Cases Of Advanced Gastric Cancer Research Articles

A Case of HER2-positive Advanced Gastric Cancer Successfully Resected by Conversion Surgery after SOX/Trastuzumab Combination Therapy

A Case of HER2-positive Advanced Gastric Cancer Successfully Resected by Conversion Surgery after SOX/Trastuzumab Combination Therapy

15-year experience of laparoscopic gastrectomy in advanced gastric cancer: analysis on short-term and long-term oncologic outcome.

Laparoscopic gastrectomy (LG) is now a widely accepted treatment option for gastric cancer. However, there is insufficient evidence for LG for advanced gastric cancer (AGC). Many retrospective studies have shown that LG for AGC is safe and feasible, but very few studies have shown the actual outcome in general practice. The aim of this study is to analyze our last 15years of experience in LG for AGC. This is a retrospective review from May 2003 to May 2017 in Seoul National University Bundang Hospital. A total of 1592 patients who had LG for AGC were enrolled of which 109 patients with open conversion were excluded. We evaluated the short-term and long-term oncologic outcomes of LG for AGC. A total of 1483 patients were analyzed. There were 432 cases of total gastrectomy, 982 cases of distal gastrectomy, and 69 cases of proximal gastrectomy. The total complication rate was 9.1% (135/1483), which included wound-related complications (0.7%), postoperative bleeding (0.5%), anastomosis or stump leakage (2.2%), intestinal obstruction (0.9%), pancreatic fistula (0.1%), intra-abdominal abscess (1.6%), and lung morbidity (3.0%). The rate of Clavien-Dindo grade 3 and above complications was 4.9%. Age was the only significant risk factor in multivariate analysis (OR 1.02; 95% CI, 1.01-1.04, P = 0.01). 5-year overall survival stratified by stage was as follows: stage IB 88.9%, stage IIA 88.7%, stage IIB 84.2%, stage IIIA 71.7%, stage IIIB 56.8%, stage IIIC 45.4%, and stage IV 25%. Total recurrence rate was 14.4%, which included local recurrence (1.1%) and distant metastases (13.3%). During our 15years of experience, we have successfully performed 1483 cases of AGC with laparoscopy. Our results showed short-term and long-term oncologic outcomes that were comparable with other studies. LG is safe and feasible in general practice for advanced gastric cancer when performed by experienced surgeons.

A Case of Advanced Gastric Cancer with Folfiri as a Preoperative Chemotherapy

Introduction In advanced gastric cancer, preoperative chemotherapy is associated with survival benefit. FOLFIRI has demonstrated promising results in terms of survival and tolerance, especially in patients with poor performance status. Case Presentation A 59-year-old male, diagnosed with pT4bN2M0 gastric cancer, underwent gastrointestinal anastomosis and three cycles of EOX chemotherapy. Due to disease progression, he was switched to FOLFIRI regimen. After 12 cycles, the patient received a subtotal gastrectomy and D2 lymphadenectomy. Microscopic examination achieved pCR, and the patient has been surviving 34 months without recurrence. No severe toxicities of chemotherapy were recorded. Conclusions FOLFIRI might be a safe and effective option in neoadjuvant treatment for advanced gastric cancer among patients with poor performance status or progression after first-line chemotherapy.

Evaluation of the expression of the oncogen C-ERBB-2/HER2 in advanced gastric cancer cases from Costa Rica.

JustificationThe prevalence of gastric cancer (GC) with increased expression of the HER2 oncoprotein shows important variations worldwide. Incidence and mortality rates of GC in Costa Rica are among the highest in Latin America and the world; however, the prevalence of HER2-positive cases in this country is unknown. Evaluation of this parameter is important to decide the therapeutic approach for GC patients. The aim of this study was to provide an estimation of the prevalence of GC patients overexpressing the HER2 oncogene in Costa Rica.MethodsThe investigation was carried out in two phases. The first one consisted of a retrospective review of 331 clinical records of patients diagnosed with advanced or metastatic GC from January 2010 to January 2012 in four hospitals in Costa Rica. In the second phase, immunohistochemistry (IHC) and fluorescent in situ hybridisation (FISH) analyses were performed in formalin-fixed and paraffin-embedded (FFPE) surgical samples from 50 patients diagnosed with GC between 2012 and 2015.ResultsOf the 331 clinical files reviewed, the assessment of HER2 status was carried out in 62 patients (18.7%), of which only five (8%) were HER2-positive. In the 50 surgical specimens in which IHC and FISH analyses were performed, two of them (4%) presented overexpression and amplification of the HER2 oncogene.ConclusionThis study suggests that the prevalence of GC cases overexpressing the HER2 oncogene in Costa Rica is less than 8%. This is the first attempt ever undertaken to estimate the prevalence of HER2-positivity in GC in Costa Rica.

Prognostic implications and interaction of L1 methylation and p53 expression statuses in advanced gastric cancer

BackgroundTP53 is frequently mutated across various tissue types of cancers. In normal cells, long interspersed nuclear element-1 (LINE-1, L1) is mostly repressed by DNA methylation in its 5′ untranslated region but is activated by DNA demethylation process during tumorigenesis. p53 is indispensable for maintaining genomic stability and plays its role in controlling genomic stability by repressing retrotransposon activity. However, it is unclear whether p53 regulates expression or methylation of L1 differently depending on the mutational status of TP53. Four hundred ninety cases of advanced gastric cancer (AGC) were analyzed for their statuses in p53 expression and L1 methylation using immunohistochemistry and pyrosequencing, respectively. Whether L1 methylation and expression statuses were differently affected by types of TP53 mutants was analyzed in gastric cancer cell line.ResultsBy p53 immunohistochemistry, tumors were classified into 4 groups according to the intensity and extent of stained tumor nuclei. L1 methylation level was significantly higher in p53 expression group 1 than in the other groups in which L1 methylation level was similar (P < 0.001). Although L1 methylation and p53 expression statuses were associated with patient survival, multivariate analysis revealed that L1 methylation was an independent prognostic parameter. In in vitro analysis of AGS cells with the introduction of wild type or mutant types of TP53, L1 methylation level and activity were different depending on types of TP53 mutation.ConclusionsFindings suggest that L1 methylation level is affected by TP53 mutation status; although, L1 methylation status was an independent prognostic parameter in patients with AGC. Further study is required to elucidate the mechanism of how wild type or mutant p53 affects L1 activity and methylation status of L1 CpG island.

Serum Inflammatory Cytokines Comparison in Gastric Cancer Therapy.

To compare serum inflammatory cytokines between laparoscopic-assisted and open radical gastrectomy in the perioperative period, 80 cases of advanced gastric cancer were chosen for the study. They were divided into laparoscopy group (40 cases) and abdominal open surgery group (40 cases), performed laparoscopic-assisted radical gastrostomy and conventional open radical gastrectomy, respectively. Serum Heme oxygenase-1 (HO-1), TNF-α, IL-6 and CRP were measured by ELISA on preoperative day 1, post-operative day 1 and post-operative day3. Serum HO-1, TNF-α, IL-6 and CRP had no significant difference between the laparoscopy group and the open group on pre-operative day 1. Serum HO-1, IL-6 and CRP of the laparoscopy group were significantly lower than that of the open group on post-operative day 1 and day 3 except for Serum TNF-α which had no significant difference. Laparoscopic-assisted radical gastrectomy was minimally invasive compared with conventional open radical gastrectomy in advanced gastric cancer patients.

Successful treatment of advanced gastric cancer with liver metastasis by S-1 + CDDP and S-1 therapy without surgery

It is generally reported that prognosis of patients who have unresectable gastric cancer is from 3 to 5months with best supportive care. Despite the improvement of survival after the appearance of S-1, the outcome of treatment for advanced gastric cancer is still unfavorable. Here we present a valuable case of advanced gastric cancer with synchronous liver metastasis, which was treated by S-1 + CDDP and S-1 therapy without surgery. A 58-year-old man was referred to our hospital with a diagnosis of advanced gastric cancer with liver metastasis at stage of cT3N0M1. He underwent first-line chemotherapy consisting of S-1 plus cispatin. 3months later, a follow-up endoscopy revealed complete response (CR) of the gastric lesion. 3months later, computed tomography (CT) also demonstrated disappearance of liver metastasis. Then he underwent maintenance chemotherapy with S-1 alone for 8months. To date, there has been no recurrence for 6years and 6months since the acquisition of CR.

A Case of Advanced Gastric Cancer that Presented with a Liver Abscess

A Case of Advanced Gastric Cancer that Presented with a Liver Abscess

A Case of Advanced Gastric Cancer with Intraperitoneal Hemorrhage due to Rupture of the Metastasis Lymph Node

A Case of Advanced Gastric Cancer with Intraperitoneal Hemorrhage due to Rupture of the Metastasis Lymph Node

A Case of Synchronous Advanced Gastric Cancer and Intraductal Papillary Mucinous Carcinoma Treated with Combined Distal Gastrectomy and Splenic Artery and Vein-preserving Total Pancreatectomy

A Case of Synchronous Advanced Gastric Cancer and Intraductal Papillary Mucinous Carcinoma Treated with Combined Distal Gastrectomy and Splenic Artery and Vein-preserving Total Pancreatectomy

A case of advanced gastric cancer with severe thrombocytopenia after administration of Nivolumab, following acute hepatitis E with decreased platelet count

A case of advanced gastric cancer with severe thrombocytopenia after administration of Nivolumab, following acute hepatitis E with decreased platelet count

Successful conversion surgery for unresectable gastric cancer with giant para-aortic lymph node metastasis after downsizing chemotherapy with S-1 and oxaliplatin: a case report

BackgroundAlthough patients with stage IV gastric cancer who respond well to systemic chemotherapy can be treated with gastrectomy, the prognosis of patients with unresectable gastric cancer with para-aortic lymph node metastasis is poor. We herein report a case of remnant gastric cancer with para-aortic lymph node metastasis that was treated with potentially curative conversion surgery after showing a complete response to chemotherapy with S-1 and oxaliplatin (SOX).Case presentationAn 81-year-old man was diagnosed with type 3 remnant gastric cancer with giant para-aortic lymph node metastasis, and he received SOX chemotherapy. After three courses of SOX chemotherapy, the primary tumor and para-aortic lymph node metastases markedly reduced in size, indicating a partial response. Because conversion surgery was possible, the patient underwent total remnant gastrectomy with D2 and para-aortic lymph node dissection. Histological examination revealed no residual cancer cells in the resected stomach and lymph nodes. The patient was diagnosed with a complete pathological response and was discharged on postoperative day 24. Currently, 1 year after surgery, the patient is alive and has not shown any tumor recurrence.ConclusionTo the best of our knowledge, this is the first case of advanced remnant gastric cancer with giant para-aortic lymph node metastasis that showed a pathological complete response and favorable outcome after SOX chemotherapy.

Combinatory low methylation statuses of SAT-α and L1 are associated with shortened survival time in patients with advanced gastric cancer.

L1 and SAT-α are repetitive DNA elements that undergo demethylation in association with cancerization. Unlike L1 hypomethaylation, nothing is known regarding the prognostic implication of SAT-α hypomethylation alongside L1 hypomethaylaton in gastric cancers. Formalin-fixed paraffin-embedded samples from 492 cases of advanced gastric cancer were analyzed to determine their L1 and SAT-α methylation status using pyrosequencing methylation assay. L1 and SAT-α methylation statuses were correlated with clinicopathological parameters, including survival. L1 or SAT-α methylation levels were lower in gastric cancers with venous invasion or nodal metastasis than those without. L1 methylation was lower in gastric cancers with lymphatic emboli than in those with no lymphatic emboli, but was higher in gastric cancers with perineural invasion than in those with no perineural invasion. Multivariate survival analysis revealed that both tumoral L1 and SAT-α hypomethylations were found to correlate independently with OS (HR = 1.477; 95% CI 1.079-2.021 and HR = 1.394; 95% CI 1.011-1.922, respectively) and RFS (HR = 1.477; 95% CI 1.090-2.001 and HR = 1.516; 95% CI 1.106-2.078, respectively). Combined L1 and SAT-α hypomethylation turned out to correlate independently with OS (HR = 2.003; 95% CI 1.268-3.164) and RFS (HR = 2.226; 95% CI 1.411-3.510). Not only tumoral L1 hypomethylation, but also tumoral SAT-α hypomethylation was found to be independent prognostic parameters in patients with advanced gastric cancer. SAT-α methylation status can be used to further divide gastric cancers with L1 hypomethylation into subsets of gastric cancers with better and worse prognosis.

A case of advanced gastric cancer that might develop in the region where omental implantation was previously performed

A case of advanced gastric cancer that might develop in the region where omental implantation was previously performed

Sa1250 CAN WE DISTINGUISH BETWEEN MALIGNANT GASTRIC LYMPHOMA AND ADVANCED GASTRIC CANCER BY ENDOSCOPIC FINDINGS?

Malignant gastric lymphoma (MGL) occupies a small proportion within 5% of gastric malignancy. However, unlike advanced gastric cancer (AGC) that requires surgical treatment, MGL must undergo chemotherapy or radiotherapy. Therefore, it is important to conduct differential diagnosis and the most important step is the initial impression of endoscopist. The purpose of this study was to confirm endoscopic features and possibility distinguishing between AGC and MGL. A total of 48 MGL patients and 48 age and sex-matched AGC patients were assessed by endoscopic review between June 2008 and February 2017. Two endoscopic specialists divided into Borrmann type (1, 2, 3 and 4) and early gastric cancer-like type (total five groups) based on endoscopic morphologic findings. Seven experts (more than 3 years) and eight trainees (less than 1 year) watched a total of 96 endoscopic cases randomly arranged and wrote down first endoscopic diagnosis on the exam paper. When analyzing the results of the exam, we assessed diagnostic accuracy and effect of endoscopic subgroups according to the endoscopic experience. The overall diagnostic accuracy with endoscopic findings were 0.604 by experts and 0.493 by trainees (P=0.050). Although the expert group showed a tendency high overall accuracy, there was no significant difference of accuracy according the final pathology (MGL, 0.518 vs 0.440, p=0.378; AGC, 0.690 vs 0.547, p=0.089, respectively). Moreover, there was no significant difference of overall diagnostic accuracy base on endoscopic five subgroups. On the subgroup analysis, experts showed significant higher diagnostic accuracy for endoscopic Borrmann type 4 including MGL or AGC cases compared with trainees (0.696 vs 0.474, p=0.001). Even if experts tend to have high endoscopic diagnostic accuracy, it is not easy to differentiate between MGL and AGC based on endoscopic findings. Especially for beginners, even if judged AGC on endoscopy will always consider MGL for differential diagnosis.

Presence of cancer cells in the periarterial tissues of patients with advanced gastric cancer.

Lymphadenectomy with gastrectomy is considered a curative surgical treatment for gastric cancer. Periarterial connective tissue-preserving lymphadenectomy has become a common procedure following developments in laparoscopic surgery. However, the presence of cancer cells in the periarterial tissue, including neural invasion, has not been examined. In the present study, the periarterial tissues from the vessel roots of the left gastric artery (LGA) and right gastroepiploic artery (RGEA) after gastrectomy were evaluated for the presence of cancer cells. The study included 28 consecutive patients who underwent gastrectomy for gastric cancer. The vessel roots of the RGEA and LGA were obtained from surgically resected specimens and examined by two independent pathologists to determine the presence of cancer cells in the periarterial tissues. The collected specimens included 23 RGEA roots and 26 LGA roots from 28 patients. In 8 cases of early gastric cancer, no cancer cells were indicated in the periarterial tissues. By contrast, cancer cells, including neural invasion in 2 cases, were identified in the periarterial tissues from the roots of examined gastric arteries in 3/20 (15%) cases of advanced gastric cancer. Notably, all 3 cases featured multiple regional lymph node (LN) metastases. Cancer cells were detected in the perivascular tissue of the major gastric arteries from cases with advanced gastric cancer with LN metastases, suggesting the requirement for oncologic evaluation to ensure adequate vascular tissue margins and an adequate periarterial layer during lymphadenectomy.

A Case of Advanced Gastric Cancer with Gastric Outlet Obstruction Placed a Duodenal Stent Achieved Pathological Complete Response after Neoadjuvant Chemotherapy

A Case of Advanced Gastric Cancer with Gastric Outlet Obstruction Placed a Duodenal Stent Achieved Pathological Complete Response after Neoadjuvant Chemotherapy

Analysis of Clinicopathologic Characteristics of Gastric Cancer

Objective Western Inner Mongolia is a high risk area of gastric cancer. However, detailed clinical and pathological data of gastric cancer has been lacking. Our hospital is one of the largest gastric cancer diagnoses and treatment centers in western Inner Mongolia. This study was designed to investigate the characteristics of clinical data of patients with gastric cancer in Western Inner Mongolia at our hospital over the past eight years. Methods Data of 1548 cases of gastric cancer patients from 2007.01.01 to 2015.01.01 in our hospital was retrospectively analyzed for their clinical characteristics. Results Of the 1548 patients, 1251 cases (80.81%) were male and 297 (19.19%) were female, and the average age was 60.94±10.90 years old. The cancer location was mainly on the antrum, accounting for 40.76%. Different ages of gastric cancer location constituent ratio was different, and the difference was significant (χ2=39.836, P=0.000). Poorly differentiated adenocarcinoma was a major histological type, accounting for 46.58%. Different ages of histological classification and the differentiation constituent ratio was also different, and the difference was significant (χ2=67.300, P=0.000). There were 144 cases of early gastric cancer, accounting for 9.30%; 1404 cases of advanced gastric cancer, accounting for 90.70%. The majority pathologic type of advanced gastric cancers were Bormann Ⅲ(53.92%). Ⅲ+Ⅳ stage was a majority of TNM stage, accounting for 72.41％. Different ages of TNM stage was different, the difference was significant (χ2=9.013, P=0.029). Conclusion Advanced gastric cancer is the major type of patients with gastric cancer in Western Inner Mongolia. Gastric cancer has a higher incidence in older male patients. Poorly differentiated adenocarcinoma and cancer in antrum have a larger probability. Compared with older patients, there is higher occurrence of malignant cancer and earlier TNM stage in younger patients. Mongolian patients and Han patients showed no significant difference.

Efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer: a Meta-analysis

Objective To evaluate the efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer (AGC). Methods The related randomized controlled trials were searched in the following databases such as Cochrane Library, PubMed, Web of Science from database establishment to April 2017. Data extraction and quality assessment by means of NOS were completed by two researchers. The survival rate, recurrence rate, mortality and morbidity were analyzed by RevMan 5.3 software. Results Seventeen literatures which were strictly filtrated from the original 2 383 literatures were included for Meta-analysis and the NOS score was 6-8. A total of 2 302 AGC cases were included to divide for 1 175 undergoing surgery with intraperitoneal chemotherapy and 1 127 undergoing surgery alone. Meta-analysis results showed that compared with surgery alone, surgery with intraperitoneal chemotherapy could improve the 1-year (OR = 1.93, 95% CI 1.41 - 2.66, P < 0.000 1), 2-year (OR= 1.82, 95% CI 1.41- 2.35, P < 0.000 01) and 3 -year (OR= 1.93, 95% CI 1.54- 2.42, P < 0.000 01) survival rate of ACG cases, while the overall mortality was reduced (OR= 0.47, 95% CI 0.34- 0.64, P < 0.000 01). In terms of recurrence rate, the overall (OR= 0.46, 95% CI 0.32- 0.68, P < 0.000 1) and peritoneal (OR= 0.47, 95% CI 0.29- 0.76, P= 0.002) recurrence rates of surgery with intraperitoneal chemotherapy were both lower than those of surgery alone. There were not significantly differences between surgery with intraperitoneal chemotherapy and surgery alone in lymph nodes and liver metastasis rate. However, surgery with intraperitoneal chemotherapy had more high occurrence rates than surgery alone (OR= 1.47, 95% CI 1.16- 1.85, P= 0.001), especially the bone suppression (OR= 3.07, 95% CI 1.70- 5.54, P= 0.002) and bleeding (OR= 3.00, 95% CI 1.09- 8.27, P= 0.03), and there were no differences in other complications. Subgroup results indicated that the overall mortalities were obviously decreased in surgery with intraperitoneal chemotherapy+ MMC (OR= 0.35, 95% CI 0.20- 0.62, P= 0.000 3) or CDDP+ 5-Fu (OR= 0.32, 95% CI 0.17- 0.61, P= 0.000 5) compared with surgery alone. Conclusions Surgery with intraperitoneal chemotherapy can improve survival rate of AGC cases over a period of time and reduce mortality and peritoneal recurrence, but it is likely to cause the morbidities. The safety needs to be improved in the future. Key words: Stomach neoplasms; Surgical procedures, operative; Drug therapy, combination; Randomized controlled study; Meta-analysis; Systemic review

Role of Minimally Invasive Surgery in Advanced Gastric Cancer: Report of 50 Cases of Advanced Gastric Cancer

INTRODUCTIION: Laparoscopic surgery been used em multiple procedures because as is well known has advantages over surgery open as the fastest shorter Recovery, faster intestinal functioning Return, Best immunological and Cosmetics response, decreased need for analgesics, Paralytic ileus, early oral via Home and Shorter hospitalization, being should be standardized laparoscopic techniques. ideally, the risk of recurrence and survival Impact finally is the goal of any new intervention that arises evaluate. OBJETIVE: Evaluation of minimally invasive surgery in the staging of gastric cancer and palliative treatment of advanced gastric cancer. Its considered that laparoscopic surgery has functions in both the Diagnostic and Surgery Palliative and of course Curative surgery in laparoscopic Staging by: evaluation of resectability and metastasis as has been clearly described in gastric cancer where results are similar to conventional cirurgia because the number of nodes removed, tumor-free margins and even the size of the surgical specimen are equal. In selected cases, a laparoscopic approach is reasonable as long as the surgeon laparoscopic lot of skill and experience. MATERIAL AND METHODS: 50 cases of laparoscopic management of advanced gastric cancer were evaluated diagnostic laparoscopy was performed, verifying findings unresectability as ascits, metastasis, liver, peritoneal carcinomatosis. All patients for palliative pain management celiac neurolysis was performed complex without any complications, biopsies were taken, 20 (40%) patients underwent palliative bypass laparoscopically gastroenteroanastomosis no known complications, no intraoperative mortality was presented. operative half time 60 minutes. DISCUSSION / CONCLUSION: The minimally invasive approach in patients with advanced gastric cancer is a reliable strategy for safe and reproducible palliative management of these patients.Figure