Gastric Cancer Survivors Research Articles

Risk of metabolic syndrome and fatty liver in gastric cancer survivors: A propensity score-matched analysis.

266 Background: With the recent development in cancer treatments, the number of cancer survivors is rapidly increasing. The aim of this study was to investigate the prevalence and risk of metabolic syndrome and fatty liver in GC survivors compared with that in non-cancer (NC) subjects. We also analysed the risk for metabolic dysfunction-associated fatty liver disease (MAFLD)8 in GC survivors compared with that in NC subjects. Methods: In this cross-sectional study, participants who visited Gangnam Severance Hospital from 2014 to 2019 for health check-ups were enrolled. After age- and sex-matched 1:4 propensity score matching, 119 GC survivors and 476 NC subjects were included. GC survivors were divided into operated gastric cancer survivors (OpGC) (n = 95) and non-operated survivors (non-OpGC) (n = 24). MetS was diagnosed by metabolic components and FL was assessed by ultrasonography. Results: MetS was observed in 21.0% of GC survivors and 30.5% of NC subjects, and in 13.7% of OpGC survivors and 50.0% of non-OpGC survivors. FL was observed in 25.2% of GC survivors and 37.6% of NC subjects, and in 21.1% of OpGC survivors and 41.7% of non-OpGC survivors. After adjusting for age, sex, MetS risk was significantly lower in OpGC survivors (odds ratio [OR] = 0.377, 95% confidence interval [CI]: 0.200-0.711, P = 0.003). FL risk was significantly lower in OpGC survivors (OR = 0.467, 95% CI: 0.267–0.816, P = 0.007), but not in non-OpGC survivors, compared with NC subjects. Risk of metabolic dysfunction-associated fatty liver disease was significantly lower in OpGC survivors (OR = 0.412, 95% CI: 0.233–0.729, P = 0.002) compared with NC subjects. Conclusions: OpGC survivors showed a lower risk of MetS and FL compared with NC subjects. These associations can be explored to ensure timely medical intervention in GC survivors.

Risk of Psoriasis in Postgastrectomy Gastric Cancer Survivors: A Nationwide Population-Based Cohort Study

BackgroundAlthough patients with psoriasis have an increased risk of cancers, little is known about the risk of psoriasis in cancer patients.ObjectiveWe aimed to comparatively analyze the incidence and risk factors of psoriasis in gastric cancer patients who underwent gastrectomy and in the general population.MethodsA nationwide retrospective cohort of 52,608 gastric cancer survivors (2007~2015) was compared to 123,438 matched controls from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. We also calculated the HRs for psoriasis according to adjuvant cancer treatment, obesity, and vitamin B12 supplementation in gastric cancer survivors.ResultsDuring a mean follow-up of 6.85 years, 645 of the 52,608 gastric cancer patients developed psoriasis, while 1,806 in the 123,438 matched control group developed psoriasis. Gastric cancer patients had a decreased risk of psoriasis (HR, 0.86; 95% confidence interval, 0.79~0.94), especially those who underwent subtotal gastrectomy. We found that vitamin B12 supplementation for more than 3 years had an additive effect on decreasing the risk of psoriasis in gastric cancer patients who underwent subtotal gastrectomy. Total gastrectomy, radio/chemotherapy, and obesity did not affect the risk of psoriasis in gastric cancer survivors.ConclusionThe incidence of psoriasis is slightly lower in gastric cancer survivors than in the general population. Our results suggest that the development of psoriasis may be reduced by removing the source of systemic inflammation caused by Helicobacter pylori infection through subtotal gastrectomy in gastric cancer survivors.

Factors affecting the quality of life of gastric cancer survivors

BackgroundThe number of gastric cancer survivors has been increasing, and such survivors experience various changes in their lives post-recovery. Adapting to these changes requires appropriate interventions that can improve their quality of life (QoL). This study was conducted to investigate the factors affecting the QoL of gastric cancer survivors and provide basic data for effective intervention.MethodsData were collected between September 8 and September 29, 2017, from the Gastric Cancer Center at a tertiary hospital. Questionnaire surveys were conducted using the EORTC QLQ-C30/STO22, Self-Efficacy-Scale, Multidimensional Scale of Perceived Social Support, and Quality of Life-Cancer Survivors Questionnaire on gastric cancer survivors who were followed up for 3 years after gastrectomy. Data were analyzed using descriptive statistics, t test, ANOVA, Pearson’s correlation coefficient, and multiple regression analysis.ResultsA total of 136 gastric cancer survivors completed the questionnaire survey. There were significant positive correlations of QoL with self-efficacy, functional status, and social support (r = .35, p < .001; r = .53, p < .001; r = .26, p < .001, respectively). There were significant negative correlations of QoL with general symptoms (r = − .39, p < .001) and gastric cancer-specific symptoms (r = − .51, p < .001). The regression model explained 48.3% of the QoL, and the affecting factors were gastric cancer-specific symptoms (β = − .397, p < .001), religious belief (β = .299, p < .001), functional status (β = .251, p = .003), and self-efficacy (β = .191, p = .004).ConclusionThis study confirmed that gastric cancer-specific symptoms, spiritual well-being, self-efficacy, and functional status affect the QoL of gastric cancer survivors. Hence, these factors should be considered in the interventions to improve the QoL of gastric cancer survivors.

Ранний рак желудка: клиническое наблюдение

Gastric cancer (GC) is one of the most common types of malignant neoplasms in Russia and worldwide. In recent decades, GC incidence and mortality have been declining. However, gastric cancer remains one of the leading causes of morbidity and mortality, facilitating further improvements of GC diagnostics and treatment. As known, early gastric cancer is a tumor limited to the gastric mucosa or the submucosal layer of the stomach wall. The detection of early-stage GC is the goal of screening programs. The rapid development of endoscopic technologies and the introduction of the ZOOM endoscopy and narrow-band imaging for precise diagnostics have dramatically improved the quality and effectiveness of patient examinations. These advances have underpinned the increased detection of early gastric cancer. Early gastric cancer can be completely cured. Until recently, the gold standard treatment for GC, including its early stages, was radical resection and gastrectomy. This treatment approach is fully justified and ideal from the perspective of oncology. At the same time, it is associated with postoperative complications and deaths, as well as with a substantial decrease in the quality of life in long term GC survivors. Latest endoscopic technologies enable to perform organ-preserving operations in patients with early GC. As a result, it is possible to reduce dramatically the probability of postoperative complications and to improve the quality of life of patients. As of today, the optimization of endoscopic techniques for the treatment of early GC, as well as the search and implementation of new techniques are considered as the most important issues. The article presents a review of key endoscopic methods used for diagnosis and treatment of GC and a clinical case of a patient with early subcardial stomach cancer. KEYWORDS: oncology, gastric cancer, early gastric cancer, dysplastic changes in the stomach mucosa, endoscopy, endoscopic diagnostics, endoscopic resection, OVESCO. FOR CITATION: Malikhova O.A., Ryabova V.E., Lozovaya V.V. et al. Early gastric cancer: clinical case. Russian Medical Inquiry. 2022;6(6):334– 340 (in Russ.). DOI: 10.32364/2587-6821-2022-6-6-334-340.

S1459 Endoscopic Resection Is Superior to Gastrectomy for Gastric Cancer Regarding the Risk of Incident Type 2 Diabetes: A Nationwide Cohort Study

Introduction: Management of comorbidities in gastric cancer survivors is imperative, given increasing survival rate in patients with gastric cancer. Patients with gastric cancer are known to have higher risk of developing type 2 diabetes (T2D) compared to those without gastric cancer, but it is unknown whether the risk of incident T2D in patients with gastric cancer differs by treatment procedures. Methods: Using data from a nationwide cohort provided by the National Health Insurance Service in Korea, patients undergoing endoscopic submucosal dissection (ESD) or total gastrectomy (TG) for gastric cancer between 2004 to 2013 were identified. Exclusion criteria were patients who had history of other cancers or T2D, received adjuvant chemotherapy, died within 3 years after procedures. The risk of incident T2D after ESD or TG was estimated using multivariate Cox regression analyses adjusted for baseline characteristics, considering competing risks of incident T2D and death. Subgroup analyses were performed according to baseline age and sex. Results: Total of 3,006 patients undergoing ESD and 15,647 patients undergoing TG were included in this study. Compared to those undergoing ESD, patients undergoing TG had higher risk of incident T2D (hazard ratio [HR], 1.42; 95% confidence interval [95% CI], 1.26-1.58). Higher risk of incident T2D in patients undergoing TG remained significant across subgroups according to baseline age and sex. Conclusion: Patients undergoing ESD haver lower risk of developing T2D after procedure, compared to those undergoing TG. More careful postoperative care regarding glycemic control after TG is warranted. This study highlighted novel strength of endoscopic resection regarding risk of incident T2D and enabled more informed treatment decision for early gastric cancer patients.Figure 1.

Preferences of gastric cancer survivors for follow-up care-a multicenter discrete choice experiment study.

The purposes of this discrete choice experiment are as follows: (1) to investigate the preferences of gastric cancer survivors for follow-up care, and (2) to quantify the importance of follow-up care-related characteristics that may affect the gastric cancer survivors' choices of their follow-up, so as to provide references for the development of the follow-up strategy of gastric cancer survivors. Discrete choice experimental design principle was applied to develop the survey instrument. All questionnaires were filled out by the respondents and collected on site. A mixed logit model was used to estimate gastric cancer survivors' preferences. Willingness to pay estimates and simulations of follow-up uptake rates were calculated. All six attributes are significantly important for the follow-up care of gastric cancer survivors (p < 0.05). Achieving very thorough follow-up contents was the most valued attribute level (coefficient = 1.995). Specialist doctors are the most preferred providers followed by specialist nurses, and gastric cancer survivors were willing to pay more for these attribute levels. Changes in attribute levels affected uptake rate of follow-up. When the multiple attribute levels were changed at the same time, a very thorough follow-up content was provided by the same specialist doctor (specialist nurse), and the probability of receiving follow-up increases by 95.82% (94.90%). The characteristics of follow-up care in our study reflect the health management services' expectations of gastric cancer survivors. A dedicated specialist nurse involved in follow-up care should be developed to contribute to solve the complex and multifaceted personal needs of gastric cancer survivors.

Is it Beneficial to Utilize an Articulating Instrument in Single-Port Laparoscopic Gastrectomy?

PurposeAs the number of gastric cancer survivors is increasing and their quality of life after surgery is being emphasized, single-port surgery is emerging as an alternative to conventional gastrectomy. A novel multi-degree-of-freedom (DOF) articulating device, the ArtiSential® device (LivsMed, Seongnam, Korea), was designed to allow more intuitive and meticulous control for surgeons facing ergonomic difficulties with conventional tools. In this study, we evaluated the feasibility of this new device during single-port laparoscopic distal gastrectomy (SP-LDG) for early gastric cancer (EGC) patients.Materials and MethodsConsecutive patients diagnosed with EGC who underwent SP-LDG with ArtiSential® (LivsMed) graspers between April 2018 and August 2020 were enrolled in the study. The clinical outcomes were compared with those of a control group, in which prebent graspers (Olympus Medical Systems Corp) were used for the same procedures.ResultsSeventeen patients were enrolled in the ArtiSential® group. There was no significant difference in operative time (205.4±6.0 vs. 218.1±9.9 minutes, P= 0.270) or the quality of surgery, in terms of the number of retrieved lymph nodes (49.5±3.5 vs. 45.9±4.0, P=0.473), length of hospital stay (15.4±2.0 vs. 12.4±1.3 days, P=0.588), and postoperative complications (40.0% vs. 41.2%, P=0.595), between the ArtiSential® group and the control group.ConclusionsThe new multi-DOF articulating grasper is feasible and can be used as an alternative for prebent graspers during SP-LDG.

Incidence features of second primary malignancy among gastric cancer survivors, 1992-2012.

BackgroundWith the expanding population of cancer survivors, screening for second primary malignancy (SPM) is one issue concerning survivorship care. This study aimed to evaluate the potential risk of developing SPMs and determine the features of SPMs among patients after the diagnosis of gastric cancer (GC).MethodsWe identified 33,705 GC patients from the Surveillance, Epidemiology, and End Results Program (SEER) database. The standardized incidence ratios (SIRs) were calculated to estimate the risk of SPMs. The SIRs were stratified by age, race, stage, and latency period since GC diagnosis.ResultsA total of 2,018 among 33,705 GC patients developed SPMs. Compared with the general population, these GC survivors had higher risks of developing second malignancies of the esophagus, stomach, small intestine, colon, pancreas, and thyroid. Conversely, these GC survivors had lower chances of developing prostate and female breast cancer.ConclusionsIn stratified analyses, we identified the features associated with a higher risk of developing SPMs, including age between 20 and 39 years, latency between 60 and 119 months, localized stage, and American Indian/Alaska Native ethnicity. Hence, GC survivors are at a higher risk of developing SPMs than the general population. Careful attention and continuous surveillance should be used when treating these patients.

Increased risk for uterine cancer among first-degree relatives to Swedish gastric cancer patients

PurposeIn order to further understand genetically predisposing factors of gastric cancer, a retrospective study on 107 patients with gastric cancer was conducted. The family history of cancer cases was registered, in search of associations between gastric cancer and other cancer types.Materials and methodsWithin Stockholm County in Sweden, all patients previously diagnosed with gastric cancer and still alive were invited to participate in the study. Patients were asked to complete a questionnaire about their gastric cancer diagnosis and if any cancers had occurred in their family. A blood sample for DNA extraction was collected. The proportions of different cancer types in the relatives of the patients were compared to the general Swedish population in 1970 and 2010.ResultsAmong first- and second-degree relatives to the index patients with gastric cancer, the frequency of uterine cancer as well as gastric cancer was significantly overrepresented compared to the general population in Sweden. The frequency of breast cancer was significantly lower.ConclusionsThere seems to be an increased risk of both gastric cancer and uterine cancer in the families of gastric cancer survivors, indicating a possible hereditary connection between these two cancer types.

Nutritional status, sarcopenia, gastrointestinal symptoms and quality of life after gastrectomy for cancer – A cross-sectional pilot study

Gastrointestinal (GI) symptoms, malabsorption, reduced food intake and weight loss are common sequela of gastrectomy. This can result in malnutrition with a subsequent prolonged recovery, reduced physical functioning and deteriorated quality of life (QoL). Few studies have investigated the relationship between GI-symptoms, QoL and malnutrition in long-term survivors of gastric cancer. Therefore, we assess nutritional status, GI-symptoms and QoL 2-5 years after gastrectomy for malignancy. A cross-sectional, pilot study was carried out in patients who underwent total or subtotal gastrectomy at Oslo University Hospital between 2012 and 2016, who had not experienced disease recurrence. Subjects above 85 years were excluded. The nutritional status of the patients fell into three groups by a score of subjective global assessment (SGA)-A, B, and C. Muscle mass was measured by body composition by bioelectrical impedance analysis and muscle strength was measured by handgrip strength (HGS). Dietary intake was assessed by repeated 24-hdietary recalls. GI-symptoms and QoL were assessed using GI-Symptom Rating Scale (GSRS) and the SF-36 questionnaire. 21 patients were included. Mean (SD) weight loss was 12.8% (11.6) from preoperative status to follow up. Percentage weight loss was larger after total gastrectomy compared with subtotal gastrectomy (17.9% (12.3) vs. 6.6% (7.1) (p=0.03)). A low mean intake of energy and protein was reported compared to dietary recommendations for the general Nordic population and intake in a national dietary survey. All of the patients were classified as pre-sarcopenic, and 5% as sarcopenic. Persistent weight loss >10% was observed in 45% of the subjects and these were in risk of malnutrition. Subjects with malnutrition had higher GSRS score for the abdominal pain syndrome (p=0.042) and lower SF-36 scores for bodily pain (p=0.01) and vitality (p=0.02) compared with those without malnutrition. A high prevalence of weight loss, and pre-sarcopenia was observed. Malnutrition as assessed by SGA was associated with more GI-Symptoms and reduced QoL scores. Further studies with larger number of participants are needed to verify our findings.

Per oral vitamin B12 replacement therapy after gastrectomy and its optimal dose (retrospective study) and our protocol of a prospective clinical trial.

338 Background: Postgastrectomy vitamin B12 deficiency is common metabolic sequel and worsens the quality of life of gastric cancer survivors. Recently, oral vitamin B12 replacement is reported. Therefore, we investigated retrospectively the efficacy of oral vitamin B12 replacement for gastric cancer patients with vitamin B12 deficiency after total gastrectomy. Methods: We reviewed 73 patients with gastric cancer who underwent total gastrectomy and were treated vitamin B12 replacement. Patients were consisted of 56 males and 17 females and median age was 70 y/o. We investigated initial treatment of vitamin B12 replacement and improvement of vitamin B12 deficiency. Results: Initial treatment of vitamin B12 replacements were intramuscular injection for 42 patients, per oral replacement for 28 patients and intravenous injection for 3 patients. Finally, all patients were treated with per oral replacement and the serum vitamin B12 levels became within normal range. Final vitamin B12 doses of replacement therapy were 500 µg of 20 out of 73 pts, respectively. Conclusions: Vitamin B12 replacement therapy should be necessary and continued. According to our results, one vitamin B12 tablet a day is enough. The vitamin B12 deficiency symptoms could be prevented. 500 micrograms vitamin B12 replacement orally is maybe effective and necessary. Our prospective clinical protocol (UMIN000030727): In this study, an oral vitamin B12 preparation (1500 μg/day, administered daily) was set as the control treatment, and a specific clinical trial was started to determine whether 500 μg/day daily administration would be sufficient for replacement therapy. Clinical trial information: UMIN000030727.

Advantages of Distal Subtotal Gastrectomy over Total Gastrectomy in the Quality of Life of Long-Term Gastric Cancer Survivors.

PurposeThis study evaluated differences and shifting patterns in the health-related quality of life (HRQoL) of 5-year gastric cancer survivors after either a distal subtotal gastrectomy (DSG) or total gastrectomy (TG).Materials and MethodsWe analyzed the prospectively collected HRQoL data of 528 patients who survived 5 years without recurrence using the European Organization for the Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Quality of Life Questionnaire-Stomach module according to the type of surgery. The purpose was to identify the proportion of patients with deteriorating HRQoL and to assess the clinical significance of these changes.ResultsDeteriorating HRQoL was prevalent in both groups, including a large proportion of the DSG group. Decreased overall health status and scores on several function scales were less in the DSG group, while increases on the symptom scales were higher in the TG group. For most of the scales, gaps in HRQoL during the early postoperative period did not merge within the 5 years. Scores on the diarrhea and body image scales revealed “moderate changes” in both groups.ConclusionsDuring the 5-year period after surgery, the TG group suffered from inferior HRQoL compared to the DSG group. However, a large proportion of the DSG group also suffered HRQoL deterioration. In general, the TG group experienced more HRQoL decline, with diarrhea and body image being the major concerns for both groups. To improve HRQoL after gastrectomy, patients must be better informed about post-gastrectomy symptoms. These symptoms must be vigorously investigated, and medical interventions should be available parallel to nutritional support. Favorable evidence of function-preserving gastrectomy should be established and disseminated to improve the HRQoL of early gastric cancer patients.

Correction: Increased Risk of Osteoporotic Fracture in Postgastrectomy Gastric Cancer Survivors Compared With Matched Controls: A Nationwide Cohort Study in Korea.

Shin, Dong Wook MD, PH, MBA; Suh, Beomseok MD, MPH, MBA; Lim, Hyunsun PhD; Suh, Yun-Suhk MD, PhD; Choi, Yoon Jin MD, PhD, MD; Jeong, Su-Min MD; Yun, Jae Moon MD, MPH; Song, Sun Ok MD, PhD; Park, Youngmin MD, MPH

Increased Risk of Osteoporotic Fracture in Postgastrectomy Gastric Cancer Survivors Compared With Matched Controls: A Nationwide Cohort Study in Korea

Gastrectomy can lead to bone loss. Previous studies have suggested that there is an increased risk of fracture in gastric cancer survivors. However, these studies were performed without proper control groups. Therefore, we used Korean national health insurance data to compare the fracture risk in gastric cancer survivors who received gastrectomy to that of the general population. A total of 133,179 gastric cancer survivors were included and matched to noncancer controls using 1:1 propensity score matching. Cox proportional hazards regression analysis was used to determine the relative risk of fracture between the gastric cancer survivors and matched controls. We also examined the factors associated with fracture in gastric cancer survivors. Compared with the matched controls, gastric cancer survivors had an elevated risk of osteoporotic fracture (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.53-1.70), which was most prominent in patients who underwent total gastrectomy (HR 2.18, 95% CI 1.96-2.44) and adjuvant chemotherapy (HR 2.01, 95% CI 1.81-2.23). In multivariate analysis, anemia was significantly associated with increased fracture risk (aHR 1.34, 95% CI 1.13-1.59), while decrease in weight >5% was not (aHR 1.06, 95% CI 0.89-1.25). Gastric cancer survivors who underwent gastrectomy had an increased osteoporotic fracture risk than did matched controls. Total gastrectomy, adjuvant chemotherapy, and anemia were associated with an even higher risk in these patients. Additional studies are needed to establish optimal strategies, such as screening for osteoporosis and preventive interventions, that will reduce fracture risk in this population.

Helicobacter pylori Infection following Endoscopic Resection of Early Gastric Cancer.

The role of Helicobacter pylori (H. pylori) infection in patients following endoscopic resection of early gastric cancer (EGC) remains unclear. This article presents a review of literature published in the past 15 years. H. pylori‐mediated persistent methylation levels are associated with the development of metachronous gastric cancer. The methylation of certain specific genes can be used to identify patients with a high risk of metachronous gastric cancer even after H. pylori eradication. H. pylori eradication after endoscopic resection should be performed as early as possible for eradication success and prevention of metachronous precancerous lesions. Although whether the eradication of H. pylori could prevent the development of metachronous cancer after endoscopic resection is controversial, several meta‐analyses concluded that H. pylori eradication could reduce the incidence of metachronous gastric cancer significantly. In addition, H. pylori eradication in gastric cancer survivors after endoscopic resection could reduce healthcare cost and save lives in a cost‐effective way. Taken together, H. pylori eradication after endoscopic resection of EGC is recommended as prevention for metachronous precancerous lesions and metachronous gastric cancer.

Risk of Dementia in Gastric Cancer Survivors Who Underwent Gastrectomy: A Nationwide Study in Korea.

This study was designed to compare the risk of dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), between gastric cancer patients who underwent gastrectomy and the general population. All patients (n = 63,998) aged ≥ 50years who received a diagnosis of gastric cancer and underwent curative gastrectomy between 2007 and 2012 and a noncancer control population (n = 203,276), matched by age and sex, were identified from the Korean National Health Insurance Services and traced until 2017. Hazard ratios and 95% confidence intervals for dementia were calculated with a Cox regression analysis. Gastric cancer patients who received a gastrectomy showed an increased risk of AD [adjusted hazard ration (aHR) 1.08, 95% confidence interval (CI) 1.03-1.14], and the risk was especially marked for those who received a total gastrectomy (aHR 1.39, 95% CI 1.25-1.54). Gastric cancer survivors showed a decreased risk for VaD (aHR 0.85; 95% CI 0.73-0.98) regardless of operation type. Those who received continual vitamin B12 supplementation after a total gastrectomy were less likely than controls to develop AD (aHR 0.71; 95% CI 0.54-0.92). Compared with controls, gastric cancer patients who received a total gastrectomy had an increased incidence of AD and a decreased risk of VaD. Our results suggest that vitamin B12 deficiency might play a role in the development of AD and highlight the need for vitamin B12 supplementation after total gastrectomy.

The clinicopathological features of long-term survivors of metastatic gastric cancer

Abstract Background Metastatic gastric cancer has a poor prognosis. Overall survival in these patients is approximately 1 years, despite the development of chemotherapeutic and biological agents. The incidence of long-term survivors of metastatic gastric cancer beyond 5 years after the initiation of chemotherapy has been reported to be less than 10%. Methods The characteristics of long-term survivors were compared with those of poor responders to determine the specific factors that regulate chemosensitivity. Those who died within six months after the initiation of chemotherapy were considered as poor responders in this analysis. Medical records were retrospectively reviewed to determine the clinicopathological features of metastatic gastric cancer patients receiving chemotherapy in Nagoya Memorial Hospital. Statistical analyses were carried out by Fisher’s exact test and then a multivariate analysis. Differences with P values less than 0.05 were considered statistically significant. The chart review was approved by ethics committee of Nagoya Memorial Hospital. Results We experienced 8 long-term survivors and 12 poor responders. The analysis showed that number of metastatic sites might be different between 2 groups (P = 0.0144). The objective response rates of long-term survivors and poor responders were 62.5% (CR 4, PR 1) and 0%, respectively. Conclusions We found that tumor burden might be associated with the prognosis of affected patients. Good response to systemic chemotherapy should be essential for prolonged survival of patients with distant metastases.

Postoperative dynamic survival of gastric cancer patients: A multi-institutional, international analysis of 22 265 patients.

How to best evaluate the disease-specific survival (DSS) of gastric cancer (GC) survivors over time is unclear. Clinicopathological data from 22 265 patients who underwent curative intend resection for GC were retrospectively analyzed. Changes in the patients' 3-year conditional disease-specific survival (CS3) were analyzed. We used time-dependent Cox regression to analyze which variables had long-term effects on DSS and devised a dynamic predictive model based on the length of survival. Based on 1-, 3-, and 5-year survivorships, the CS3 of the population increased gradually from 62% to 68.1%, 83.7%, and 90.6%, respectively. Subgroup analysis showed that the CS3 of patients who had poor prognostic factors initially demonstrated the greatest increase in postoperative survival time (eg, N3b: 26.6%-84.1%, Δ57.5% vs N0: 84.1%-93.3%, Δ9.2%). Time-dependent Cox regression analysis showed the following predictor variables constantly affecting DSS: age, the number of examined lymph nodes (LNs), T stage, N stage, and site (P < .05). These variables served as the basis for a dynamic prediction model. The influence of prognostic factors on DSS and CS3 changed dramatically over time. We developed an effective model for predicting the DSS of patients with GC based on the length of survival time.

Incidence and Mortality Rates of Second Pancreatic Cancer Among Survivors of Digestive Cancers: A Nationwide Population-Based Study.

We analyzed the incidence and mortality rates of second pancreatic ductal adenocarcinoma (PDAC) among survivors of digestive cancers in South Korea. We evaluated data from the Korea National Health Insurance to identify individuals with digestive cancers in 2005 to 2015. The standardized incidence ratios (SIRs) of second PDACs and survival rates were evaluated. Among 772,534 patients with first digestive cancers, 1696 (0.22%) developed second PDACs. The incidence of second PDACs increased until 10 years since the first cancer diagnosis. Patients with biliary tract cancers (BTCs) showed a higher incidence of second PDACs than did those with gastrointestinal cancers or hepatocellular carcinoma. In ages 20 to 49 years, SIRs (95% confidence interval) were higher in survivors of hepatocellular carcinoma (3.08; 1.04-3.08), gastric cancer (3.40; 1.90-3.40), colorectal cancer (5.00; 2.75-5.00), gallbladder cancer (58.52; 11.81-58.52), intrahepatic cholangiocarcinoma (86.99; 1.73-86.99), extrahepatic cholangiocarcinoma (89.41; 27.42-89.41), and ampulla of Vater cancer (156.78; 48.08-156.78). In ages 50 to 64 years, colorectal cancer (1.42; 1.04-1.42), gastric cancer (1.66; 1.29-1.66), and BTCs revealed higher SIRs. In ages more than 65 years, SIR was increased only in BTCs. Second PDACs revealed a more favorable prognosis than first PDACs. Careful surveillance for second PDACs after curative treatment of BTCs and colorectal cancers should be considered.

Long-term survivors of metastatic gastric cancer for &gt;5 years after chemotherapy initiation

Long-term survivors of metastatic gastric cancer for &gt;5 years after chemotherapy initiation