Gastric Stump Cancer Patients Research Articles

Molecular and pathological analyses of gastric stump cancer by next-generation sequencing and immunohistochemistry

Gastric stump cancer (GSC) has distinct clinicopathological characteristics from primary gastric cancer. However, the detailed molecular and pathological characteristics of GSC remain to be clarified because of its rarity. In this study, a set of tissue microarrays from 89 GSC patients was analysed by immunohistochemistry and in situ hybridisation. Programmed death ligand 1 (PD-L1) was expressed in 98.9% of tumour-infiltrating immune cells (TIICs) and 6.7% of tumour cells (TCs). Epstein–Barr virus (EBV) was detected in 18 patients (20.2%). Overexpression of human epidermal growth factor receptor 2 and deficiency of mismatch repair (MMR) protein expression were observed in 5.6% and 1.1% of cases, respectively. Moreover, we used next-generation sequencing to determine the gene mutation profiles of a subset of the 50 most recent patients. The most frequently mutated genes were TP53 (42.0%) followed by SMAD4 (18.0%) and PTEN (16.0%), all of which are tumour suppressor genes. A high frequency of PD-L1 expression in TIICs and a high EBV infection rate suggest immune checkpoint inhibitors for treatment of GSC despite a relatively low frequency of deficient MMR gene expression. Other molecular characteristics such as PTEN and SMAD4 mutations might be considered to develop new treatment strategies.

Comparison of clinicopathological features and prognosis analysis between gastric stump cancer and recurrence of gastric cancer after radical gastrectomy

To investigate and compare the clinicopathological characteristics of gastric stump cancer(GSC) and the recurrent of gastric cancer (RGC) following radical gastrectomy, and to evaluate survival prognosis. A retrospective cohort study was performed on clinicopathological and survival data of patients with GSC (n=31) and with RGC (n=105) following radical gastrectomy at the Chinese People's Liberation Army General Hospital between January 1992 and August 2017. GSC was defined as cancer occured in remnant stomach ≥10 years after radical gastrectomy, while RGC was defined as <10 years. Patients of both groups received radical resection or palliative operation with tumor resection and had complete clinicopathological data regarding the first operation and gastric stump operation. T-test was used to compare quantitative data between the two groups, and Pearson χ2 test was used to compare qualitative data between the two groups. Kaplan-Meier method was applied to draw survival curves and log-rank test to assess survival differences. Of the 136 enrolled patients, 113 were male and 23 were female. In the first operation, compared with RGC group, in GSC group, the Borrmann type and histological differentiation were more better [Borrmann I(: 11/31 (35.5%) vs. 5/105 (4.8%), χ2=23.003, P=0.001; the high differentiation: 15/31 (48.4%) vs. 1/105 (1.0%), χ2=57.137, P=0.001]; the tumor diameter was smaller [<4 cm: 28/31(90.3%) vs. 56/105(53.3%), χ2=14.045, P=0.001]; the pT stage [pT1: 12/31 (38.7%) vs. 3/105 (2.9%), χ2=50.373, P=0.001], pN stage [pN0: 28/31 (90.3%) vs. 19/105 (18.1%), χ2=55.722, P=0.001] and pTNM staging [I(: 26/31 (83.9%) vs. 11/105 (10.5%), χ2=66.688, P=0.001] were earlier. Most of the GSC occurred at non-anastomotic sites, while the recurrence mostly occurred at anastomotic sites [51.6%(16/31) vs. 61.9%(65/105), χ2=7.520, P=0.023]. Compared with RGC group, GSC group had better histological differentiation [high differentiation: 5/31 (16.1%) vs. 2/105(1.9%), χ2=10.029, P=0.007]. There was more histological type change between the first and the second operation in GSC group than that in RGC group[48.4%(15/31) vs. 26.7%(28/105), χ2=5.222, P=0.022]. The overall survival time of GSC group was significantly longer than that of RGC group [mean: (161.0±18.6) months vs. (50.8±27.6) months, respectively, Log-rank: 76.818, P=0.001]. The survival time after the second surgery of GSC group was longer than that of RGC group [mean: (30.7±18.4) months vs. (20.5±15.0) months, P=0.003]. In the subgroup analysis of all the 136 patients according to histological type change between the two surgeries (unchanged 93 patients, changed 43 patients), compared with unchanged group, the overall survival time of changed group was longer [mean: (99.6±56.5) months vs. (72.1±58.1) months, P=0.008]. GSC patients have better histological differentiation and earlier clinical stage of primary gastric cancer, and longer survival time compared with RGC patients. The histological type change between two operations may be used as a new factor to define GSC.

Meta-analysis of gastric stump cancer after gastrectomy for gastric cancer

To study the clinicopathological features and prognosis of gastric stump cancer (GSC) following subtotal gastrectomy for gastric cancer, to compare the clinicopathologic differences between narrow GSC and generalized GSC, and to compare the prognosis between GSC and primary proximal gastric cancer (PPGC) after radical resection. Literatures of GSC-associated clinical study were searched by computer from the Cochrane Library, Medline, PubMed, CNKI, Wanfang and VIP databases, and the retrieval period was from the establishment of database to December 31, 2017. (1) GSC was defined as a carcinoma arising in the gastric remnant after radical gastrectomy for gastric cancer, and confirmed by the pathological or histological examination, the elapsed time from the initial operation was not considered in the definition. (2) Retrospective or prospective clinical cohort study. (3) Study included at least one of below items: gender, anastomotic type in gastric cancer surgery, the interval between the initial surgery and diagnosis of GSC, the location, treatment, pathological differentiation, pathologic stage, lymph node metastasis rate and prognosis of GSC. (4) When similar studies were reported by the same institution or author, either the better quality study or the newest publication was chosen. (1) Abstracts, reviews, case reports, meeting record, editorials and repeated research. (2) Studies including patients with initial non-gastric cancer. In this study, gastric stump cancer(GSC) after gastric cancer was divided into two groups: the incidence without limit interval time (generalized GSC group) and above 10 years (narrow GSC group). Selective trials were Meta-analyzed by the Stata13.0 software and statistical analysis was performed using SPSS 21.0 software. A total of 27 literatures were finally enrolled, which comprised 1463 GSC patients, including 1146 males and 317 females. The generalized group and narrow GSC group had 921 and 542 patients respectively. The generalized GSC group and the narrow GSC group did not significantly differ in terms of previous reconstruction mode, types of differentiation, pathologic T staging, postoperative pathology tumor-node-metastases staging, and distant metastasis rate (χ2=2.341, 0.926, 0.350, 0.965, 2.311 respectively, all P>0.05). As compared to generalized GSC group, narrow GSC group had higher ratio of male patients (82.8% vs. 75.7%, χ2=9.909, P=0.002), more lesions locating in anastomotic stoma (37.8% vs. 26.1%, χ2=18.091, P=0.000), higher ratio of patients undergoing radical resection (84.2% vs. 70.3%, χ2=11.738, P=0.001), higher positive rate of postoperative lymph node (45.8% vs. 34.5%, χ2=6.319, P=0.012), and larger size of tumor [(5.9±2.2) cm vs. (4.5±1.9) cm, t=9.151, P=0.000]. The overall 5-year survival rate and postoperative pathology stage III(-IIII( survival ratio in narrow GSC group were higher compared to general GSC group (42.7% vs. 30.6% and 27.5% vs. 18.1%, respectively), which were significantly different (χ2=10.938, P=0.000; χ2=4.128, P=0.042), while the postoperative pathology stage I(-II( survival ratio was not significantly different between two groups (67.3% vs. 67.0% respectively, χ2=0.015, P=0.92). There was no significant difference in the 5-year survival rate between GSC with radical resection and PPGC(RR=1.04, 95%CI:0.79-1.36, P=0.805) and the 5-year survival rate of same postoperative pathology stage was not significantly different between two groups (I(-II( stage: RR=1.08, 95%CI:0.93-1.26, P=0.328; III(-IIII( stage: RR=0.59, 95%CI:0.33-1.04, P=0.111). There are some different clinicopathological features between the generalized and the narrow GSC after gastric cancer surgery. The prognosis of GSC after radical resection is similar to primary proximal gastric cancer.

Characteristics of gastric stump cancer: A single hospital retrospective analysis of 262 patients

Owing to its relative rarity, the characteristics of gastric stump cancer (GSC) have not been fully understood. In this study, we clarified the detailed characteristics from a large cohort of GSC patients. For this retrospective cohort study from 1 hospital in Japan, we recruited 262 GSC patients who underwent surgery for GSC between 1984 and 2012. GSC was defined in accordance with Japanese Gastric Cancer Association. Stage was categorized in accordance with the 7th TNM classification for primary gastric cancer. Although the time interval between the primary and second operations differed significantly depending on the primary disease (34.3years for benign vs 9.9years for malignant on average), it did not influence survival. The 5-year overall survival rates of patients with N0, N1, N2, and N3 were 70.4%, 27.7%, 21.8%, and 6.4%, respectively, whereas the rates for those with stage I, II, III, and IV were 77.8%, 37.4%, 18.6%, and 10.5%, respectively. Recurrence in the peritoneum was the most common pattern, followed by recurrence in the local region or lymph nodes. The Cox proportional hazard model demonstrated that age > 65, T stage, N stage, and tumor histology were significant independent prognostic factors for survival, whereas neither primary disease nor primary anastomosis type significantly impacted survival. Neither primary disease nor anastomosis type affected survival significantly, despite significant differences in their characteristics. In addition, the time interval between the primary and second surgery did not impact survival.

Gastric Stump Cancer: More Than Just Another Proximal Gastric Cancer and Demanding a More Suitable TNM Staging System

Background. Considerable controversy persists about the biological behavior of gastric stump cancer (GSC). The aim of this study is to clarify if this cancer is just another proximal gastric cancer or if it emerges as a distinctive clinicopathologic entity. Methods. This review of a prospectively collected gastric cancer database identified 73 patients with GSC in a single institution between January 1980 and June 2012 and compared them with 328 patients with proximal gastric cancer (PGC) and 291 patients with esophagogastric junction cancer (EGJC). Results. Patients with GSC were predominantly males. Eighty-three percent of GSC penetrated the subserosal or the serosal layers. The median number of lymph nodes retrieved in GSC patients was significantly lower than in PGC patients or in EGJC patients. Cumulative survival curves were not different between GSC, PGC, or EGJC patients. Unlike that observed in PGC and in EGJC, no significant differences in cumulative survival according to the TNM staging system were observed in GSC cases. Conclusions. The outcome of patients with GSC displayed significant differences when compared to those with other proximal gastric cancers concerning the lack of survival association with the TNM staging system. Therefore a more suitable staging system should be designed for these unique cancers.

Treatment and prognosis of gastric stump carcinoma in comparison with primary proximal gastric cancer

Background The intention of this study was to evaluate the outcome of patients with gastric stump cancer (GSC) in comparison with patients treated for primary proximal gastric cancer (PPGC). Methods Nineteen patients with GSC undergoing surgery between January 1989 and August 2005 were compared with 194 PPGC patients treated during the same time period. Various factors such as epidemiologic data, type of treatment, and histopathologic data were evaluated in the analysis. Results The overall 5-year disease-specific survival was 42% for resected GSC patients in comparison with 37% for resected PPGC patients. There was no statistically significant difference in the survival rate detected between these 2 groups. On multivariate analysis the infiltration of the gastrojejunal anastomosis by the carcinoma was shown to be a significant predictor for the outcome of patients with GSC. Conclusions In summary, no significant difference in the outcome between GSC and PPGC has been detected.

Surgical management of gastric stump cancer: a report of 37 cases

To observe the clinicopathological characteristics of gastric stump cancer (GSC) and evaluate the benefits of radical surgery of GSC. The clinicopathological characteristics and postoperative survival time of 37 GSC patients who underwent surgery were investigated retrospectively. The survival time was compared according to the type of surgical operation (radical resection vs palliative operation). Twenty-one cases that received radical resection were analyzed based on the pTMN stage. Survival curves were traced by using Kaplan-Meier methods. Most GSC (32/37) was detected in patients who had received Billroth II reconstruction after partial gastrectomy for benign gastric disease. The lesser curvature side and the suture line of anastomosis were the most frequent sites where GSC occurred (27/37). Differentiated adenocarcinoma was the dominant histopathological type (24/37). The postoperative 5-year survival rate of early stage GSC patients (n=9) was significantly higher than advanced stage GSC (n=12) (55.6% vs 16.5%, xL2=11.48, P<0.01). Five-year survival rate of 21 GSC patients with radical resection were 75% (3/4) for stage I, 60% (3/5) for stage II, 14.2% (1/7) for stage III, and 0% (0/5) for stage IV respectively. The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative operation (43.0 m vs 13.0 m, x L2=36.31, P<0.01), the median survival time of stage IV patients with radical resection was 23.8 months. Without remote metastasis, radical resection for GSC is possible, and is an effective way to improve the prognosis of GSC. Even in stage IV GSC, radical resection can still prolong the survival time. It is necessary for the patients with benign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth II reconstruction procedure at 15-20 years.

Gastric Stump Cancer

Purpose: Gastric stump cancer is defined as a cancer that develops in the stomach after a resection in cases of non-malignant or malignant gastric disease. The interval between the gastrectomy and the detection of gastric stump cancer must be over 5 years. Since duodenogastric reflux gastritis is a precancerous condition and one of the most important factors inducing gastric stump cancer, we compared the bile-acid content of gastric juice between gastric stump cancer patients and controls. Materials and Methods: To evaluate retrospectively the surgical treatment of patients with gastric stump cancer, we reviewed the cases histories of 1016 stomach cancer patients who had been operated on at the Department of General Surgery, Kosin University Gospel Hospital, between 1995 and 1998. The gastric juice was collected during the operations on the gastric stump cancer patients by using a needle puncture of the fundus of the stomach and during the endoscopic examinations of the control subjects. The samples were analyzed for various bile acids (gas chromatography/mass spectrometry). Results: The 6 gastric stump cancer cases accounted for of all gastric cancer patients; 5 patients were first operated on for a peptic ulcer and the remaining one for an adenocarcinoma of the stomach. All of the cases were men. The reconstruction method after the initial gastrectomy was a Billroth II in all cases. The sites of the gastric stump cancer were the anastomotic sitein 2 patients, the upper body in 2, the fundus in 1 and the cardia in 1. The operative methods were 3 total gastrectomies, 2 subtotal gastrectomies with Roux en Y anastomosis, and 1 partial gastrectomy with lymph node dissection and had a curative intention in all patients. All of the patients were still surviving at the time of this report. The gastric juices of 4 gastric stump patients showed significantly higher contents of cholic acid () compared to the gastric juices of 35 control subjects ()(p). Chenodeoxycholic acid and lithocholic acid were not significantly different. Conclusion: The gastric juice of gastric stump cancer patients contained a significantly higher cholic acid content. At the time of the initial gastrectomy, an operative method that prevents duodenogastric reflux may prevent or minimize the development of gastric stump cancer, and more aggressive surgical treatment may improve survival.

Prognostic Factors in Gastric Stump Carcinoma

To compare prognostic results in patients with gastric stump cancer (GSC) versus those with primary gastric cancer (PGC). Gastric stump carcinomas have often been described as having low resectability rates and a poor prognosis. Results of surgical treatment of 50 patients with GSC were compared with that of 516 patients with PGC. The resectability rate was 94% for GSC patients and 96.5% for PGC patients, without significant differences in terms of postoperative complications, death rate, and median survival time (31.6 vs. 32.9 months). The multivariate analysis showed an independent prognostic effect for R0 resection, pT1 and pT2 category, and age older than 65 years. The prognosis after resection and adequate lymphadenectomy does not differ between patients with GSC and PGC.

Early gastric stump cancer following distal gastrectomy

Background—Gastric stump cancer (GSC) is usually diagnosed at an advanced stage, and consequently the prognosis is poor.Aims—To investigate the clinicopathological characteristics of GSC at an early stage to assist in...

Endoscopic screening for gastric stump cancer—Would it be beneficial?

Abstract The incidence of gastric cancer is increased in the gastric stump. It has, therefore, been recommended that subjects who have undergone partial gastrectomy be screened by regular endoscopy. However, several factors make it very difficult to test, in a clinical trial, the efficacy of such screening. To solve this problem, known clinical observations on partial gastrectomy patients were applied to a hypothetical cohort of 100,000 German or American partial gastrectomy patients. In this way the possible benefits of regular endoscopic screening in such a population were predicted. Markov type of decision analysis was used on the hypothetical cohorts to see if yearly endoscopy significantly improved outcomes as compared with no endoscopic screening. Under the very liberal, but arbitrary, assumption that endoscopic screening could prevent death from gastric stump cancer in 80% of those diagnosed as having gastric stump cancer, 8.5% and 5.4% of German male and female gastrectomy patients, respectively, and 2.2% and 1.3% of American male and female gastrectomy patients, respectively, would benefit from screening. Lives of German men and women would be prolonged 10 and 13 yr, respectively, (11 and 15 yr for American men and women). Life expectancy of the total male and female cohort would increase by 9 and 8 mo, respectively, (U.S.A.: 2 and 2 mo). Per 100 endoscopies invested, 6.4 and 4.3 (U.S.A.: 1.8 and 1.2) male and female life years would be gained. However, a sensitivity analysis shows the outcomes of the calculations to depend most on the rate of a 5-yr survival gained by endoscopy and surgery: as the postoperative 5-yr survival of gastric stump cancer patients falls below 80%, the benefit achieved by endoscopic screening becomes even less apparent. In American subjects who have undergone partial gastrectomy, the benefit of endoscopic screening would probably be too low to justify screening. Only in populations with high frequencies of gastric cancer may endoscopic screening be beneficial.

Endoscopic screening for gastric stump cancer—Would it be beneficial?: A hypothetical cohort study

The incidence of gastric cancer is increased in the gastric stump. It has, therefore, been recommended that subjects who have undergone partial gastrectomy be screened by regular endoscopy. However, several factors make it very difficult to test, in a clinical trial, the efficacy of such screening. To solve this problem, known clinical observations on partial gastrectomy patients were applied to a hypothetical cohort of 100,000 German or American partial gastrectomy patients. In this way the possible benefits of regular endoscopic screening in such a population were predicted. Markov type of decision analysis was used on the hypothetical cohorts to see if yearly endoscopy significantly improved outcomes as compared with no endoscopic screening. Under the very liberal, but arbitrary, assumption that endoscopic screening could prevent death from gastric stump cancer in 80% of those diagnosed as having gastric stump cancer, 8.5% and 5.4% of German male and female gastrectomy patients, respectively, and 2.2% and 1.3% of American male and female gastrectomy patients, respectively, would benefit from screening. Lives of German men and women would be prolonged 10 and 13 yr, respectively, (11 and 15 yr for American men and women). Life expectancy of the total male and female cohort would increase by 9 and 8 mo, respectively, (U.S.A.: 2 and 2 mo). Per 100 endoscopies invested, 6.4 and 4.3 (U.S.A.: 1.8 and 1.2) male and female life years would be gained. However, a sensitivity analysis shows the outcomes of the calculations to depend most on the rate of a 5-yr survival gained by endoscopy and surgery: as the postoperative 5-yr survival of gastric stump cancer patients falls below 80%, the benefit achieved by endoscopic screening becomes even less apparent. In American subjects who have undergone partial gastrectomy, the benefit of endoscopic screening would probably be too low to justify screening. Only in populations with high frequencies of gastric cancer may endoscopic screening be beneficial.