Curative Resection For Gastric Cancer Research Articles

Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy.

The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy. From 2009 to 2013, 859 patients who underwent curative resection for gastric cancer were enrolled from a prospectively maintained database. Visceral fat area (VFA) was assessed by preoperative CT scans. Patients were divided into two groups by VFA. Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group. Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival. Some 859 patients were included in the study, 308 of whom were classified as high VFA. High VFA was correlated with advance age (P = 0.020), higher albumin levels (P = 0.001), hemoglobin levels (P < 0.05), ASA grade (P = 0.043) and Charlson Comorbidity Index (P = 0.004). Relative to patients with low VFA, those with high VFA had longer surgical durations (P = 0.004), higher rate of postoperative complications (P = 0.004), and longer hospital stays (P = 0.004). High VFA was identified as the only determinant for surgical complications by logistic regression analysis (OR, 2.236, 95% CI, 1.537-3.254; P < 0.001). Cox proportional hazards regression revealed no correlation between VFA and overall survival (OS) or disease-free survival (DFS). Increased VFA independently predicts surgical complications in patients after gastrectomy. However, VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer.

Adjuvant Chemoradiotherapy After Curative Resection for Gastric Cancer

Standard adjuvant therapy for gastric cancer is either postoperative 5-fluorouracil (5-FU) and radiation therapy, or pre- and postoperative

646P - Comprehensive complication index (CCI) predicts cancer-specific survival of patients with postoperative complications after curative resection of gastric cancer

646P - Comprehensive complication index (CCI) predicts cancer-specific survival of patients with postoperative complications after curative resection of gastric cancer

Bone health in long-term gastric cancer survivors: A prospective study of high-dose vitamin D supplementation using an easy administration scheme

Bone disease in long-term survivors after gastric cancer resection has received little research attention. This study aimed to investigate bone health after curative resection of gastric cancer and the consequences of high-dose vitamin D supplementation in patients with low levels of 25-(OH)-vitamin D. Disease-free patients at least 24months after gastric cancer resection represented the study cohort. Serum markers of bone metabolism were assessed at baseline and at 3 and 12months. Bone mineral density and presence of fractures were assessed by X-ray at baseline. Patients with 25-(OH)-vitamin D ≤30ng/mL at baseline received 16,000IU of vitamin D3 every 10days during the 1-year follow-up. Forty patients were included in the study. Mean time from surgery was 48.9 (24-109)months. Vitamin D insufficiency and secondary hyperparathyroidism were observed in 38 and 20 patients, respectively. Densitometry showed osteoporosis in 14 women and seven men and prevalent fractures in 12 women and six men at baseline. After 3months of vitamin D supplementation, 35 patients reached values of 25-(OH)-vitamin D over 30ng/mL. After 12months, 38 patients were in the normal range of 25-(OH)-vitamin D. At the same time, iPTH levels and markers of bone turnover (C-terminal cross-linked telopeptide of type-I collagen, serum concentrations of bone-specific alkaline phosphatase and osteocalcin) significantly decreased after vitamin D intervention. Oral administration of high doses of vitamin D is easily implemented and restored 25-(OH)-vitamin D and iPTH values, which are frequently disturbed after gastric cancer resection.

Abstract 5725: Search for a combination of risk stratification markers for recurrence after curative resection of gastric cancer

Abstract Objective: Adjuvant chemotherapy after curative resection is standard treatment for stage II/III gastric cancer. Personalized therapy based on biomarker analysis is expected to further improve outcomes. We analyzed frozen specimens of gastric cancer to investigate markers for stratification of recurrence risk and report our findings. Methods: We studied 778 patients with stage II/III gastric cancer in whom ≥5 years had elapsed since curative resection. We first measured the expression levels of 127 genes in gastric cancer tissue by quantitative polymerase-chain-reaction (PCR) assay in 255 patients (training set, 145; validation set, 110) to identify poor prognostic factors. Next, we studied patients who received 1 year of adjuvant chemotherapy after curative resection of T4a, Nx, M0, stage III gastric cancer and performed an exploratory proteomic analysis to compare the expressions of 1756 proteins between 12 patients who died of recurrence within 3 years and 12 patients who survived with no recurrence for at least 5 years. Proteins with a max fold change of &amp;gt;2 and significant differences (P&amp;lt;0.001) were identified. Immunostaining of tissue microarray sections from another cohort of 499 patients was performed to confirm our results and to identify combinations of markers for risk stratification. Results: On quantitative PCR assay, SPARC, HER2, CXCR4, INHBA, VSNL1, MMP11, CCR7, MRP1, CEACAM7, p53, EZH2, PDGFRB, and VCAM1 were identified as candidate markers. On exploratory proteomic analysis, SPARC, CLC, PRG2, and PRG3 were identified. A tissue microarray was constructed for the 16 candidate markers to evaluate combinations of markers. The combination of SPARC, EZH2, HER2, and p53 could be used for risk stratification (5-year survival rate, 68% vs. 33%; P=0.0111). Conclusions: The combination of SPARC, EZH2, HER2, and p53 can be used as a marker to stratify the risk of recurrence after curative resection of stage II/III gastric cancer. Citation Format: Takashi Oshima, Yohei Miyagi, Yayoi Kimura, Kentaro Sakamaki, Shoji Yamanaka, Naohide Oue, Toru Aoyama, Tsutomu Sato, Haruhiko Cho, Manabu Shiozawa, Takaki Yoshikawa, Yasushi Rino, Wataru Yasui, Toshio Imada, Munetaka Masuda. Search for a combination of risk stratification markers for recurrence after curative resection of gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5725. doi:10.1158/1538-7445.AM2017-5725

Tumor-Stroma Ratio is an independent predictor for overall survival and disease free survival in gastric cancer patients

BackgroundDespite different prognostic factors have been already studied, patients undergoing potentially curative resection for gastric cancer, still have a poor outcome. There is therefore the need to identify novel prognostic factors. Recently, Tumor-Stroma Ratio (TSR) was proven to be associated with prognosis in different types of cancers. Aim of this study was to evaluate the prognostic value of TSR in gastric cancer patients. Methods106 patients underwent gastrectomy between January 2004 and December 2015. Demographics and histopathological characteristics were collected. We considered a 50% TSR cutoff value to divide patients in Stroma-Rich (≥50%) and Stroma-Poor (<50%) groups. ResultsForty-one (38.7%) patients were classified as Stroma-Poor while 65 (61.3%) as Stroma-Rich (61.3%). The Stroma-Rich patients had a higher number of positive lymph-nodes, lymph node ratio (LNR), a higher percentage of T3/T4 local invasion and N2/N3, and a more advanced TNM. Moreover, these patients showed a higher percentage of lymphovascular and perineural invasion. With a median FU of 38 months Stroma-Rich patients had a significantly worse 5-years actuarial overall survival (OS) and disease free survival (DFS) compared to Stroma-Poor patients. Moreover, the multivariate analysis showed that Stroma-Rich was the only independent factor associated with OS and DFS together with TNM-Stage. ConclusionsTSR is an independent marker of poor prognosis in patients with gastric cancer that should be readily incorporated into routine clinical pathology reporting. Identification of sensitive markers for patients who had undergone curative gastrectomy and who are at high risk of recurrence could provide useful information for planning follow-up after surgery or intensive and or/targeting adjuvant chemotherapy.

Nomogram for lymph node metastasis prediction with early gastric cancer patients: To decide additional gastrectomy after endoscopic dissection.

4045 Background: Accurate prediction of metastatic lymph node is critical to avoid unnecessary gastrectomy and improve quality of life for patients with early gastric cancer. The aim of this study was to develop and validate a nomogram for prediction of lymph node metastasis in early gastric cancer patients. Methods: We reviewed the clinicopathological data of 10595 patients who underwent curative resection for early gastric cancer from 2001 to 2015 at Samsung Medical Center. This model was externally validated by 2100 patients who underwent curative resection for gastric cancer in National Cancer Center. Multivariate analysis using the Cox proportional hazard regression model was performed to develop the nomogram, and discrimination and calibration were evaluated by external validation. Overall survival, disease free survival, and recurrence free survival were compared between gastrectomy groups of 6641 patients and endoscopic dissection group of 999 patients who was performed the treatment in Samsung Medical Center for early gastric cancer by risk on nomogram to demonstrate the efficacy of nomogram. Results: Multivariate analyses revealed that age, tumor size, lymphatic invasion, depth of invasion, and histologic differentiation were significant prognostic factors for lymph node metastasis. The nomogram had good discrimination with a concordance index of 0.845 [95% confidence interval 0.832-0.858], supported by an external validation point of 0.813[95% confidence interval 0.786-0.84]. In low risk on nomogram, endoscopic dissection group had similar overall survival (P = 0.319), disease free survival (P = 0.469) and recurrence free survival (P = 0.091) compared to gastrectomy group. Conclusions: We developed and validated a nomogram predicting lymph node metastasis for early gastric cancer based on a large database. This personalized nomogram is useful to avoid unnecessary gastrectomy after endoscopic dissection resulting in improved quality of life for early gastric cancer patients.

Postoperative Prolonged Inflammatory Response as a Poor Prognostic Factor After Curative Resection for Gastric Cancer.

Postoperative inflammatory complications are associated with poorer prognosis in gastrointestinal malignancies. The aims of this study were to clarify the impact of postoperative inflammation itself on overall survival (OS) and relapse-free survival (RFS) in advanced gastric cancer patients. We retrospectively analyzed 490 patients who underwent curative resection for pStage II and III gastric cancer from 2005 to 2008. We evaluated postoperative inflammation based on duration of hyperthermia (body temperature ≥38°C) and leukocytosis (≥12,000/µL-1). OS and RFS were compared between a prolonged inflammation group and non-prolonged inflammation group. Multivariate analysis using the Cox proportional hazard model was performed to identify independent prognostic factors. The prolonged inflammation group comprised 57 (11.7%) patients who had hyperthermia for 4days or longer and 42 (8.6%) patients who had leukocytosis for 7days or longer. OS and RFS were significantly worse in the prolonged hyperthermia group (OS: hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.19-2.73, P=0.004; RFS: HR 1.66, 95% CI 1.08-2.45, P=0.015). The prolonged leukocytosis group also showed significantly worse OS (HR 1.92, 95% CI 1.19-2.96, P=0.004) and RFS (HR 1.90, 95% CI 1.19-2.88, P=0.004). Multivariate analysis identified prolonged hyperthermia as an independent factor for predicting poor prognosis (OS: HR 1.77, 95% CI 1.13-2.68, P=0.013; RFS: HR 1.60; 95% CI 1.03-2.39, P=0.038). Prolonged hyperthermia and leukocytosis after curative gastrectomy were associated with poorer OS and RFS in advanced gastric cancer patients.

Impact of systemic inflammation on gastric cancer outcomes.

BackgroundThe prognostic value of neutrophil-lymphocyte ratio (NLR) and Glasgow Prognostic Score (GPS) has been extensively validated in various cancers. We aimed to examine the usefulness of a combination of NLR and GPS (named CNG) for predicting survival outcomes in patients after curative resection for gastric cancer (GC).MethodsWe retrospectively analyzed the records of 1056 patients who underwent curative resection as initial treatment for GC from October 2000 to September 2012. The preoperative CNG was calculated as follows: patients with hypoalbuminemia (< 35 g/L), elevated C-reactive protein (> 10 mg/L), and elevated NLR (≥ 2) were allocated a score of 3; patients with two, one, or no abnormal values were allocated a score of 2, 1, or 0, respectively.ResultsThe NLR and GPS were the only inflammatory variables independently associated with overall survival (OS) in multivariate analysis. When they were replaced by CNG in multivariate analysis, CNG was independently associated with OS (hazard ratio [HR] for CNG 1 [1.367, 95% CI: 1.065–1.755; P = 0.014], CNG 2 [1.887, 95% CI: 1.182–3.011; P = 0.008], and CNG 3 [2.224, 95% CI: 1.238–3.997; P = 0.008]; P = 0.020). In stage-matched analysis, the prognostic significance was still maintained in stage I-III (P = 0.002, P = 0.042, and P < 0.001, respectively). In addition, 5-year survival rates ranged from 92% (stage I) to 35% (stage III) and from 65%(CNG 0) to 18%(CNG 3) with tumor-nodes-metastasis (TNM) stage or CNG alone. However, the combination of TNM and CNG stratified 5-year survival rates from 98% (TNM I, CNG 0) to 12% (TNM III, CNG 3).ConclusionThe preoperative CNG is a novel predictor of postoperative survival, and the combination of CNG and TNM effectively stratifies outcomes in patients after curative resection for GC.

Patterns of Initial Recurrence in Gastric Adenocarcinoma in the Era of Preoperative Therapy.

We sought to determine the sites of recurrence and identify predicting factors for recurrence and survival in patients who underwent gastrectomy for adenocarcinoma at an institution where preoperative therapy is commonly used for advanced gastric cancer. We collected clinicopathologic data and sites of recurrence from a prospectively maintained database of patients who underwent potentially curative resection of gastric or gastroesophageal adenocarcinoma at our institution in 1995-2014, and we assessed associations between these characteristics and recurrence patterns and survival. We identified 488 patients who underwent R0 resection of localized gastric cancer. The median age was 63years (interquartile range 53-71years), and 60% were male. The most common T and N categories, per endoscopic ultrasonography, were T3 (58%) and N0 (61%). Preoperative treatment was used in 61% of patients. A total of 125 (26%) patients experienced recurrence during follow-up. Recurrences were locoregional in 19 patients (15%), peritoneal in 61 (49%), and nonperitoneal distant in 67 (54%). The peritoneum also was the most common organ of recurrence (49%), followed by the liver (21%). The median time from primary resection to recurrence was 2.7years for locoregional, 1.3years for peritoneal, and 0.6years for nonperitoneal distant recurrence (p=0.01). Median overall survival was markedly shorter after peritoneal and nonperitoneal distant recurrences than after locoregional recurrences. The peritoneum was a common site of recurrence after curative resection of gastric cancer and was associated with poor survival. Prophylactic treatment targeting the peritoneal cavity might improve survival of advanced gastric cancer.

Weight loss and quality of life in patients surviving 2 years after gastric cancer resection

BackgroundMalnutrition is common in patients undergoing gastric cancer resection, leading to weight loss, although little is known about how this impacts on health-related quality of life (HRQL). This study aimed to explore the association between HRQL and weight loss in patients 2 years after curative gastric cancer resection. MethodsConsecutive patients undergoing curative gastric cancer resection and surviving at least 2 years without disease recurrence were recruited. Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the specific module for gastric cancer (STO22) before and 2 years postoperatively and associations between HRQL scores and patients with and without ≥ 10% body weight loss (BWL) were examined. ResultsA total of 76 patients were included, of whom 51 (67%) had BWL ≥10%. At 2 years postoperatively, BWL ≥10% was associated with deterioration of all functional aspects of quality of life, with persistent pain (21.6%), diarrhoea (13.7%) and nausea/vomiting (13.7%). By contrast, none of the patients with BWL <10% experienced severe nausea/vomiting, pain or diarrhoea. ConclusionsDisabling symptoms occurred more frequently in patients with ≥10% BWL than in those with <10% BWL, with a relevant negative impact on HRQL. A cause–effect relationship between weight loss and postoperative outcome remains unsolved.

Recurrence patterns of gastric cancer in the era of preoperative therapy.

119 Background: The purpose of this study was to determine the disease sites and survival durations of patients who developed a recurrence after undergoing gastrectomy for adenocarcinoma. Methods: We collected data from a prospectively maintained database of gastric cancer patients who underwent potentially curative resection of gastric or gastroesophageal cancer at our institution from 1995-2014. Univariate and multivariate analyses were performed to determine the associations between clinicopathologic factors and treatment outcomes. Results: We identified 488 patients who underwent R0 resection of localized gastric cancer. The median age was 63 years (IQR, 53-71 years), and 60% were male. The most common EUS stages were T3 (58%) and N0 (61%). Preoperative treatment was used in 61% of patients. The majority (76%) of patients underwent extended (D1+/D2) lymphadenectomy, and the median number of examined lymph nodes was 21 (IQR, 14-29). Of the 488 patients, 125 (26%) experienced recurrence during follow up. The sites of recurrence were locoregional (n = 19 [15%]), peritoneal (n = 61 [49%]), and non-peritoneal distant at any site (n = 67 [53.6%]). The site of recurrence was not associated with neoadjuvant therapy (p = 0.35). The median time from the primary resection to recurrence was 2.7 years (95% CI, 0.8-3.2 years) for locoregional, 1.3 (0.7-1.7) for peritoneum, and 0.6 (0.5-0.9) for distant disease (p = 0.01). The median overall survival time from recurrence was 1.0 year (95% CI, 0.5-3.1 years) for locoregional, 0.6 (0.4-0.9) for peritoneum, and 0.8 (0.5-1.0) for distant recurrence (p = 0.05). A multivariate analysis revealed that age ≥ 65 years (HR, 1.52 [95% CI, 1.12-2.05 years]; p = 0.01) and advanced EUS T stage (3.06 [2.10-4.46]; p &lt; 0.001) were associated with a shorter recurrence-free survival duration. Conclusions: Peritoneal carcinomatosis was the most common site of recurrence after curative resection of gastric cancer, with associated poor survival, and was not associated with the use of neoadjuvant therapy. Future trials should focus on treatment of the peritoneum, which may improve the survival of patients with advanced gastric cancer.

Efficacy of contrast enhanced computed tomography and diagnostic laparoscopy in detecting unsuspected peritoneal metastasis in gastric carcinoma

Background: Gastric cancer remains the second most common cause of death from cancer worldwide. Peritoneal metastasis is the most frequent pattern of disease failure after curative resection of gastric cancer. Detection of these deposits and free cancer cells are necessary for predicting the risk of recurrence and prognostication. Methods: The study was conducted in Department of Surgery from October 2011 to July 2013. The study was designed as a prospective comparative study. All the patients diagnosed with gastric cancer by upper gastrointestinal endoscopy guided biopsy and not having clinical and / or radiological evidence of distant metastasis were included in the study. All patients underwent contrast enhanced computed tomography pre-operatively to detect metastatic disease or advanced gastric cancer. Subsequently the patients were planned for diagnostic laparoscopy followed by appropriate surgery. Sensitivities of the procedure in detecting peritoneal metastases was calculated and compared. Results: A total of 35 gastric cancer patients who met the inclusion and exclusion criteria were recruited in the study. The mean age of these patients was 53.5 years. Diagnostic laparoscopy detected 11 cases of metastatic diseases which were not picked up by CECT, which was statistically significant (p <0.05). Diagnostic laparoscopy showed adjacent organ infiltration in 18 patients, 9 of which were also identified on CT scan. Difference in detection of adjacent organ infiltration was not statistically significant. Infiltration of the serosal surface was seen in 31 patients and 9 of them were identified on CECT scan. Conclusions: Diagnostic laparoscopy is more sensitive and specific than current generation MDCT in detecting peritoneal metastasis and liver surface nodules in cases of gastric cancer. Diagnostic laparoscopy is also more specific in diagnosing the local infiltration into adjacent organs.

Adjuvant S-1 chemotherapy after curative resection of gastric cancer in Chinese patients: assessment of treatment tolerability and associated risk factors.

The use of adjuvant chemotherapy with S-1 (tegafur, gimeracil, and oteracil potassium) has been shown to improve the outcome of patients with gastric cancer. There are limited data on the tolerability of S-1 in Chinese patients. In this multicentre retrospective study, we assessed the toxicity profile in local patients. Patients with stage II-IIIC gastric adenocarcinoma who had undergone curative resection and who had received S-1 adjuvant chemotherapy were included in the study. Patient demographics, tumour characteristics, chemotherapy records, as well as biochemical, haematological, and other toxicity profiles were extracted from medical charts. Potential factors associated with grade 2-4 toxicities were identified. Adjuvant S-1 was administered to 30 patients. Overall, 19 (63%) patients completed eight cycles. The most common grade 3-4 adverse events included neutropaenia (10%), anaemia (6.7%), septic episode (16.7%), diarrhoea (6.7%), hyperbilirubinaemia (6.7%), and syncope (6.7%). Dose reductions were made in 22 (73.3%) patients and 12 (40.0%) patients had dose delays. Univariate analyses showed that patients who underwent total gastrectomy were more likely to experience adverse haematological events (P=0.034). Patients with nodal involvement were more likely to report adverse non-haematological events (P=0.031). Patients with a history of regular alcohol intake were more likely to have earlier treatment withdrawal (P=0.044). Lower body weight (P=0.007) and lower body surface area (P=0.017) were associated with dose interruptions. The tolerability of adjuvant S-1 in our patient population was similar to that in other Asian patient populations. The awareness of S-1-related toxicities and increasing knowledge of potential associated factors may enable optimisation of S-1 therapy.

The patterns and timing of recurrence after curative resection for gastric cancer in China.

BackgroundThe recurrence of gastric cancer after curative resection had adverse effects on patients’ survival. The treatment presence varied from different countries. The aims of this study were to understand the recurrence incidence, patterns, and timing and to explore the risk factors in China.MethodsOne thousand three hundred four patients who undergoing curative resection from more than 100 hospitals between January 1st 1986 and September 1st 2013, were surveyed in detail. Clinical pathological factors were examined as potential risk factors of each recurrence pattern using univariate and multivariate analyses. Recurrence timing was also analyzed based on disease-free survival.ResultsAmong 1304 gastric cancer patients, 793 patients (60.8%) experienced recurrence and 554 patients (42.5%) experienced recurrence within 2 years after operation. The median disease-free survival was 29.00 months (interquartile range [IQR] 12.07, 147.23). Receiving operation in general hospitals was one of independent risk factors of local-regional recurrence (OR = 1.724, 95% CI 1.312 to 2.265) and distant metastasis (OR = 1.496, 95% CI 1.164 to 1.940). Patients would suffer lower risk of distant metastasis if they received no more than 3 cycles adjuvant chemotherapy (OR = 0.640, 95% CI 0.433 to 0.943). Adjuvant radiotherapy could reduce the risk of recurrence (OR 0.259, 95% CI 0.100 to 0.670), especially distant metastasis (OR = 0.260, 95% CI 0.083 to 0.816).ConclusionsMore than 60% patients experienced recurrence after curative resection for gastric cancer, especially within 2 years after surgery. Risk factors were clarified between various recurrence patterns. Advanced gastric cancer and undergoing operation in general hospitals contributed to increased recurrence risk and worse survival. Enough number of lymph nodes harvest and standard D2 lymphadenectomy could reduce recurrence. Chinese patients would benefit from adjuvant chemotherapy and radiotherapy.

Preoperative Nutritional Deficiency Is a Useful Predictor of Postoperative Outcome in Patients Undergoing Curative Resection for Gastric Cancer

BACKGROUND: Preoperative nutritional deficiency (ND) has been shown to be a valuable prognostic factor in urologic malignancies. We aimed to investigate the prognostic value of ND in patients with gastric cancer (GC). METHODS: A single-center cohort of 1026 GC patients undergoing curative resection between 2003 and 2012 was categorized to ND and nutritionally replete (NR) groups. Patients with body mass index <18.5 kg/m2, preoperative albumin <35 g/l, or preoperative weight loss ≥5% of body weight were defined as ND. RESULTS: Of the 1026 patients included in the study, 585 (57.0%) were categorized as ND. Overall survival (OS) at 5 years was 68.5% for ND patients and 44.0% for NR patients (P<.001). Multivariate analysis revealed that ND was a significant predictor of OS (hazard ratio: 1.954; 95% confidence interval: 1.552-2.460; P<.001). In stage-stratified analysis, it was still independently associated with OS in tumor-nodes-metastasis stage II and III (P=.004 and P<.001, respectively). Of note, the prognostic significance of ND was still maintained when stratified by age, sex, anemia, and adjuvant chemotherapy (all Ps<.05). CONCLUSION: Preoperative ND is a novel predictor of outcome in GC, especially in stage II to III GC, and may help clinicians identify high-risk patients for proactive nutritional interventions.

Timing of Adjuvant Chemotherapy and Impact on Survival for Resected Gastric Cancer.

Because postoperative convalescence often prolongs the interval between surgery and chemotherapy in patients undergoing treatment for advanced gastric cancer, this study assesses the survival impact of timing of adjuvant chemotherapy (AC) in patients undergoing curative resection for gastric cancer. The 2003-2012 ACS NCDB was analyzed for patients treated with gastrectomy for stages 1-3 gastric cancer. Treatment groups were stratified by time to initiation of AC: initiation of chemotherapy within 8weeks postoperatively, between 8 and 12weeks postoperatively, after 12weeks postoperatively, and no chemotherapy. Univariate and multivariate analyses were performed. Of 7942 patients undergoing gastrectomy, 29% received AC. Of those who received AC, 58% initiated AC within 8weeks, 28% initiated AC between 8 and 12weeks, and 14% received AC after 12weeks. Among patients who received AC, median survival was not significantly different between time cohorts, even when stratified by pathologic stage. Median survival was longer for chemotherapy cohorts when compared with the no chemotherapy cohort, specifically in patients with pathologic stages 2 and 3 disease. In multivariable analysis, patients who received AC had a 27-29% lower hazard of death (p<.0001), with administration of AC at any time, compared with patients who did not receive AC, but had no difference in hazard when comparing delayed AC to earlier administration of AC. Time to initiation of AC does not impact survival. With improved survival over patients who did not receive AC, even delayed initiation of chemotherapy should be offered, when appropriate.

Albumin concentrations plus neutrophil lymphocyte ratios for predicting overall survival after curative resection for gastric cancer.

BackgroundIn patients with gastric cancer (GC), survival is poor, given the late diagnosis. Risk-stratifying these patients earlier could help improve care. We determined whether combining preoperative albumin concentration and the neutrophil lymphocyte ratio (COA-NLR) could predict overall survival (OS) better than other prognostic indexes.MethodsWe calculated the COA-NLR and other prognostic indexes with data obtained within 1 week before surgery in a retrospective analysis of patients with GC undergoing curative resection between September 2000 and November 2012. Patients with concentrations of hypoalbuminemia above 35 g/L and an NLR value of 2.3 or higher were given a score of 2. Patients with one of these conditions or neither were allocated scores of 1 or 0, respectively. Patients were monitored until July 2014.ResultsOS in the 873 eligible patients was 44.9% in patients with a COA-NLR score of 0, 29.8% in patients with a score of 1, and 20.3% in patients with a score of 2 (P<0.001). The COA-NLR score was independently associated with OS (hazard ratio, 1.35; 95% confidence interval, 1.12 to 1.63; P=0.002). Moreover, the area under the receiver operating characteristics curve was 0.62 for the COA-NLR, which was significantly higher (<0.001) than that of the NLR ratio (0.60), the Glasgow prognostic score (0.58), and the platelet lymphocyte ratio (0.54). The COA-NLR was especially accurate for patients with stage I–II GC and the three values (0, 1, and 2) divided patients into subgroups more accurately than did the other indexes (area under the curve value: 0.66, P<0.001).ConclusionThe preoperative COA-NLR index is useful for predicting postoperative OS in patients with GC and can be used to guide targeted therapy.

Validity of the Japanese version of functional assessment of cancer therapy-gastric (FACT-Ga) and its sensitivity to ascites volume change: a retrospective analysis of Japanese clinical trial participants.

The functional assessment of cancer therapy-gastric (FACT-Ga) questionnaire was designed to evaluate quality of life (QOL) in patients with gastric cancer. We aimed to explore the reliability and validity of FACT-Ga in Japanese patients, and assess the sensitivity of the gastric cancer subscale for detecting changes in cancer-related variables over time. The Japanese version of FACT-Ga was used, and data were obtained from Japanese patients who participated in either of two clinical trials: treatment for advanced or recurrent gastric cancer with ascites (advanced-GC group), or adjuvant chemotherapy after curative resection of gastric cancer (adjuvant group). Psychometric data including data used to determine reliability, internal consistency, and clinical validity were analyzed. Clinical validity was evaluated by comparing subscale scores for patients in the two groups, and by comparing subscale scores for patients with different performance status scores. Correlation between gastric cancer subscale scores and gastric cancer-related variables was also examined. In addition, sensitivity of the gastric cancer subscale to changes in ascites volume, abdominal girth, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) was examined by evaluating their correlation in the advanced-GC group. We collected data on 156 patients (62 advanced-GC group patients and 94 adjuvant group patients). Response rates for the subscales were over 80% at most time points for both the groups. Cronbach's coefficient alpha revealed good internal consistency for each subscale. At baseline, the adjuvant group had higher QOL scores than the advanced-GC group (P<0.05), and QOL scores for patients with different performance status scores differed significantly. Changes in gastric cancer subscale scores showed statistically significant correlation with changes in ascites volume (Spearman's rank correlation coefficient, 0.5; P<0.05). FACT-Ga is reliable and clinically valid for Japanese patients with gastric cancer. Detection of QOL changes that correlate with ascites volume changes suggests that it could be used more broadly; FACT-Ga scores could be used as an endpoint for patients with gastric cancer-related ascites.

Prognostic significance of CEA expression by RT-PCR in peritoneal wash from patients with gastric cancer: result of a 5-year follow-up after curative resection

Objective: Peritoneal recurrence is the most common cause of death after surgery for gastric cancer. Reverse transcriptase polymerase chain reaction (RT-PCR) analysis has been used to detect free cancer cells in peritoneal wash during surgery. This study was conducted to evaluate the prognostic significance of carcinoembrionic antigen (CEA) mRNA detected by RT-PCR in peritoneal wash from patients with gastric cancer after curative resection through a 5-year follow-up.Materials and methods: Peritoneal wash were obtained from 117 patients who underwent curative surgery for gastric cancer. The association between the CEA RT-PCR results, clinicopathological factors, and factors affecting gastric cancer recurrence were evaluated.Results: Among the 117 cases, 38 (32.5%) revealed positive CEA expression. Patients with positive CEA expression showed a higher rate of peritoneal recurrence than those with negative CEA expression (p = 0.047). Depth of invasion, lymph node metastasis, TNM stage, and CEA expression were factors affecting recurrence. CEA expression and depth of invasion were significant prognostic factors in a multivariate analysis, and CEA expression was the most important prognostic factor for recurrence in patients who had undergone curative resection for gastric cancer (hazard ratio: 2.747, p = 0.046).Conclusions: CEA expression in the peritoneal wash was significantly associated with peritoneal recurrence and was the most important prognostic factor for gastric cancer recurrence after curative resection.