Gastric Cancer In China Research Articles

Value of reduction surgery for incurable advanced gastric cancer: Discussion based on REGATTA trial

Over 30% of gastric cancers in China are at stage IV disease at the time of diagnosis which is incurable or unresectable. Reduction surgery refers to non-curative gastrectomy for reducing tumor burden in the absence of severe symptoms. The benefit of reduction gastrectomy for these patients is controversial. Most of the retrospective data support its necessity. However, the results of the Japanese REGATTA study showed that reduction gastrectomy could not bring any survival benefit to patients compared with chemotherapy alone, so the guideline of the Japanese Society of Gastric Cancer is strongly against reduction gastrectomy. Although the design of the REGATTA study is not perfect and the conclusion is challenged, it provides the highest level of evidence. Surgeons should abstain from prophylactic reduction gastrectomy in clinical setting. The strategy should be decided by MDT discussion.

Treatment patterns and long-term clinical outcomes in Chinese patients with nonmetastatic gastric cancer: Results from the non-interventional EVIDENCE registry study.

307 Background: Although gastric cancer (GC) is a leading cause of cancer-related death in China, important questions about optimal management remain unanswered. The EVIDENCE registry study evaluated data from patients with GC in China to assess the pattern of treatments and long-term clinical outcomes. Methods: Five cohorts of patients with different HER2 and metastatic (m) status were evaluated from April 2013 to June 2018 in this prospective, multicenter, non-interventional, real-world study. Data from patients with operable non-mGC are reported: Cohort III (HER2+) and Cohort V (HER2−). Outcome measures included overall survival (OS), event-free survival (EFS), and disease-free survival (DFS). Results: Cohorts III/V included 758 patients (Cohort III, 271; Cohort V, 487); 75.5% were male and the mean age was 58.8 years. The majority of Cohort III/V patients (538/758; 71.0%) received only adjuvant treatment, with 215/758 (28.4%) receiving S1+oxaliplatin. Neoadjuvant or adjuvant trastuzumab was administered to 43/758 patients (Cohort III, 42; Cohort V, 1). Radiation during neoadjuvant or adjuvant treatment was administered to 23/758 (3.0%) patients. The median duration of follow-up was 515 days, during which 72 (9.5%) patients died due to progressive disease. OS rates (95% CI) for Cohorts III and V were 94% (89–96) and 95% (92–97) at 1 year, and 76% (67–83) and 70% (64–75) at 3 years, respectively. Respective EFS rates were 82% (76–87) and 86% (83–89) at 1 year, and 62% (53–70) and 57% (51–63) at 3 years; and respective DFS rates were 88% (82–93) and 86% (81–89) at 1 year and 69% (58–78) and 62% (55–68) at 3 years. Multivariate analysis indicated that the primary tumor site (p = 0.004) and overall cancer stage (p < 0.001) were associated with DFS. Regarding the primary tumor site, there was a trend towards better DFS for antrum tumors (hazard ratio 0.59; 95% CI 0.32–1.07) when evaluated against gastroesophageal junction tumors. Conclusions: This longitudinal analysis of clinicopathologic characteristics and outcomes of Chinese patients with non-mGC will provide critical information that will help to inform disease management. Clinical trial information: NCT01839500.

Optimization of TNM staging and control of pathological quality in gastric cancer

Comprehensive treatment of gastric cancer is mainly based on the pathological staging. The T stage mainly depends on the accurate determination of the depth of the tumor invasion. The accurate T stage should be standardized pathological examination and continuous sectioning. N stage may be influenced by the number of lymph node examined. Insufficient lymph node examined may lead to stage migration. Therefore, standardizing lymph node dissection and lymph node harvest after surgery is important. M stage is mainly to improve the detection rate of peritoneal lavage cytology (CY), identify high risk factors for peritoneal metastasis, and optimize the prediction of peritoneal metastasis molecular markers, as a complementary methods of clinical examination. Currently, the quality of standardized pathological diagnosis of gastric cancer in China still needs to be improved. This article mainly elucidates the related studies and clinical experience of our center on how to do better in the optimization of gastric cancer TNM staging and pathological quality control.

Consensus on eradication of Helicobacter pylori and prevention and control of gastric cancer in China (2019, Shanghai).

China is a country with high prevalence of Helicobacter pylori (H.pylori) infection, which in turn is closely related to the occurrence of gastric cancer. Therefore, the risks of H.pylori infection and gastric cancer are highly overlapping, and the prevention and treatment of H.pylori infection are necessary to prevent gastric cancer. Based on evidence-based medicine and the Delphi method, the National Clinical Medical Research Center for Digestive Disease along with the National Early Gastrointestinal Cancer Prevention and Treatment Center Alliance organized dozens of experts in the fields of digestive diseases, H.pylori research, gastric cancer surgery, epidemiology, health economics, and health management to discuss the relationship between H.pylori eradication and prevention and the treatment of gastric cancer. A preliminary consensus on the relationship between H.pylori infection and gastric cancer, H.pylori eradication and gastric cancer prevention, and H.pylori screening and eradication strategy was reached. The consensus further clarified the relationship between H.pylori and gastric cancer and how to formulate future prevention and control strategies for gastric cancer. This consensus could provide guidance on early detection, diagnosis, and treatment of H.pylori to reduce the occurrence of gastric cancer in China.

Comparing prognostic values of the 7th and 8th editions of the American Joint Committee on Cancer TNM staging system for gastric cancer.

Our aim was to compare the prognostic value of the American Joint Committee on Cancer (AJCC) 7th and 8th editions staging systems for patients with gastric cancer in China. A total of 1326 gastric cancer patients diagnosed between 2008 and 2012 were included. The discriminative ability of the AJCC 8th and 7th editions was compared using the Harrell's concordance index (C-index). There are two main modifications in the 8th edition. (i) pN3 staging was divided into pN3a and pN3b. The gastric cancer patients with pN3a experienced significantly better overall survival compared with those with pN3b (5-year overall survival: 34.5% vs. 15.6%, P < 0.001) (stratified by pT: pT3: 5-year overall survival: 33.9% vs. 13.2%, P < 0.001; pT4a: 32.8% vs. 16.9%, P = 0.056; pT4b: 17.0% vs. 11.1%, P = 0.048). (ii) Subgroup staging adjustments. The subgroup staging adjustments (T3N3bM0 (IIIB→IIIC), T4aN3aM0 (IIIC→IIIB), T4bN0M0 (IIIB→IIIA), and T4bN2M0 (IIIC→IIIB)) resulted in more gastric cancer patients being accurately staged. Furthermore, the C-index value of the 8th edition tumor node metastasis (TNM) staging system was significantly higher than that of the AJCC 7th TNM staging system to predict the survival of gastric cancer patients (0.701 vs. 0.685, P < 0.001). The 8th edition of the TNM staging system is superior to the 7th edition staging system for prediction of survival of gastric cancer patients in China.

Epidemiological characteristics of gastric cancer in China, 2015

Objective: To estimate the morbidity and mortality of gastric cancer and its distribution in China in 2015 and provide information for future cancer prevention and control study and policy decision. Methods: In 2018, a total of 501 cancer registry systems reported data to the office of National Central Cancer Registry, and the data from 368 cancer registry systems met the criteria. The overall, gender specific, age specific and area specific morbidity and mortality rates of gastric cancer in China were estimated based on national population data in 2015. Chinese standard population in 2000 and World Segi's population data were used to calculate the age-standardized rates (ASR) of morbidity and mortality, including ASR of China and the world. Results: In 2015, the qualified 368 cancer registry system covered a total of 309 553 499 population in China, including 156 934 140 males and 152 619 359 females. We estimated that there were 403 000 new gastric cancer cases, with the crude morbidity rate of 29.31 per 100 000, ASR China of 18.68 per 100 000, ASR world of 18.57 per 100 000, and a cumulative rate of 2.29% for 0-74 years. There were 290 900 new gastric cancer deaths, with the crude mortality rate of 21.16 per 100 000, ASR China of 13.08 per 100 000, ASR world of 12.92 per 100 000, and a cumulative rate of 1.5% for 0-74 years. Gastric cancer ranked second as the most common cancers and third as the most common cancer causes of death in China. In general, both the morbidity rate (ASR China, male: 26.54 per 100 000; female: 11.09 per 100 000; rural area: 21.82 per 100 000; urban area: 16.37 per 100 000) and mortality rate (ASR China, male: 18.75 per 100 000; female: 7.72 per 100 000; rural area: 15.84 per 100 000; urban area: 11.05 per 100 000) were higher in males than those in females, and higher in rural area than those in urban area. The morbidity and mortality rates of gastric cancer increased from the age of 40 years and peaked in age group of 80-years. The case number of gastric cancer significantly increased from the age group of 50-years, peaked at 60-70 years, and the majority of cases occured in age group of 55-80 years. There was an overall consistent trend of the age-specific morbidity and mortality rates across different subgroups by sex and geographic areas, with the rates were higher in males than those in females, and higher in rural area than that in urban area. Conclusions: The incidence of gastric cancer varied with sex, age and areas (urban area and rural area). The present analysis provides the latest data on the prevalence of gastric cancer in China, which can help optimize the current screening guidelines and the prevention and control strategies of gastric cancer to reduce the disease burden caused by gastric cancer in China.

Surgical choice of proximal gastric cancer in China: a retrospective study of a 30-year experience from a single center in China

ABSTRACTBackground: Total gastrectomy with D2 lymphadenectomy is indicated for proximal advanced gastric cancer located in the upper one-third of the stomach; however, due to preserved function and clinical benefits of a proximal gastrectomy, the choice of a surgical method for patients with proximal early-stage gastric cancer remains controversial.Methods: We conducted a retrospective study involving 649 patients with proximal gastric cancer. The clinical-pathological features, characteristics, lymph node metastatic patterns, prognosis, postoperative complications, and recurrence were compared between the patients who underwent proximal and total gastrectomies with different T and N stages.Results: The lymph node metastatic rates among T stages were significantly different. There was no difference in overall survival rates for stage Ia, Ib, and IIa patients but significant difference in T3 and T4 stages who underwent proximal and total gastrectomy. Complications were more frequently detected in patients who underwent total gastrectomy than proximal gastrectomy.Conclusion: Considering the survival benefits and preserved function, proximal gastrectomy can be performed safely in stage Ia and Ib gastric cancer (T1N0, T1N1, and T2N0) with an excellent remission rate. Proximal gastrectomy is not recommended for advanced gastric cancer.

Ten years of the CLASS Group: retrospect and prospect

The CLASS group's vision carries out "research, standardization and promotion of new technologies for laparoscopic gastric cancer surgery, cooperation, mutual benefit, hand in hand to the international academic frontier, leading the scientific development of minimally invasive surgery for gastric cancer in China, and benefiting people's health with high-level clinical research". In the past ten years, CLASS group has become a pioneering force in promoting the progress of laparoscopic surgery for gastric cancer in China. The successful implementation of the CLASS - 01 trail has created a new standard in the clinical research of minimally invasive gastrointestinal surgery and cultivated a high - level surgical clinical research team all over the country. After the successful CLASS - 01 trial, the trials from CLASS - 02 to - 05 has been successfully implemented, CLASS - 06 to - 10 series are in an orderly advancement. On the tenth anniversary of the establishment of the CLASS group, we would like to thank the help from peer, review the development process, look forward to future cooperation, and work together to create a new situation of minimally invasive surgery.

2025P - Expression of PD-L1 in Chinese patients with common cancers

BackgroundPD-L1 immunohistochemistry (IHC) data in China was less reported. We systematically investigated PD-L1 IHC data of Chinese patients generated by Origimed. MethodsPD-L1 was stained using IHC on cancer samples from 2060 Chinese patients in Origimed since 2017. Written informed consent was obtained from each patient. IHC staining was performed on FFPE tissue sections using anti-PD-L1 antibody 28-8. Tumor Proportion Score (TPS) was applied on all the samples. We investigated PD-L1 TPS in lung adenocarcinoma (n=893), lung squamous carcinoma (n=172), liver cancer (n=404), esophageal cancer (n=186), colorectal cancer (n=166), pancreatic cancer (n=136) and gastric cancer (n=103). We then further applied PD-L1 combined positive score (CPS) on the 103 gastric cancer samples. All the slides were reviewed by the same senior pathologist. 95% confidence interval (CI) was obtained by bootstrap. Information entropy (Shannon’s formula) was measured in natural units. ResultsThe highest proportion of PD-L1 TPS>= 1% was observed in lung squamous carcinoma (49%; 95% CI: [43%, 59%]), followed by lung adenocarcinoma (25%; 95% CI: [22%, 28%]), liver cancer (14%; 95% CI: [11%, 18%]), esophageal cancer (12%; 95% CI: [8.1%, 17%]), pancreatic cancer (11%; 95% CI: [5.9%, 16%]), gastric cancer (7%; 95% CI: [1.9%, 12%]) and colorectal cancer (4%; 95% CI: [1.2%, 6.6%]). The proportion of PD-L1 CPS>= 1 for gastric cancer was 17% (95% CI: [9.7%, 24%]). In gastric cancer, information entropy of TPS and CPS was 0.40 and 0.78, respectively. ConclusionsThe proportion of PD-L1 TPS>= 1% in Chinese lung squamous cell carcinoma (49%) was much higher than that in lung adenocarcinoma (25%). PD-L1 CPS contained more information than TPS in gastric cancer. Thus, we recommend applying CPS to gastric cancer in China. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureX. Pan: Full / Part-time employment: Origimed. Y. Dai: Full / Part-time employment: Origimed. D. Chen: Full / Part-time employment: Origimed. K. Wang: Full / Part-time employment: Origimed. X. Dong: Full / Part-time employment: Origimed. All other authors have declared no conflicts of interest.

LBA43 - Randomized phase III ANGEL study of rivoceranib (apatinib) + best supportive care (BSC) vs placebo + BSC in patients with advanced/metastatic gastric cancer who failed ≥2 prior chemotherapy regimens

BackgroundRivoceranib is an oral, selective tyrosine kinase inhibitor of VEGFR-2 with demonstrated efficacy for gastric cancer in China. ANGEL was a global phase III study to evaluate the efficacy and safety of rivoceranib in gastric cancer. MethodsMain eligibility criteria included advanced/metastatic adenocarcinoma of the stomach or gastroesophageal junction after failure of≥2 prior lines of chemotherapy; ECOG PS≤1. Patients were stratified by geographic region (Asia vs North America/Europe), disease measurability, prior ramucirumab use, and treatment therapy line (3rd or≥4th), and randomized (2:1 ratio) to rivoceranib 700mg qd po or matched placebo with BSC until disease progression, intolerable toxicity or withdrawal of consent. Primary endpoint: overall survival (OS, ITT population). Secondary endpoints: progression-free survival (PFS); objective response rate (ORR); disease control rate (DCR); quality of life (QoL); safety. Clinical trial registration: NCT03042611. ResultsOverall, 460 patients (rivoceranib n=308, placebo n=152) were enrolled from Feb 2017 – Oct 2018. Baseline demographics were balanced. While mOS in≥3rd-line patients did not show statistical difference for rivoceranib vs placebo (5.78 vs 5.13mo; HR=0.93; 95% CI 0.74–1.15; p=0.4850), mPFS was significantly improved with rivoceranib (2.83 vs 1.77mo; HR=0.57; 95% CI 0.46–0.79; p<0.0001), as was ORR (6.87% vs 0%; p=0.0020) and DCR (42.37% vs 13.08%; p<0.0001) in patients with measurable lesions. Furthermore, in≥4th-line patients (rivoceranib n=122, placebo n=63) mOS (6.43 vs 4.73mo; HR=0.65; 95% CI 0.46–0.92; p=0.0195) and mPFS (3.52 vs 1.71mo; HR=0.38; 95% CI 0.27–0.53; p<0.0001) were significantly improved with rivoceranib vs placebo. Treatment was generally well tolerated; the most common treatment-related AEs were hypertension (34%) and hand-foot syndrome (26%). ConclusionsWhile OS was not significantly improved in the overall population, most other efficacy endpoints including OS in≥4th-line suggest that rivoceranib has a benefit and is well tolerated in patients with gastric cancer. Clinical trial identificationNCT03042611. Editorial acknowledgementLee Miller, Miller Medical Communications Ltd. Legal entity responsible for the studyLSK BioPharma. FundingLSK BioPharma. DisclosureY. Kang: Advisory / Consultancy: ONO; Advisory / Consultancy: BMS; Advisory / Consultancy: Daehwa; Advisory / Consultancy: LSK Biopharma; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Macrogenics; Advisory / Consultancy: Zymeworks; Advisory / Consultancy: Blueprint; Advisory / Consultancy: Merck Serono; Advisory / Consultancy, Research grant / Funding (institution): Novartis; Advisory / Consultancy: Astellas; Research grant / Funding (institution): Roche. M. Di Bartolomeo: Honoraria (self), Speaker Bureau / Expert testimony: Lilly spa; Honoraria (self), Speaker Bureau / Expert testimony: Servier; Honoraria (self), Speaker Bureau / Expert testimony: Merck-Serono; Honoraria (self), Speaker Bureau / Expert testimony: MSD; Travel / Accommodation / Expenses: Roche spa; Travel / Accommodation / Expenses: Sanofi. I. Chau: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Eli-Lilly; Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: MSD; Advisory / Consultancy: Bayer; Advisory / Consultancy: Roche; Advisory / Consultancy, Research grant / Funding (institution): Merck-Serono; Advisory / Consultancy: Five Prime Therapeutics; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Oncologie International; Advisory / Consultancy: Pierre Fabre; Research grant / Funding (institution): Janssen-Cilag; Research grant / Funding (institution): Sanofi Oncology. H.H. Yoon: Honoraria (institution), Advisory / Consultancy, Research grant / Funding (institution): Merck; Honoraria (institution), Advisory / Consultancy, Research grant / Funding (institution): LSK; Honoraria (institution), Advisory / Consultancy: BeiGene; Advisory / Consultancy: FivePrime Therapeutics; Research grant / Funding (institution): Eli Lilly; Research grant / Funding (institution): Merrimack; Research grant / Funding (institution): Genetech/Roche; Research grant / Funding (institution): Boston Biomedical. S. Cascinu: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Bayer; Honoraria (self), Speaker Bureau / Expert testimony: Amgen; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Lilly. M. Ryu: Honoraria (self), Advisory / Consultancy: ONO; Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy: Lilly; Honoraria (self), Advisory / Consultancy: Taiho; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy: Daehwa. K. Lee: Honoraria (self), Travel / Accommodation / Expenses: BMS; Honoraria (self): Eli Lilly; Research grant / Funding (institution): ALX Oncology; Research grant / Funding (institution): Array BioPharma; Research grant / Funding (institution): ASLAN Pharmaceuticals; Research grant / Funding (institution): AstraZeneca/MedImmune; Research grant / Funding (institution): Five Prime Therapeutics; Research grant / Funding (institution): Green Cross Corp.; Research grant / Funding (institution): LSK BioPharma; Research grant / Funding (institution): Macrogenics; Research grant / Funding (institution): Merck KGaA; Research grant / Funding (institution): MSD; Research grant / Funding (institution): Ono Pharmaceutical; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Pharmacyclics. A. McGinn: Shareholder / Stockholder / Stock options, Full / Part-time employment: LSK BioPharma. N. Sankar: Shareholder / Stockholder / Stock options, Full / Part-time employment: LSK BioPharma. N. Boku: Honoraria (self), Research grant / Funding (institution): Ono Pharmaceutical; Honoraria (self), Research grant / Funding (institution): Taiho Pharmaceutical; Honoraria (self), Research grant / Funding (institution): Bristol-Myers Squibb; Honoraria (self): Eli Lilly; Honoraria (self): Chugai. All other authors have declared no conflicts of interest.

Time Trends And Age-Period-Cohort Effects On The Incidence Of Gastric Cancer In Changle From 2003 To 2012.

PurposeAlthough the incidence of gastric cancer in China has declined over the past decades, they were still much higher than the average of global. This aim of this study was to describe the trends and age-period-cohort effects on gastric cancer incidence from 2003 to 2012 in Changle and to explore the potential reason.Materials and methodsData on patients with gastric cancer diagnosed between 2003 and 2012 were collected by the population-based Changle cancer registration (n=4111). Age-standardized incidence rates of gastric cancer were calculated and joinpoint regression was used to evaluate the trends of gastric cancer incidence. Time trends in gastric cancer incidence by the period of diagnosis and birth cohort were analyzed by sex. Age-period-cohort analysis was performed to investigate the independent effects of age, period of diagnosis and birth cohort among over 25-year-old residents.ResultsA steady downward trend was observed among men, with the incidence ranging from 96.15 per 100,000 in 2003 to 62.6 per 100,000 in 2012 (APC, −5.1%; 95% CI: −6.9 to −3.2%). A similarly declining trend was observed among women with the incidence ranging from 34.5 per 100,000 to 15.7 per 100,000 (APC, −5.7%; 95% CI: −9.3 to −2.0%). Age-period-cohort model of incidence rate showed increasing age effect and decreasing period of diagnosis effects in both men and women. Birth cohorts exhibited a decreasing trend in the incidence among women who were born after 1935 and men after 1940.ConclusionRecent decreases in the incidence of gastric cancer were due to decreased period of diagnosis and cohort effects, which was attributed to the improvements in their lifestyle and habits.

The long-term population impact of endoscopic screening programmes on disease burdens of gastric cancer in China: A mathematical modelling study

BackgroundGastric cancer (GC) incidence and mortality in China remained high due to delayed diagnosis and accounted for about half of the world's GC cases and deaths. Early detection with endoscopic screening and consequent timely treatment can significantly improve survival. This study aimed to explore the long-term population impact of endoscopic screening on national GC disease burdens in China. MethodsMost of previous studies investigated the disease burdens of cancer using Markov model or age-period-cohort (APC) model, which are difficult to estimate the population size of undiagnosed cases. In this paper, we proposed a new dynamic compartmental model based on GC natural history and calibrated model outputs to diagnosed GC cases and GC-related death counts using Markov Chain Monte Carlo methods. We investigated the impact of screening strategies with various coverage (10%, 40%, 70%) and frequency (every 1, 3, 5 years) on disease burdens. ResultsWe estimated that 2.22 (95%CI: 1.97–2.47) million Chinese are living with GC in 2019, among which, 42.7% (40.3–45.0%) remained undiagnosed. Without systematic screening, we projected 10.46 (9.07–11.86) million incident cases and 7.35 (6.59–8.11) million GC-related deaths over the next 30 years (2019–2049). Screening with coverage rate at 10%, 40%, 70% every 3 years could prevent 0.85 (0.63–1.06), 2.32 (1.79–2.86), and 3.04 (2.38–3.70) million incident cases, and prevent 1.17 (1.01–1.32), 3.08 (2.70–3.46), and 3.93 (3.46–4.40) million deaths respectively, compared with ‘no screening’ scenario. Screening would substantially increase the number of diagnosed GC cases within the first three years of program initiation, but this number would quickly reduce below ‘no screening’ scenario. Three-yearly screening at the above coverage rates would reduce the proportion of undiagnosed GC cases to 38.8% (36.9–40.7%), 25.5% (23.4–27.6%), and 17.8% (16.0–19.6%) by 2049, respectively. Delaying implementation of the screening program would substantially reduce its effectiveness. ConclusionsInitiating national endoscopic screening programmes would likely have a major effect on reducing GC incidence and mortality in China. Health resources should be substantially increased and directed to treatment of GC to cope with the initial rise in diagnosed GC cases.

Apatinib Plus Chemotherapy Shows Clinical Activity in Advanced NSCLC: A Retrospective Study.

Apatinib is an oral TKI with antiangiogenic properties, and it is currently approved for the treatment of advanced gastric cancer in China. This agent has also been tested in other human solid tumors, including non-small cell lung cancer (NSCLC). Since the combination of chemotherapy and an antiangiogenic agent has been shown to be a feasible strategy in NSCLC, it is conceivable that a similar approach combining apatinib with chemotherapy may yield clinical activity. With this in mind, we investigated the efficiency of apatinib in combination with pemetrexed or docetaxel in advanced NSCLC. We treated a total of 20 patients with metastatic NSCLC adenocarcinoma with apatinib in combination with either pemetrexed or docetaxel from January 2016 to March 2017. The performance status of these patients was 0 or 1. All of these patients had been previously treated with two or more lines of treatment and had experienced disease progression prior to study enrollment. The overall objective response rate (ORR) was 30%, with 6 patients who had partial response (PR), 10 patients who had stable disease (SD), and 4 patients who had progressive disease (PD). The main adverse events were skin rash, hypertension, palmar–plantar erythrodysesthesia syndrome, diarrhea, and fatigue. Nearly 30% of patients required interruption of treatment as a result of toxicity. Our study demonstrated that apatinib combined with systemic cytotoxic chemotherapy has clinical efficacy in patients with disease-refractory metastatic NSCLC and provides evidence for further studies investigating apatinib-based combination regimens.

Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life

Background/objectivesThe assessment of nutritional status and the quality of life in patients with gastric cancer has become one of the important goals of current clinical treatment. The purpose of this study was to assess the nutritional status in hospitalized gastric cancer patients by using patient-generated subjective global assessment (PG-SGA) and to analyze the influence of nutritional status on the patients’ quality of life (QOL).MethodsWe reviewed the pathological diagnosis of gastric cancer for 2322 hospitalized patients using PG-SGA to assess their nutritional status and collected data on clinical symptoms, the anthropometric parameters (height, weight, body mass index (BMI), mid-arm circumference (MAC), triceps skin-fold thickness (TSF), and hand-grip strength (HGS). We also collected laboratory data (prealbumin, albumin, hemoglobin) within 48 h after the patient was admitted to the hospital. The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) was used for QOL assessment in all patients.ResultsBy using PG-SGA, we found 80.4% of the patients were malnourished (score ≥ 4) and 45.1% of the patients required urgent nutritional support (score ≥ 9). In univariate analysis, old age (> 65 years, p < 0.001), female (p = 0.007), residence in a village (p = 0.004), a lower level of education (p < 0.001), and self-paying (p < 0.001) were indicated as risk factors of patients with gastric cancer to be suffering from severe malnutrition. There was a negative correlation between PG-SGA and various nutritional parameters (p < 0.05). The quality of life was significantly different in gastric cancer patients with different nutritional status (p < 0.01).ConclusionMalnutrition of hospitalized patients with gastric cancer in China is common and seriously affects the patients’ quality of life. The nutritional status should be evaluated in a timely manner and reasonable nutritional intervention should be provided as soon as possible. The PG-SGA was fit for using as a clinical nutrition assessment method, being worthy of clinical application.

The necessity of adjuvant radiotherapy for locally advanced gastric cancer in China.

Nearly 50% of the new gastric cancer cases and gastric cancer-related deaths worldwide occur in China. Although the Guidelines for the Diagnosis and Treatment of Gastric Cancer from the National Health Commission of the People’s Republic of China have explicitly emphasized the necessity of adjuvant chemoradiation for gastric cancer, few clinical institutions in China routinely administer postoperative adjuvant radiation therapy in patients with gastric cancer. At present, radical resection combined with postoperative chemotherapy alone is the most common treatment for locally advanced gastric cancer in China. However, several phase III prospective randomized controlled trials in Europe have shown that adjuvant chemotherapy alone after a radical resection does not improve the disease-free survival (DFS) or overall survival (OS) of patients with gastric cancer. As in Japan and South Korea, D2 radical resection is the recommended surgical approach for gastric cancer in China. However, several studies have shown that the rate of D2 resection in the treatment of gastric cancer patients in China is low. Nearly 50% of patients undergo a D0-1 radical resection, even at the leading gastric cancer centers in China. The results of the INT-0116 study in the US suggest that gastric cancer patients who undergo a D0-1 radical resection and have stage T3-4 or N+ disease should receive concurrent postoperative radiation therapy and chemotherapy. In conclusion, many patients with gastric cancer do not receive a standard D2 resection in China. As a result, it is important to consider postoperative adjuvant chemoradiation especially in those patients who undergo a D0-1 radical resection.

The necessity of adjuvant radiotherapy for locally advanced gastric cancer in China

Nearly 50% of the new gastric cancer cases and gastric cancer-related deaths worldwide occur in China. Although the Guidelines for the Diagnosis and Treatment of Gastric Cancer from the National Health Commission of the People’s Republic of China have explicitly emphasized the necessity of adjuvant chemoradiation for gastric cancer, few clinical institutions in China routinely administer postoperative adjuvant radiation therapy in patients with gastric cancer. At present, radical resection combined with postoperative chemotherapy alone is the most common treatment for locally advanced gastric cancer in China. However, several phase III prospective randomized controlled trials in Europe have shown that adjuvant chemotherapy alone after a radical resection does not improve the disease-free survival (DFS) or overall survival (OS) of patients with gastric cancer. As in Japan and South Korea, D2 radical resection is the recommended surgical approach for gastric cancer in China. However, several studies have shown that the rate of D2 resection in the treatment of gastric cancer patients in China is low. Nearly 50% of patients undergo a D0-1 radical resection, even at the leading gastric cancer centers in China. The results of the INT-0116 study in the US suggest that gastric cancer patients who undergo a D0-1 radical resection and have stage T3-4 or N+ disease should receive concurrent postoperative radiation therapy and chemotherapy. In conclusion, many patients with gastric cancer do not receive a standard D2 resection in China. As a result, it is important to consider postoperative adjuvant chemoradiation especially in those patients who undergo a D0-1 radical resection.

Phase II study of apatinib: A novel VEGFR inhibitor in pretreated patients with metastatic penile cancer.

TPS538 Background: Apatinib is an oral, highly potent tyrosine-kinase inhibitor targeting VEGFR2 and has been approved as monotherapy for treatment of metastatic gastric cancer in China. This phase II study aims to evaluate the efficacy and safety of apatinib monotherapy in pretreated patients with metastatic penile cancer in China (all patients have failed cisplatin-based chemotherapy previously). Methods: From October 2016 to May 2018, 9 patients were enrolled, and eight patients were eligible for efficacy analysis. All patients received apatinib 500 mg/day p.o. in a 4-week cycle, with the endpoint progression-free survival (PFS). This trial is ongoing. Longer follow-up and complete enrollment are needed for the final efficacy assessment. Clinical trial information: UMIN000021849.

Prognosis of Young Survivors of Gastric Cancer in China and the U.S.: Determining Long-Term Outcomes Based on Conditional Survival.

Young survivors of gastric cancer (GC) have better prognoses than elderly patients, yet their disease-specific survival (DSS) has received little attention. Data on young patients (aged ≤40 years) with GC undergoing resections at three Chinese institutions (n = 542) and from the SEER database (n = 533) were retrospectively analyzed. Three-year conditional disease-specific survival (CS3) was assessed. The effects of well-known prognostic factors over time were analyzed by time-dependent Cox regression. Overall, young Chinese patients with GC had a better 5-year DSS than U.S. patients (62.8% vs. 54.1%; p < .05). The disease-specific mortality likelihood of the entire cohort was not constant over time, with most deaths occurring during the first 3 years after surgery but peaking at 1 and 2 years in China and the U.S., respectively. Based on 5-year survivorship, the CS3 rates of both groups were similar (90.9% [U.S.] vs. 91.5% [China]; p > .05). Cox regression showed that for Chinese patients, site, size, T stage, and N stage were independent prognostic factors at baseline (p < .05). For U.S. patients, grade, T stage. and N stage significantly affected DSS at baseline (p < .05). In both groups, only T stage continuously affected DSS within 3 years after gastrectomy. However, for both groups, the initial well-known prognostic factors lost prognostic significance after 5 years of survival (all p > .05). Although the 5-year DSS rates of young Chinese patients with T3 and T4a disease were significantly better than those of young U.S. patients, in each T stage, the CS3 of both regions trended toward consistency over time. For young patients with GC, the factors that predict survival at baseline vary over time. Although the initial 5-year DSS is heterogeneous, insight into conditional survival will help clinicians evaluate the long-term prognoses of survivors while ignoring population differences. With the increasing number of young survivors of gastric cancer (GC), it is essential for clinicians to understand the dynamic prognosis of these patients. Based on large data sets from China and the U.S., this study found that the prognostic factors that predict survival for young patients with GC at baseline vary over time. Although the initial 5-year disease-specific survival is heterogeneous, insight into conditional survival will help clinicians evaluate the long-term prognoses of survivors while ignoring population differences. This knowledge may be more effective in helping young patients with GC to manage future uncertainties, especially when they need to make important life plans.

The combination of apatinib and S-1 for the treatment of advanced gastric cancer in China: A meta-analysis of randomized controlled trials.

Apatinib-targeted therapy is considered a promising treatment option for malignancies. This study systematically evaluated the efficacy and safety of the combination of apatinib and S-1 for the treatment of patients with advanced gastric cancer (GC). Clinical trials were searched from the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases. Outcome measures including therapeutic efficacy, quality of life (QoL), and adverse events were extracted and evaluated. Data from 8 trials including 393 patients with advanced GC were included. The results indicated that, compared with S-1 alone, the combination of apatinib with S-1 significantly improved patient partial response rate (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.21-3.02, P = .005), overall response rate (ORR, OR = 2.40, 95% CI = 1.51-3.82, P = .0002), and disease control rate (DCR, OR = 2.78, 95% CI = 1.51-5.10, P = .0010), whereas the rates of complete response (CR, OR = 2.38, 95% CI = 0.93-6.12, P = .07) and stable disease (SD, OR = 0.99, 95% CI = 0.64-1.54, P = .97) and QoL (OR = 1.22, 95% CI = 0.51-2.92, P = .66) did not differ significantly. Moreover, the group receiving the combined therapy had higher rates of hand-foot syndrome (OR = 2.23, 95% CI = 1.19-4.17, P = .01), hypertension (OR = 8.85, 95% CI = 4.07-19.26, P < .00001), albuminuria (OR = 11.25, 95% CI = 3.32-38.06, P = .0001), and hemoglobin reduction (OR = 3.19, 95% CI = 1.32-7.67, P = .010), whereas analysis of other adverse events did not show significant differences (P > .05). The combination of apatinib and S-1 is more effective for GC treatment than S-1 alone. However, this combined treatment could lead to increased hand-foot syndrome, hypertension, albuminuria, and hemoglobin reduction. Therefore, the benefits and risks should be considered before treatment.

Therapeutic arrangement and strategies in perioperative treatment of locally advanced gastric cancer from the view of whole-process management

The incidence of gastric cancer is high in China. Most patients are advanced incurable and by surgery at diagnosis. At present, the treatment of advanced gastric cancer in China has been mainly based on multidisciplinary treatment including surgery, chemotherapy, radiotherapy, molecular targeted therapy, as well as immunotherapy. In the pursuit of the ultimate goal of prolonging survival, from the perspective of management throughout the patient journey, we should further optimize and arrange the strategies, methods, techniques and timing in perioperative treatment. There are still many unsolved problems to promote gastric cancer surgery from simple technical resection to biological resection. Treatment procedure based on evidence-based medicine and efficacy evaluation criteria may result in correct decision. In addition molecular markers based on gene sequencing may help select oppropriate agents and predict efficacy and prognosis. In clinical practice, how to achieve individualized treatment based on precise staging and goal orientation is the aim of continuous efforts to prolong the survival of advanced gastric cancer patients.