shanghai NewCore Biotechnology Co., Ltd., Shanghai, 200240, China
| | - Ai-Guang Zhao
- Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Chang ZY, Gao WX, Zhang Y, Zhao W, Wu D, Chen L. Establishment and evaluation of a prognostic model for patients with unresectable gastric cancer liver metastases. World J Clin Cases 2024; 12:2182-2193. [PMID: 38808342 PMCID: PMC11129128 DOI: 10.12998/wjcc.v12.i13.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Liver metastases (LM) is the primary factor contributing to unfavorable outcomes in patients diagnosed with gastric cancer (GC). The objective of this study is to analyze significant prognostic risk factors for patients with GCLM and develop a reliable nomogram model that can accurately predict individualized prognosis, thereby enhancing the ability to evaluate patient outcomes. AIM To analyze prognostic risk factors for GCLM and develop a reliable nomogram model to accurately predict individualized prognosis, thereby enhancing patient outcome assessment. METHODS Retrospective analysis was conducted on clinical data pertaining to GCLM (type III), admitted to the Department of General Surgery across multiple centers of the Chinese PLA General Hospital from January 2010 to January 2018. The dataset was divided into a development cohort and validation cohort in a ratio of 2:1. In the development cohort, we utilized univariate and multivariate Cox regression analyses to identify independent risk factors associated with overall survival in GCLM patients. Subsequently, we established a prediction model based on these findings and evaluated its performance using receiver operator characteristic curve analysis, calibration curves, and clinical decision curves. A nomogram was created to visually represent the prediction model, which was then externally validated using the validation cohort. RESULTS A total of 372 patients were included in this study, comprising 248 individuals in the development cohort and 124 individuals in the validation cohort. Based on Cox analysis results, our final prediction model incorporated five independent risk factors including albumin levels, primary tumor size, presence of extrahepatic metastases, surgical treatment status, and chemotherapy administration. The 1-, 3-, and 5-years Area Under the Curve values in the development cohort are 0.753, 0.859, and 0.909, respectively; whereas in the validation cohort, they are observed to be 0.772, 0.848, and 0.923. Furthermore, the calibration curves demonstrated excellent consistency between observed values and actual values. Finally, the decision curve analysis curve indicated substantial net clinical benefit. CONCLUSION Our study identified significant prognostic risk factors for GCLM and developed a reliable nomogram model, demonstrating promising predictive accuracy and potential clinical benefit in evaluating patient outcomes.
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Affiliation(s)
- Zheng-Yao Chang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Xing Gao
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yue Zhang
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wen Zhao
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Di Wu
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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An W, Bao L, Wang C, Zheng M, Zhao Y. Analysis of Related Risk Factors and Prognostic Factors of Gastric Cancer with Liver Metastasis: A SEER and External Validation Based Study. Int J Gen Med 2023; 16:5969-5978. [PMID: 38144441 PMCID: PMC10748731 DOI: 10.2147/ijgm.s434952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
Background Gastric cancer (GC) has a poor prognosis, particularly in patients with liver metastasis (LM). This study aims to identify relevant factors associated with the occurrence of LM in GC patients and factors influencing the prognosis of gastric cancer with liver metastasis (GCLM) patients, in addition to developing diagnostic and prognostic nomograms specifically. Patients and Methods Overall, 6184 training data were from the Surveillance, Epidemiology, and End Results (SEER) database from 2011 to 2015. 1527 validation data were from our hospital between January 2018 and December 2022. Logistic regression was used to identify the risk factors associated with the occurrence of LM in GC patients, Cox regression was used to confirm the prognostic factors of GCLM patients. Two nomogram models were established to predict the risk and overall survival (OS) of patients with GCLM. The performance of the two models was evaluated using the area under the curve (AUC), concordance index (C-index), and calibration curves. Results A nomogram included five independent factors from multivariate logistic regression: sex, lymph node removal, chemotherapy, T stage and N stage were constructed to calculate the possibility of LM. Internal and external verifications of AUC were 0.786 and 0.885, respectively. The other nomogram included four independent factors from multivariate Cox regression: surgery at primary site, surgery at other site, chemotherapy, and N stage were constructed to predict OS. C-index for internal and external validations were 0.714 and 0.702, respectively, and the calibration curves demonstrated the robust discriminative ability of the models. Conclusion Based on the SEER database and validation data, we defined effective nomogram models to predict risk and OS in patients with GCLM. They have important value in clinical decision-making and personalized treatment.
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Affiliation(s)
- Wenxiu An
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
| | - Lijie Bao
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
| | - Chenyu Wang
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
| | - Mingxin Zheng
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd, Shenyang City, Liaoning Province, People’s Republic of China
| | - Yan Zhao
- Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang City, Liaoning Province, People’s Republic of China
- Liaoning Provincial Key Laboratory of Interdisciplinary Research on Gastrointestinal Tumor Combining Medicine with Engineering, Shenyang City, Liaoning Province, People’s Republic of China
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Li Y, Li J, Meng M, Duan S, Shi H, Hang J. Development and Validation of a Radiomics Nomogram for Liver Metastases Originating from Gastric and Colorectal Cancer. Diagnostics (Basel) 2023; 13:2937. [PMID: 37761304 PMCID: PMC10528017 DOI: 10.3390/diagnostics13182937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The origin of metastatic liver tumours (arising from gastric or colorectal sources) is closely linked to treatment choices and survival prospects. However, in some instances, the primary lesion remains elusive even after an exhaustive diagnostic investigation. Consequently, we have devised and validated a radiomics nomogram for ascertaining the primary origin of liver metastases stemming from gastric cancer (GCLMs) and colorectal cancer (CCLMs). This retrospective study encompassed patients diagnosed with either GCLMs or CCLMs, comprising a total of 277 GCLM cases and 278 CCLM cases. Radiomic characteristics were derived from venous phase computed tomography (CT) scans, and a radiomics signature (RS) was computed. Multivariable regression analysis demonstrated that gender (OR = 3.457; 95% CI: 2.102-5.684; p < 0.001), haemoglobin levels (OR = 0.976; 95% CI: 0.967-0.986; p < 0.001), carcinoembryonic antigen (CEA) levels (OR = 0.500; 95% CI: 0.307-0.814; p = 0.005), and RS (OR = 2.147; 95% CI: 1.127-4.091; p = 0.020) exhibited independent associations with GCLMs as compared to CCLMs. The nomogram, combining RS with clinical variables, demonstrated strong discriminatory power in both the training (AUC = 0.71) and validation (AUC = 0.78) cohorts. The calibration curve, decision curve analysis, and clinical impact curves revealed the clinical utility of this nomogram and substantiated its enhanced diagnostic performance.
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Affiliation(s)
- Yuying Li
- Department of Radiology, Changzhou Second People’s Hospital Affiliated with Nanjing Medical University, Changzhou 213000, China; (Y.L.); (J.L.); (M.M.)
- Graduate College, Dalian Medical University, Dalian 116000, China
| | - Jingjing Li
- Department of Radiology, Changzhou Second People’s Hospital Affiliated with Nanjing Medical University, Changzhou 213000, China; (Y.L.); (J.L.); (M.M.)
- Graduate College, Dalian Medical University, Dalian 116000, China
| | - Mingzhu Meng
- Department of Radiology, Changzhou Second People’s Hospital Affiliated with Nanjing Medical University, Changzhou 213000, China; (Y.L.); (J.L.); (M.M.)
| | - Shaofeng Duan
- GE Healthcare, Precision Health Institution, Shanghai 201100, China;
| | - Haifeng Shi
- Department of Radiology, Changzhou Second People’s Hospital Affiliated with Nanjing Medical University, Changzhou 213000, China; (Y.L.); (J.L.); (M.M.)
| | - Junjie Hang
- Department of Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
- Department of Oncology, Changzhou Second People’s Hospital Affiliated with Nanjing Medical University, Changzhou 213000, China
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Ng KKC, Cheng NMY, Lok HT, Kung JWC, Fung AKY, Chan SL. Is hepatic resection justified for non-colorectal non-neuroendocrine liver metastases? A systematic review and meta-analysis. Surgeon 2022; 21:160-172. [PMID: 35718702 DOI: 10.1016/j.surge.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hepatic resection (HR) is effective for colorectal or neuroendocrine liver metastases. However, the role of HR for non-colorectal non-neuroendocrine liver metastases (NCNNLM) is unknown. This study aims to perform a systematic review and meta-analysis on long-term clinical outcomes after HR for NCNNLM. METHODS electronic search was performed to identify relevant publications using PRISMA and MOOSE guidelines. Primary outcomes were 3- and 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes were post-operative morbidity and 30-day mortality. RESULTS There were 40 selected studies involving 5696 patients with NCNNLM undergone HR. Pooled data analyses showed that the 3- and 5-year OS were 40% (95% CI 0.35-0.46) and 32% (95% CI 0.29-0.36), whereas the 3- and 5-year DFS were 28% (95% CI 0.21-0.36) and 24% (95% CI 0.20-0.30), respectively. The postoperative morbidity rate was 28%, while the 30-day mortality was 2%. Subgroup analysis on HR for gastric cancer liver metastasis revealed the 3-year and 5-year OS of 39% and 25%, respectively. CONCLUSIONS HR for NCNNLM may achieve satisfactory survival outcome in selected patients with low morbidities and mortalities. However, more concrete evidence from prospective study is warrant in future.
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Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong.
| | - Nicole M Y Cheng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Hon-Ting Lok
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Janet W C Kung
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Andrew K Y Fung
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Stephen L Chan
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong
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Sun M, Ding H, Zhu Z, Wang S, Gu X, Xia L, Li T. Identifying Optimal Surgical Intervention-Based Chemotherapy for Gastric Cancer Patients With Liver Metastases. Front Oncol 2021; 11:675870. [PMID: 34912701 PMCID: PMC8666972 DOI: 10.3389/fonc.2021.675870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed at evaluating the effects of surgical treatments-based chemotherapy in the treatment of gastric cancer with liver metastases (GCLM). It has not been established whether Liver-directed treatment (LDT) options such as hepatectomy and gastrectomy plus chemotherapy (HGCT), radiofrequency ablation and gastrectomy plus chemotherapy (RFAG), transarterial chemoembolization and gastrectomy plus chemotherapy (TACEG), gastrectomy plus chemotherapy (GCT) enhance the survival of GCLM patients. METHODS We performed systematic literature searches in PubMed, EMBASE, and Cochrane library from inception to September 2021. We created a network plot to comprehensively analyze the direct and indirect evidence, based on a frequentist method. A contribution plot was used to determine inconsistencies, a forest plot was used to evaluate therapeutic effects, the publication bias was controlled by funnel plot, while the value of surface under the cumulative ranking curves (SUCRA) was calculated to estimate rank probability. RESULTS A total of 23 retrospective studies were identified, involving 5472 GCLM patients. For OS and 1-, 2-, 3-year survival rate of all trials, meta-analysis of the direct comparisons showed significant better for HGCT treatments compared with GCT or PCT. In the comparison of the 5 treatments for 1-, 2-, 3-year survival rate, HGCT and RFAG were found to be more effective than GCT and PCT, respectively. By OS and 2-, 3-year survival rate analysis, RFAG was identified as the best option, followed by HGCT, TACEG, GCT and PCT. By 1-year survival rate analysis, HGCT and RFAG were identified as the most effective options. CONCLUSION HGCT and RFAG has remarkable survival benefits for GCLM patients when compared to TACEG, GCT and PCT. HGCT was found to exhibit superior therapeutic effects for GCLM patients for 1-year survival rate while RFAG was found to be a prospective therapeutic alternative for OS and 2-, 3-year survival rate. SYSTEMATIC REVIEW REGISTRATION identifier [10.37766/inplasy2020.12.0009].
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Affiliation(s)
- Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Department of Anesthesiology, Institute of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Hubei Key Laboratory of Embryonic Stem Cell Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hangliang Ding
- Department of General Surgery, Xinchang Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Zhiqiang Zhu
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shengsheng Wang
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xinsheng Gu
- College of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Lingyun Xia
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Tian Li
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- School of Basic Medicine, Fourth Military Medical University, Xi’an, China
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Wang F, Zhang X, Li Y, Tang L, Qu X, Ying J, Zhang J, Sun L, Lin R, Qiu H, Wang C, Qiu M, Cai M, Wu Q, Liu H, Guan W, Zhou A, Zhang Y, Liu T, Bi F, Yuan X, Rao S, Xin Y, Sheng W, Xu H, Li G, Ji J, Zhou Z, Liang H, Zhang Y, Jin J, Shen L, Li J, Xu R. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (Lond) 2021; 41:747-795. [PMID: 34197702 PMCID: PMC8360643 DOI: 10.1002/cac2.12193] [Citation(s) in RCA: 437] [Impact Index Per Article: 109.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
There exist differences in the epidemiological characteristics, clinicopathological features, tumor biological characteristics, treatment patterns, and drug selections between gastric cancer patients from the Eastern and Western countries. The Chinese Society of Clinical Oncology (CSCO) has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually. Taking into account regional differences, giving full consideration to the accessibility of diagnosis and treatment resources, these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China. The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis, treatment, follow-up, and screening of gastric cancer. Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines, this updated guideline integrates the results of major clinical studies from China and overseas for the past year, focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations. For the comprehensive treatment of non-metastatic gastric cancer, attentions were paid to neoadjuvant treatment. The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated. For the comprehensive treatment of metastatic gastric cancer, recommendations for immunotherapy were included, and immune checkpoint inhibitors from third-line to the first-line of treatment for different patient groups with detailed notes are provided.
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Barchi LC, Ramos MFKP, Dias AR, Forones NM, Carvalho MPD, Castro OAP, Kassab P, Costa-Júnior WLD, Weston AC, Zilberstein B, Ferraz ÁAB, ZeideCharruf A, Brandalise A, Silva AMD, Alves B, Marins CAM, Malheiros CA, Leite CV, Bresciani CJC, Szor D, Mucerino DR, Wohnrath DR, JirjossIlias E, Martins Filho ED, PinatelLopasso F, Coimbra FJF, Felippe FEC, Tomasisch FDS, Takeda FR, Ishak G, Laporte GA, Silva HJT, Cecconello I, Rodrigues JJG, Grande JCD, Lourenço LG, Motta LMD, Ferraz LR, Moreira LF, Lopes LR, Toneto MG, Mester M, Rodrigues MAG, Franciss MY, AdamiAndreollo N, Corletta OC, Yagi OK, Malafaia O, Assumpção PP, Savassi-Rocha PR, Colleoni Neto R, Oliveira RJD, AissarSallun RA, Weschenfelder R, Oliveira SCVD, Abreu TBD, Castria TBD, Ribeiro Junior U, Barra W, Freitas Júnior WRD. BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 34:e1563. [PMID: 34008707 PMCID: PMC8121052 DOI: 10.1590/0102-672020210001e1563] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. AIM : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. METHODS To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. CONCLUSION : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
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Affiliation(s)
- Leandro Cardoso Barchi
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Faculty of Medicine São Leopoldo Mandic, Campinas, SP, Brazil
| | | | - André Roncon Dias
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Paulo Kassab
- Department of Surgery, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Wilson Luiz da Costa-Júnior
- Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, SP, Brazil
- Department of Medicine, Baylor College of Medicine, Houston,Texas
| | | | - Bruno Zilberstein
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Faculty of Medicine São Leopoldo Mandic, Campinas, SP, Brazil
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11
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Marte G, Tufo A, Steccanella F, Marra E, Federico P, Petrillo A, Maida P. Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors. J Clin Med 2021; 10:jcm10051141. [PMID: 33803135 PMCID: PMC7963158 DOI: 10.3390/jcm10051141] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Gianpaolo Marte
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
- Correspondence: ; Tel.: +39-08118775110
| | - Andrea Tufo
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
| | - Francesca Steccanella
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
| | - Ester Marra
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
| | - Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (P.F.); (A.P.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (P.F.); (A.P.)
| | - Pietro Maida
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
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12
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Cowling J, Gorman B, Riaz A, Bundred JR, Kamarajah SK, Evans RPT, Singh P, Griffiths EA. Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis. J Gastrointest Cancer 2021; 52:41-56. [PMID: 32959118 PMCID: PMC7900337 DOI: 10.1007/s12029-020-00519-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Joseph Cowling
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bethany Gorman
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Afrah Riaz
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James R Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- College of Medical and Dental Sciences, University of Leeds, Leeds, UK
| | - Sivesh K Kamarajah
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Upper GI surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS FT, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Richard P T Evans
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pritam Singh
- Nottingham Oesophago-Gastric Unit, City Hospital, Hucknall Rd, Nottingham, NG5 1PB, UK
| | - Ewen A Griffiths
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Department of Upper GI surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS FT, Mindelsohn Way, Birmingham, B15 2TH, UK.
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13
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Temido MJ, Caetano Oliveira R, Martins R, Serôdio M, Costa B, Carvalho C, Santos E, Ferreira L, Teixeira P, Cipriano MA, Tralhão JG, Alexandrino H. Prognostic Factors After Hepatectomy for Gastric Adenocarcinoma Liver Metastases: Desmoplastic Growth Pattern as the Key to Improved Overall Survival. Cancer Manag Res 2020; 12:11689-11699. [PMID: 33244263 PMCID: PMC7683833 DOI: 10.2147/cmar.s264586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/02/2020] [Indexed: 01/27/2023] Open
Abstract
Purpose Hepatectomy (Hp) is an alternative approach for the treatment of gastric carcinoma liver metastases (GCLM). However, prognostic factors that may assist patient selection are still controversial. Several pathologic features, such as the growth pattern (GP), associated with prognosis in colorectal cancer liver metastases, were never investigated in GCLM. Our principal aim was to assess if the GP has prognostic impact on GCLM. Patients and Methods Review of the clinical and pathological characteristics of 19 consecutive patients submitted to surgical resection of GCLM with curative intent at our department. Major potential prognostic factors considered were patients’ gender, age, timing and extent of Hp, postoperative course, as well as histopathological characteristics of primary and secondary tumors. Results Major morbidity occurred in four patients, mortality in one. Median and 5-year overall survival were 17 months and 26.7%, respectively. Ten patients developed recurrent disease and two patients survived more than 10 years. Factors independently associated with overall survival were the absence of major morbidity, distal location of the primary tumor, and desmoplastic GP (p<0.05). Conclusion The selection of patients is crucial for the improvement of survival rates of GCLM. Consequently, we demonstrate for the first time that the desmoplastic GP of GCLM is associated with improved outcomes, prompting further research on tumor–host interactions.
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Affiliation(s)
- Maria José Temido
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal
| | - Rui Caetano Oliveira
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto 4200-319, Portugal
| | - Ricardo Martins
- Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Marco Serôdio
- Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Beatriz Costa
- Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - César Carvalho
- Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Eva Santos
- Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Luís Ferreira
- Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Paulo Teixeira
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal.,Department Biomedical Laboratory Sciences, ESTeSC- Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra 3046-854, Portugal
| | - Maria Augusta Cipriano
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - José Guilherme Tralhão
- Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra 3000-548, Portugal.,Department of Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
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14
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Fonseca GM, Braghiroli MIFM, Pirola Kruger JA, Coelho FF, Herman P. Is There a Role for Locoregional Therapies for Non-colorectal Gastrointestinal Malignancies? Surg Oncol Clin N Am 2020; 30:125-142. [PMID: 33220801 DOI: 10.1016/j.soc.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The liver is the most common site of metastases from solid gastrointestinal tract tumors. Over the past few decades, the role of locoregional therapies, resection and thermal ablation, for neuroendocrine and colorectal liver metastases has been widely studied. However, for liver metastases originating from other gastrointestinal organs, the role of locoregional treatment remains unclear. This review summarizes and discusses the available evidence regarding benefits, risks, and indications for locoregional therapies for non-colorectal and non-neuroendocrine gastrointestinal liver metastases, highlighting the importance of multidisciplinary approach and patient selection.
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Affiliation(s)
- Gilton Marques Fonseca
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Maria Ignez Freitas Melro Braghiroli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), University of Sao Paulo, and Rede D'Or Sao Paulo, Av. Dr. Arnaldo, 251 - São Paulo, SP, Brazil. CEP: 01246-000, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil.
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15
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Jin P, Ji X, Tian Y. Surgical management of oligometastatic disease in gastric cancer. Clin Res Hepatol Gastroenterol 2020; 44:638-645. [PMID: 32147440 DOI: 10.1016/j.clinre.2020.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
A distinctive subset of metastatic gastric cancer (MGC) is oligometastatic disease (OMD), which is characterized by metastatic lesions limited in number and location. Although growing evidence mainly based on retrospective analysis or single center case series has shown favorable prognosis in the management of OMD in gastric cancer with aggressive local treatment, no existing guidelines explicitely address the definition of OMD and there are still controversial opinions on how to proceed in a new era with more effective systemic therapy selection. In this review, we present the current advances and evidence as well as controversial on the management of OMD in MGC, including the definition, diagnosis, local aggressive treatments especially surgery, prognostic factors, current ongoing randomized clinical studied as well as challenges facing the field.
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Affiliation(s)
- Peng Jin
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China.
| | - Xiaoyan Ji
- Department of Emergency Ward, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China.
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16
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Yamaguchi H, Honda M, Hamada K, Kobayashi H, Todate Y, Seto I, Takayama K, Suzuki M, Wada H, Kikuchi Y, Murakami M. The effectiveness of proton beam therapy for liver metastatic recurrence in gastric cancer patients. Jpn J Clin Oncol 2020; 50:903-908. [PMID: 32363379 DOI: 10.1093/jjco/hyaa052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/25/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The purpose of this cross-sectional study was to evaluate the efficacy and safety of proton beam therapy for liver metastatic recurrence in gastric cancer patients. METHODS Consecutive patients who underwent proton beam therapy from 2010 to 2015 were isolated from our institutional database. Patients with extrahepatic metastatic lesions were excluded. Seven patients were enrolled. The median diameter of target lesions was 31 mm (13-68 mm). The most frequent dosage was 72.6 Gy equivalent in 22 fractions. The effectiveness was assessed based on the local control, overall survival and progression-free survival rates. The local control, overall survival and progression-free survival rates were calculated using the Kaplan-Meier method. Adverse events were described according to the patients' medical records. RESULTS The median follow-up period was 41.7 months (20.7-66.3 months). The 3-year local control, overall survival and progression-free survival rates were 85.7, 68.6 and 43%, respectively. All patients completed proton beam therapy without interruption. No grade ≥3 adverse events were observed. CONCLUSIONS Proton beam therapy might be a treatment option for patients with liver metastasis of gastric cancer.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Gastroenterology, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Hiroshi Kobayashi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Yukitoshi Todate
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Ichiro Seto
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Masao Murakami
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
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17
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Uggeri F, Ripamonti L, Pinotti E, Scotti MA, Famularo S, Garancini M, Gianotti L, Braga M, Romano F. Is there a role for treatment-oriented surgery in liver metastases from gastric cancer? World J Clin Oncol 2020; 11:477-494. [PMID: 32821653 PMCID: PMC7407929 DOI: 10.5306/wjco.v11.i7.477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distant metastases are found in approximately 35% of patients with gastric cancer at their first clinical observation, and of these, 4%-14% involves the liver. Unfortunately, only 0.4%-2.3% of patients with metastatic gastric cancer are eligible for radical surgery. Although surgical resection for gastric cancer metastases is still debated, there have been changes in recent years, although several clinical issues remain to be defined and that must be taken into account before surgery is proposed.
AIM To analyze the clinicopathological factors related to primary gastric tumor and metastases that impact the survival of patients with liver metastatic gastric cancer.
METHODS We performed a systematic review of the literature from 2000 to 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The study protocol was based on identifying studies with clearly defined purpose, eligibility criteria, methodological analysis, and patient outcome.
RESULTS We selected 47 studies pertaining to the purpose of the review, which involved a total of 2304 patients. Median survival was 7-52.3 mo, median disease-free survival was 4.7-18 mo. The 1-, 2-, 3-, and 5-year overall survival (OS) was 33%-90.1%, 10%-60%, 6%-70.4%, and 0%-40.1%, respectively. Only five papers reported the 10-year OS, which was 5.5%–31.5%. The general recurrence rate was between 55.5% and 96%, and that for hepatic recurrence was between 15% and 94%.
CONCLUSION Serous infiltration and lymph node involvement of the primary cancer indicate an unfavorable prognosis, while the presence of single metastasis or ≤ 3 metastases associated with a size of < 5 cm may be considered data that do not contraindicate liver resection.
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Affiliation(s)
- Fabio Uggeri
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Lorenzo Ripamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Enrico Pinotti
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | | | - Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | | | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Fabrizio Romano
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
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18
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Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol 2020; 12:1758835920904803. [PMID: 32127925 PMCID: PMC7036491 DOI: 10.1177/1758835920904803] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background The incidence of gastric cancer with liver metastases (GCLM) is 9.9-18.7%, with a median survival time of 11 months and a 5-year survival rate <20%. Multidisciplinary treatment (MDT) is gradually gaining recognition as the most important method. However, specific treatment plans remain unclear. The aim of study was to provide a consensus to improve the diagnosis and treatment of GCLM. Methods We brought together experts from relevant medical fields across China, including the Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons, Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association, to discuss and formulate this consensus. Results A consensus was reached on the diagnosis and treatment of GCLM. Moreover, we have developed a new clinical classification system, the Chinese Type for Gastric Cancer Liver Metastases, based on the likelihood of a surgical treatment being successful. Conclusions The MDT mode should be implemented throughout all treatment of GCLM.A Chinese version of this expert consensus has been published in the Chinese Journal of Practical Surgery (Volume 39, Issue 10, p. 405-411). Written permission was obtained from the Chinese Journal of Practical Surgery to disseminate the expert consensus in English.
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Affiliation(s)
- Kecheng Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
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Omari J, Drewes R, Orthmer M, Hass P, Pech M, Powerski M. Treatment of metastatic gastric adenocarcinoma with image-guided high-dose rate, interstitial brachytherapy as second-line or salvage therapy. ACTA ACUST UNITED AC 2020; 25:360-367. [PMID: 31348004 DOI: 10.5152/dir.2019.18390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We aimed to evaluate the safety and effectiveness of image-guided high-dose rate interstitial brachytherapy (iBT) for the treatment of patients with hepatic, lymphatic, and pancreatic metastases originating from gastric cancer, an entity rarely surgically treatable with curative intent. METHODS Twelve patients with a cumulative number of 36 metastases (29 liver, 2 pancreatic, 5 lymph node) from histologically proven gastric adenocarcinoma received iBT between 2010 and 2016 and were retrospectively analyzed. Every patient underwent palliative chemotherapy prior to iBT. The iBT procedure employs a temporarily, intratumorally placed iridium-192 source in a single fraction with the goal of tumor cell eradication. Effectiveness was assessed clinically and by radiologic imaging every three months. RESULTS Local tumor control was achieved in 32 of all treated metastases (89%). Four lesions showed a local recurrence after 7 months. Lesion sizes varied from 9 to 102 mm with a median of 20 mm. The median progression-free survival was 6.6 months (range, 1.8-46.8 months). The median overall survival was 11.4 months (range, 5-47 months). One patient suffered a major complication following iBT, hepatic hematoma and abscess (Common Terminology Criteria for Adverse Events grade 3), successfully dealt with by transcutaneous drainage. CONCLUSION iBT is an overall safe procedure, which facilitates high rates of local tumor control in treatment of metastatic gastric adenocarcinoma. Compared with surgical metastasectomy, similar overall survival rates could be achieved in our patient collective after iBT application.
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Affiliation(s)
- Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Ralph Drewes
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Max Orthmer
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Peter Hass
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany;Department of Radiology, Gdansk University School of Medicine, Gdansk, Poland
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
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Luo Z, Rong Z, Huang C. Surgery Strategies for Gastric Cancer With Liver Metastasis. Front Oncol 2019; 9:1353. [PMID: 31921626 PMCID: PMC6915096 DOI: 10.3389/fonc.2019.01353] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023] Open
Abstract
Gastric cancer with liver metastasis is defined as advanced gastric cancer and remains one of the deadliest diseases with poor prognosis. Approximately 4–14% of patients with gastric cancers presented with liver metastases at the initial diagnosis. Owing to its incurability, first-line treatment for gastric cancer with liver metastases is systematic chemotherapy, whereas surgery is usually performed to alleviate severe gastrointestinal symptoms. However, continuously emerging retrospective studies confirmed the role of surgery in gastric cancer with liver metastases and showed significantly improved survival rate in patients assigned to a group of surgery with or without chemotherapy. Therefore, more and more convincing data that resulted from prospective randomized clinical trials is in need to clarify the surgery strategies in patients with gastric cancer with liver metastasis.
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Affiliation(s)
- Zai Luo
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zeyin Rong
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Huang
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Wu Z, Cheng H, Shan F, Ying X, Miao R, Dong J, Sun Y, Xu A, Zhou Y, Wang Y, Chen L, Xue Y, Cao H, Hua Y, Xu Z, Zheng M, Yan M, Huang C, Suo J, Liang H, Fan L, Hu J, Hu X, Li G, Yu P, Li G, Shi Y, Luo H, Li Y, Xie M, Liu T, Zhang Z, Shi T, Li Z, Ji J. In-Hospital Mortality Risk Model of Gastric Cancer Surgery: Analysis of a Nationwide Institutional-Level Database With 94,277 Chinese Patients. Front Oncol 2019; 9:846. [PMID: 31632900 PMCID: PMC6779801 DOI: 10.3389/fonc.2019.00846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023] Open
Abstract
Background: The objective of this study is to identify independent risks and protective factors and to construct a mortality prediction model for gastrectomy in the Chinese population. Study design: This is a population-based prospective cohort at an institutional level. Seventy-two participating hospitals reported their annual gastrectomy data between 2014 and 2016, while 44 variables covering the institution and surgical information were included in the analysis. We used R software to encode and complete data pre-processing. The first difference model was applied to build the risk model. Data from 2014 and 2015 were assigned to risk model development, while data from 2016 was used for validation. Results: In the included centers with 94,277 gastric cancer cases, the in-hospital mortality rate was 0.32%. The regression model revealed that provinces with low-middle GDP, hospitals with annual gastrectomy volume between 100 and 500, greater volume of urgent surgeries performed, larger proportion of males, and a higher proportion of liver metastasis were independent risk factors for mortality following gastric surgeries, while higher laparoscopic resection volume, greater volume of distal gastrectomy with B2 reconstruction, and larger proportion of palliative surgery were independent protective factors (p < 0.05, respectively). In the prediction test, the mean square error of the training set was 0.948, while that of the test set was 0.728, demonstrating the effectiveness of this model. Conclusions: We constructed the first mortality risk prediction model for gastric cancer surgery in the Chinese population. The identified risk factors will help with the therapy selection, while further informing Chinese medical policy decision-makers.
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Affiliation(s)
- Zhouqiao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Huimin Cheng
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiangji Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Rulin Miao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianhong Dong
- Center of Minimally Invasive Gastrointestinal Surgery, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Yihong Sun
- Department of General Surgery, Fudan University Zhongshan Hospital, Shanghai, China
| | - Aman Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanbing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanong Wang
- Department of Gastric Cancer and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Hospital, Shanghai, China
| | - Lin Chen
- Department of General Surgery, People's Liberation Army General Hospital, People's Liberation Army (PLA) Army General Hospital, Beijing, China
| | - Yingwei Xue
- Department of General Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hui Cao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yawei Hua
- Department of General Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Changming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian Suo
- Department of Gastric Surgery, The First Hospital of Jilin University, Changchun, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lin Fan
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong Hospital, Xi'an, China
| | - Jiankun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Chengdu, China
| | - Xiang Hu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guoli Li
- Department of Gastrointestinal Surgery, Nanjing General Hospital, Nanjing, China
| | - Peiwu Yu
- Department of General Surgery, The First Hospital Affiliated Hospital to Army Medical University (AMU) (Southwest Hospital), Chongqing, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Guangzhou, China
| | - Yiran Shi
- Department of General Surgery, Weifang People's Hospital, Weifang, China
| | - Huayou Luo
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital, Guangzhou, China
| | - Ming Xie
- Department of General Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guangzhou, China
| | - Tianxue Liu
- Department of General Surgery, Penglai People's Hospital, Penglai, China
| | - Zhongyuan Zhang
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
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Guner A, Yildirim R. Surgical management of metastatic gastric cancer: moving beyond the guidelines. Transl Gastroenterol Hepatol 2019; 4:58. [PMID: 31559339 DOI: 10.21037/tgh.2019.08.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/05/2019] [Indexed: 01/27/2023] Open
Abstract
Despite decreasing incidence, gastric cancer remains a major health problem worldwide and is associated with poor survival. The poor survival is mainly attributed to delayed presentation which may cause local or systemic metastases. The standard of care for patients with metastatic gastric cancer (MGC) is palliative chemotherapy with best supportive care. Although the survival has improved owing to advances in chemotherapeutic agents, it is still unsatisfactory, and some perspective changes are needed in the management of MGC to improve the outcomes. Therefore, various alternative treatment strategies for MGC have formed the most important research topics. Liver-directed treatment (LDT) options such as liver resection, radiofrequency ablation (RFA), microwave ablation (MWA), and hepatic artery infusion chemotherapy (HAIC) have been studied in the management of liver metastasis from gastric cancer (LMGC). Intraperitoneal chemotherapy (IPC) in addition to cytoreductive surgery (CRS) aiming to remove all macroscopic tumor focus resulting from peritoneal dissemination is the treatment option for peritoneal metastasis, while para-aortic lymph node dissection is the treatment option for para-aortic lymph node metastasis which is considered to be M1 disease. Conversion surgery is a novel concept aiming at R0 resection for originally unresectable or marginally resectable tumors after a remarkably good response to the chemotherapy. Large amounts of data in the literature have demonstrated the benefits of individualized approaches such as the combination of systemic and local treatment options in selected patient groups. In this review, we aimed to explore the current and future treatment options by reviewing the literature on this controversial topic.
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Affiliation(s)
- Ali Guner
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.,Department of Biostatistics and Medical Informatics, Institute of Medical Science, Karadeniz Technical University, Trabzon, Turkey
| | - Reyyan Yildirim
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Abstract
The therapeutic approach to patients with oligometastatic gastric cancer and esophageal cancer is currently undergoing a shift towards a more aggressive therapy including surgical resection. In the current German S3 guidelines surgical treatment of metastatic disease is not recommended; however, nowadays interdisciplinary tumor boards have to evaluate such patients increasingly more often. On an individual basis a radical surgical resection of the primary tumor and the metastases is considered and performed in patients who respond well to multimodal chemotherapy concepts. In this review article the currently available data from the literature are discussed and a foundation for individually extended surgical approaches is presented. Together with the currently available results of the FLOT 3 study and the mostly retrospective studies, it seems to be possible to identify patients who would profit from such an aggressive treatment. In the future randomized prospective studies, such as the RENAISSANCE/FLOT 5 study and the GASTRIPEC study will have to evaluate whether an aggressive surgical therapy within multimodal therapy concepts of metastatic gastric and esophageal carcinomas is warranted.
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Affiliation(s)
- T Schmidt
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
| | - S P Mönig
- Department of Surgery, Upper-GI-Surgery, Geneva University Hospitals, Geneva, Schweiz
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Elobu A, Thorat A, Kweyamba V, Rai R. Gastric cancer and intrahepatic cholangiocarcinoma: Gastrectomy followed by left hepatectomy to achieve R0 resection. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_112_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Shi W, Wang J, Zhang W, Shou T. Long-term survival with stable disease after multidisciplinary treatment for synchronous liver metastases from gastric cancer: A case report. Int J Surg Case Rep 2019; 65:317-321. [PMID: 31766011 PMCID: PMC6881675 DOI: 10.1016/j.ijscr.2019.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The liver is one of the most common sites of hematogenous metastases of gastric cancer. The 5-year overall survival rate of synchronous liver metastases from gastric cancer was less than 27%. We report a rare case of patient with synchronous liver metastases from gastric cancer who experienced stable disease for 7 years and 3 months following multidisciplinary modalities. THE PRESENTATION OF A CASE A 33-year-old woman was admitted to our institute because of abdominal pain lasting for a day. Haemoglobin level was 68 g/L. Computed tomography (CT) scan revealed hemoperitoneum, multiple round lesions within liver parenchyma. The pathological diagnosis was gastric cancer with liver metastases. Following multidisciplinary treatment, she experienced stable disease for7 years and 3 months. Currently, the patient remains alive with no recurrence. CONCLUSION We report a rare case of patient with synchronous liver metastases from gastric cancer who experienced stable disease for 7 years and 3 months following multidisciplinary modalities. Future trials are required to prospectively investigate the established regimen of multidisciplinary treatment.
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Affiliation(s)
- Wenjun Shi
- Department of Oncology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Junfeng Wang
- Department of General Surgical, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wenjing Zhang
- Department of Oncology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Tao Shou
- Department of Oncology, The First People's Hospital of Yunnan Province, Kunming, China.
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Yu PC, Long D, Liao CC, Zhang S. Association between density of tumor-infiltrating lymphocytes and prognoses of patients with gastric cancer. Medicine (Baltimore) 2018; 97:e11387. [PMID: 29979429 PMCID: PMC6076141 DOI: 10.1097/md.0000000000011387] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Tumor-infiltrating lymphocytes (TILs) have been shown to be of prognostic significance in patients with gastric cancer. This study aims to investigate the association between density of TILs and prognoses of patients with gastric cancer. METHODS The relative studies of tumor-infiltrating lymphocytes in tumor tissue from patients with gastric cancer were systematically searched from PubMed and Embase until October 31, 2017. The pooled hazard ratios (HRs) and their 95% confidence intervals (95%CI) for overall survival (OS) were estimated. RESULTS Twenty-nine studies involving 4,942 patients were included into analyses. Subset of TILs included CD8, CD3, CD4, and FOXP3 T cell density. Results from meta-analyses revealed that high density of intratumoral CD8 T cells (HR = 0.77, 95% CI 0.63-0.95) and CD3 (HR = 0.62, 95% CI 0.49-0.77) were associated with significantly higher OS than those with low density in patients with gastric cancer. Moreover, a larger number of general TILs density also suggested a favorable prognosis (HR 0.75, 95% CI 0.67-0.84). However, patients with high density of intratumoral FOXP3 T or CD4 T cells were not statistically associated with higher or lower OS than those with low density (HR 1.41, 95% CI 0.97-2.05; HR = 0.86, 95% CI 0.47-1.57). Sample size and follow-up period seemed to influence study outcomes. CONCLUSION The present study revealed that high density of intratumoral CD8 and CD3 T cells were associated with better OS in patients with gastric cancer.
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Affiliation(s)
- Peng-Cheng Yu
- Department of Colorectal Anal Surgery, the First Affiliated Hospital of Guangxi Medical University
| | - Di Long
- Department of Colorectal Anal Surgery, the First Affiliated Hospital of Guangxi Medical University
| | - Cheng-Cheng Liao
- Department of Chemotherapy, the Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Sen Zhang
- Department of Colorectal Anal Surgery, the First Affiliated Hospital of Guangxi Medical University
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Montagnani F, Crivelli F, Aprile G, Vivaldi C, Pecora I, De Vivo R, Clerico MA, Fornaro L. Long-term survival after liver metastasectomy in gastric cancer: Systematic review and meta-analysis of prognostic factors. Cancer Treat Rev 2018; 69:11-20. [PMID: 29860024 DOI: 10.1016/j.ctrv.2018.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the amelioration of systemic therapy, overall survival (OS) of metastatic gastric cancer (GC) patients remains poor. Liver is a common metastatic site and retrospective series suggest a potential OS benefit from hepatectomy, with interesting 5-year (5 y) and 10-year (10 y) OS rates in selected patients. We aim to evaluate the impact of liver resection and related prognostic factors on long-term outcome in this setting. METHODS We searched Pubmed, EMBASE, and Abstracts/posters from international meetings since 1990. Data were extracted from publish papers. Random effects models meta-analyses and meta-regression models were built to assess 5yOS and the impact of different prognostic factor. Heterogeneity was assessed using between study variance, I2 and Cochran's Q. Funnel plot were used to assess small study bias. RESULTS Thirty-three observational studies (for a total of 1304 patients) were included. Our analysis demonstrates a 5yOS rate of 22% (95%CI: 18-26%) and 10yOS rate of 11% (95%CI: 7-18%) among patients undergoing radical hepatectomy. A favorable effect on OS was shown by several factors linked to primary cancer (lower T and N stage, no lympho-vascular or serosal invasion) and burden of hepatic disease (≤3 metastases, unilobar involvement, greatest lesion < 5 cm, negative resection margins). Moreover, lower CEA and CA19.9 levels and post-resection chemotherapy were associated with improved OS. CONCLUSIONS Surgical resection of liver metastases from GC seems associated with a significant chance of 5yOS and 10yOS and compares favourably with results of medical treatment alone. Prospective evaluation of this approach and validation of adequate selection criteria are needed.
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Affiliation(s)
- Francesco Montagnani
- Department of Oncology, Azienda Sanitaria locale di Biella, Ponderano (BI), Italy.
| | | | - Giuseppe Aprile
- Department of Oncology, Ospedale San Bortolo, Azienda ULSS8 Berica - Distretto Est, Vicenza, Italy
| | - Caterina Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Irene Pecora
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rocco De Vivo
- Department of Oncology, Ospedale San Bortolo, Azienda ULSS8 Berica - Distretto Est, Vicenza, Italy
| | | | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Intensified neoadjuvant multimodal approach in synchronous liver metastases from gastric cancer: a single institutional experience. Clin Transl Oncol 2017; 20:658-665. [PMID: 29043568 DOI: 10.1007/s12094-017-1767-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Synchronous liver metastases (LM) from gastric (GC) or esophagogastric junction (EGJ) adenocarcinoma are a rare events. Several trials have evaluated the role of liver surgery in this setting, but the impact of preoperative therapy remains undetermined. METHODS Patients with synchronous LM from GC/EGJ adenocarcinoma who achieved disease control after induction chemotherapy (ICT) and were subsequently scheduled to chemoradiotherapy (CRT) to the primary tumor and surgery assessment were retrospectively analyzed. Pathological response, patterns of relapse, progression-free survival (PFS), and overall survival (OS) were calculated. From July 2002 to September 2012, 16 patients fulfilling the inclusion criteria were identified. RESULTS Primary tumor site was GC (nine patients) or EGJ (seven patients). LM were considered technically unresectable in nine patients. Radiological response to the whole neoadjuvant program was achieved in 13 patients. Eight patients underwent surgical resection of the primary tumor; in five of these LM were resected. A complete pathological response in the primary or in the LM was found in four and three patients, respectively. The most frequent site of relapse/progression was systemic (eight patients). Local and liver-only relapses were observed in two patients each. After a median follow-up of 91 months, the median OS and PFS were 23.0 (95% CI 13.2-32.8) and 17.0 months (95% CI 11.7-22.3). 5-year actuarial PFS is 17.6%. CONCLUSION Our results suggest that an intensified approach using ICT followed by CRT in synchronous LM from GC/EGJ adenocarcinoma is feasible and may translate into prolonged survival times in selected patients.
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