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La filtración de la esófagoyeyuno anastomosis (FEYA) es una de las complicaciones más graves tras una gastrectomía total, ya que se asocia a un aumento de la morbimortalidad quirúrgica. El manejo óptimo de la FEYA aún es controversial, existiendo cada vez más opciones mínimamente invasivas, especialmente endoscópicas. El objetivo de la presente revisión es comparar la evidencia científica publicada y actualizada referente al tratamiento médico, endoscópico y quirúrgico de una FEYA y sus resultados a corto y largo plazo además de proponer un algoritmo de manejo que permita orientar la práctica clínica. Finalmente se presenta la experiencia nacional en relación a los avances presentados en los últimos años en torno manejo clínico de FEYA.
Leakage of the esophagojejunostomy (LEY) is one of the most serious complications after total gastrectomy, as it is associated with increased surgical morbidity and mortality. The optimal management of LEY is still controversial, with increasing minimally invasive options, especially endoscopic ones. The aim of this review is to compare the published and updated scientific evidence regarding the medical, endoscopic and surgical treatment of LEY and its short and long-term results, in addition to propose a management algorithm that allows guiding clinical practice. Finally, the national experience is presented in relation to the advances presented in recent years regarding clinical management of LEY.
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Introduction@#Cases of gastric cancer have been declining worldwide in recent years. However, gastric cancer incidence increased in the last decade in Mongolia. In Mongolia, over 80% of gastric cancer cases are diagnosed during the late stage. Several studies have revealed that serum pepsinogens (PGs) level reflects, indirectly, histological and functional characteristics of the gastric mucosa.@*Goal@#We aimed to evaluate the risk of gastric cancer and its precancerous condition based on serum PGI, PGI/II biomarkers.@*Materials and Methods@#This case-control study enrolled 114 subjects, including patients with gastric cancer (n=36), atrophic gastritis (n=40) and healthy controls (n=138). The questionnaires were obtained to determine risk factors. Serum PGI, PGII, and H. pylori IgG levels were measured by ELISA (Pepsinogen I ELISA; Pepsinogen II ELISA; H.Pylori IgG ELISA; BIOHIT Plc, Helsinki, Finland). PGI to PGII ratio was calculated. Patients were classified into the ABC(D) group according to Miki K approach. Also, we developed new scoring system based on some risk factors and serum PGI, PGI/II ratio. Logistic regressions were performed to evaluate risk and expressed by odds ratio (OR) and 95% confidence intervals (95%CI).@*Results@#Mean age of the subjects was 60±10.9 years. H.Pylori was positive in 67 subjects. The serum PGI and PGI/II ratio levels were significantly decreased in gastric cancer and atrophic gastritis groups compared to the healthy control. According to classification ABC(D), group D (OR 5.04, 95% CI 1.13-22.50) had higher proportion of atrophic gastritis cases, group C (OR 6.19, 95% CI 1.04-36.78) had higher proportion of gastric cancer cases than others. Additionally, we created a risk prediction scoring system with a score ranging from 0 to 7, based on variables age, family history of gastric cancer, prior disease history, PGI and PGI/II ratio levels. For the atrophic gastritis patients, 17 (42.5%) were classified into medium-risk category (OR 4.49, 95% CI 1.38-14.58) and 17 (42.5%) were classified into high-risk category (OR 7.69, 95% CI 2.16-27.43). Whereas, 11 (30.6%) patients with gastric cancer were classified into medium-risk category (OR 4.35, 95% CI 1.13-16.85), 21 (58.3%) were classified into high-risk category (OR 14.25, 95% CI 3.60-56.43).@*Conclusion@#The methods based on serum PGI and PGI/II may identify a high risk population of gastric cancer and atrophic gastritis.
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SUMMARY OBJECTIVE: The aim of this study was to investigate the impact of sarcopenia on prognosis in patients with gastric cancer in order to explore the relationship between sarcopenia and postoperative complications as well as durations of hospital stay and intensive care unit. METHODS: A total of 175 patients who visited the oncology clinic between 2017 and 2022 with respect to their radiological images, demographic data, and laboratory parameters were perused. The OsiriX software was used to measure the skeletal muscle area that was divided by the body height in order to obtain the skeletal muscle index. RESULTS: A total of 50.28% of 175 patients (41 females and 134 males, with a mean age of 63.5 years) who met the inclusion criteria in the study were sarcopenic. Significant differences appeared between sarcopenic and non-sarcopenic patients with respect to durations of both hospital stay (p<0.01) and intensive care unit stay (p<0.01) (multivariate analysis). Furthermore, patients with sarcopenia had significantly frequent postoperative complications in comparison with those without sarcopenia. Among the patients with sarcopenia, decreased levels of hemoglobin and albumin as well as lymphocytes were encountered in terms of inflammatory markers; nevertheless, no significant differences were determined among other inflammatory markers. CONCLUSION: In patients undergoing treatment for gastric cancer, sarcopenia increases postoperative complications and prolongs hospital and intensive care stays during the treatment process.
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Objective:To investigate the expression of hsa_circ_0000437 in the serum of patients with gastric cancer and its clinical value.Methods:The serum samples from 80 patients (57 males and 23 females) with pathologically confirmed gastric cancer (GC), 50 gastric benign disease (28 males and 22 females) and 80 healthy controls (46 males and 34 females) were collected from October 2018 to December 2020 in Affiliated Hospital of Nantong University.Serum samples from 35 of 80 gastric cancer patients after operation were collected. The expression of serum hsa_circ_0000437 was determined by real-time fluorescent quantitative PCR (RT-qPCR). Serum carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA 199) and carbohydrate antigen 724 (CA724) were determined by chemiluminescence method.Comparisons of serum hsa_circ_0000437 between groups were performed by Mann-Whitney U test.The correlation between serum expression of hsa_circ_0000437 in gastric cancer patients and its clinical pathological characteristics was performed by χ 2 test.Receiver operating characteristic (ROC) curve and the area under the curve of ROC (AUC) were used to evaluate their diagnosis efficiency. Kaplan-Meier survival curve analysis was used to analyze the relationship between the expression level of serum hsa_circ_0000437 and the prognosis of patients. Results:The relative expression of hsa_circ_0000437 in GC, gastric benign disease, healthy controls were 2.252 (1.235, 4.765), 1.598(1.139, 1.982) and 1.000 (0.818, 1.385) respectively.The relative expression of hsa_circ_0000437 in GC was significantly higher than that in gastric benign disease ( P<0.001) and healthy controls ( P<0.001). The difference between gastric benign disease and healthy controls was also statistically significant ( P<0.001).The differences of serum hsa_circ_0000437 expression in GC patients between T stage, N stage, and tumor differentiation were statistically significant. The AUC of hsa_circ_0000437, CEA, CA199 and CA724 in GC patients were 0.863, 0.619, 657 and 0.608 respectively compared with healthy controls. The AUC of above four-parameter panel was 0.892 and the sensitivity was up to 97.5% (78/80). Kaplan-Meier survival curve showed that the overall survival rate of patients with high serum hsa_circ_0000437 expression was significantly lower than that of patients with low expression ( P=0.008). Conclusion:Serum hsa_circ_0000437 could be a biomarker for the auxiliary diagnosis and prognosis of GC.
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Objective:To investigate the efficacy of different doses of apatinib combined with chemotherapy in the treatment of advanced gastric cancer and its effect on prognosis.Methods:Sixty-nine patients with advanced gastric cancer who received treatment in Lishui City People's Hospital from January 2015 to February 2019 were retrospectively analyzed. All patients received apatinib combined with teggio chemotherapy. These patients were divided into groups A, B and C according to the different dosages of apatinib used: 250 mg/d ( n = 21, group A), 500 mg/d ( n = 23, group B) and 850 mg/d ( n = 23, group C). The control rate of gastric cancer, serum levels of carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4), toxic and side effects, and survival within 1 year after surgery were determined among the three groups. Results:By the end of follow-up, one patient from group A was lost, one patient from group B interrupted medication because of personal reasons, and two patients from group C withdrew from the treatment due to serious discomfort caused by drugs. After treatment, disease control rate in group C was significantly higher than that in group A [91.30% (21/23) vs. 60.00% (12/20), χ2 = 6.484, P < 0.05]. Serum levels of carcinoembryonic, CA19-9 and CA72-4 in group C were (27.51 ± 2.21) μg/L, (101.46 ± 8.02) g/L, (46.34 ± 6.15) U/mL, respectively, which were significantly lower than those in group B [(29.33 ± 2.17) μg/L, (106.67 ± 8.10) g/L, (50.67 ± 6.20) U/mL, t = 2.786, 2.168, 2.352, all P < 0.05]. Serum levels of carcinoembryonic, CA19-9 and CA72-4 in group B were significantly lower than those in group A [(31.63 ± 2.92) μg/L, (112.12 ± 8.38) g/L, (55.12 ± 6.48) U/mL, t = 2.915, 2.142, 2.274, all P < 0.05]. The incidences of hand foot syndrome and gastrointestinal discomfort in group C were (34.78% (8/23) and (39.13% (9/23), respectively, which were significantly higher than those in group A [15.00% (3/23) and 25.00% (5/20), χ2 = 5.734, 4.769, both P < 0.05]. After 1-year follow-up,1-year survival rate in group C was significantly higher than that in group A [39.13% (9/23) vs. 10.00% (2/20), log-Rank χ2 = 6.600, P < 0.05]. Conclusion:High-dose apatinib combined with chemotherapy in the treatment of advanced gastric cancer has a high disease control rate and a high 1-year survival rate, but it has serious adverse drug reactions.
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Objective:To observe the short- and long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer and its effect on tumor markers.Methods:From January 2013 to January 2017, 84 patients with advanced gastric cancer admitted to the Department of Oncology of Chang′an Hospital of Xi′an City were selected as the subjects. The patients were divided into synchronous chemoradiotherapy group and targeted chemoradiotherapy group by prospective nested control method, with 42 cases in each group. The synchronous chemoradiotherapy group was treated with synchronous chemoradiotherapy, and the targeted chemoradiotherapy group was treated with apatinib combined with chemoradiotherapy, 2 weeks was a cycle, a total of 12 cycles. The short- and long-term efficacy, median overall survival, changes of gastric cancer-related markers and adverse reactions of the two groups were compared.Results:After 3 months of treatment, there was no significant difference in the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group ( Z=0.240, P=0.887). The disease control rates of the two groups were 69.05% (29/42) and 73.81% (31/42) respectively, with no statistically significant difference ( χ2=0.233, P=0.629). After 6 months of treatment, the difference of the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group was statistically significant ( Z=6.288, P=0.043), and the disease control rates of the two groups were 42.86% (18/42) and 69.05% (29/42) respectively, with a statistically significant difference ( χ2=5.845, P=0.016). The median overall survival in the targeted chemoradiotherapy group and synchronous chemoradiotherapy groups were 18.7 months (95% CI: 8.4-24.8) and 13.8 months (95% CI: 7.2-18.7), with a statistically significant difference ( χ2=7.542, P<0.001). After 3 months of treatment, the levels of carbohydrate antigen (CA) 19-9, CA125, carcino-embryonic antigen (CEA) were (16.27±2.13) U/ml, (13.25±2.26) U/ml, (2.97±0.85) ng/ml in the targeted chemoradiotherapy group and (29.34±3.69) U/ml, (21.63±2.69) U/ml, (6.19±1.23) ng/ml in the synchronous chemoradiotherapy group respectively, all of them were lower than those before treatment, and the CA19-9, CA125, CEA in the targeted chemoradiotherapy group were lower than those in the synchronous chemoradiotherapy group, and there were statistically significant differences ( t=19.880, P<0.001; t=15.458, P<0.001; t=13.957, P<0.001). The total incidence of grade 3-4 adverse reactions in the targeted chemoradiotherapy group was 23.81% (10/42) and 28.64% (12/42) in the synchronous chemoradiotherapy group, and there was no statistically significant difference ( χ2=0.186, P=0.667). Conclusion:The long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer is better than that of synchronous chemoradiotherapy, and it is safe and reliable. At the same time, it can prolong the overall survival and reduce the levels of serum tumor markers.
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Objective: To investigate the safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with different types of peritoneal metastasis. Methods: A prospective study "one arm exploratory clinical study of conversion therapy of apatinib with S-1 and oxaliplatin in the treatment of advanced gastric cancer" (clinical registration ChiCTR-ONC-17010430) from medical record database was retrospectively analyzed. Patients aged 18-70 years with gastric cancer peritoneal metastasis confirmed by histology and laparoscopic exploration, and had not receive radiotherapy, chemotherapy, targeted therapy or immunotherapy before were enrolled. Before operation, the patients received 6 cycles of S-1 (80-120 mg/d, d1-d14) and oxaliplatin (130 mg/m(2), d1), and 5 cycles of apatinib (500 mg/d, d1-d21) conversion regimen. Three weeks after chemotherapy, whether the operation was performed or not depending on re-evaluation and patient preference. The main outcome were adverse reactions, and the secondary outcome were objective remission rate (ORR), disease control rate (DCR), and overall survival (OS) rate. The follow-up period was up to May 2020. Results: A total of 27 patients with gastric cancer peritoneal metastasis were enrolled in this study. There were 13 males and 14 females, with a median age of 58 (30-68) years old. There were 9 cases of P1a, 5 cases of P1b, and 13 cases of P1c. There were 14 cases with 1-5 scores of PCI (peritoneal cancer index), and 13 cases with 6 scores or above. The incidence of adverse reactions was 100%. The most common adverse reactions were hematological events including leucopenia (70.4%, 19/27) and granulocytopenia (74.1%, 20/27). Non-hematological adverse events included fatigue (51.9%, 14/27) and oral mucositis (37.0%, 10/27). One patient was withdrawn due to grade 4 thrombocytopenia. Among 26 patients with feasible efficacy evaluation, 18 (69.2%) achieved partial remission, 3 (11.5%) achieved stable disease, and 5 (19.2%) disease progression. The objective remission rate was 69.2% (18/26) and the disease control rate was 80.8% (21/26). Fourteen patients underwent surgery, including 6 patients undergoing R0 resection with the R0 resection rate of 42.9% (6/14). The postoperative pathological response rate was 64.3% (9/14). The follow-up time was 12-40 months, and the follow-up rate was 100%. The 1-year OS rate was 65.2% and the survival time was (14.0±1.7) months. The 1-year OS rates of P1a/P1b group and P1c group were 81.8% and 42.0% respectively, whose difference was statistically significant (P=0.041). The 1-year OS rates of PCI 1-5 group and PCI ≥6 group were 67.3% and 38.5% respectively, whose difference was statistically significant (P=0.022). Conclusion: In the conversion treatment of gastric cancer peritoneal metastasis, the safety of apatinib combined with oxaliplatin and S-1 is acceptable, and this regimen shows a good short-term survival efficacy in patients with P1a/P1b and PCI of 1-5.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Oxaliplatin , Percutaneous Coronary Intervention , Peritoneal Neoplasms/drug therapy , Prospective Studies , Pyridines , Retrospective Studies , Stomach Neoplasms/drug therapyABSTRACT
Resumen La cirugía estándar del cáncer gástrico ha sido definida en las últimas décadas por evidencia principalmente entregada desde oriente, donde se han incorporado actualizaciones para el manejo mínimamente invasivo, especialmente en estadios iniciales de esta enfermedad. Existe evidencia actual, entregada por múltiples estudios randomizados y controlados, que comparan la cirugía mínimamente invasiva y cirugía abierta en cáncer gástrico. Es así que podemos afirmar con suficiente respaldo, que en cáncer gástrico incipiente la gastrectomía subtotal laparoscópica se puede considerar como el tratamiento estándar. Sin embargo, aún se deben esperar más resultados para aseverar lo mismo en el caso de las gastrectomías totales, tanto para cáncer incipiente como avanzado. Nuestro objetivo en esta actualización es incluir la evidencia actual disponible en el manejo del cáncer gástrico en relación al tratamiento mínimamente invasivo.
Standard surgery for gastric cáncer has been defined in recent decades by evidence mainly from the East, where updates for minimally invasive management have been incorporated, especially in the early stages of this disease. There is current evidence from múltiple randomized and controlled studies comparing minimally invasive surgery and open surgery in gastric cancer. Consequently, we can affirm with sufficient support that in early gastric cancer, laparoscopic distal gastrectomy can be considered as the standard treatment. However, more results should be expected to make the same statement for total gastrectomies, both for early and locally advanced gastric cancer. The aim in this update is to report on the current available evidence in the management of gastric cancer with minimally invasive treatment.
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Humans , Stomach Neoplasms/surgery , Minimally Invasive Surgical Procedures/methods , Treatment Outcome , Laparoscopy/methods , Minimally Invasive Surgical Procedures/trends , Gastrectomy/methods , Gastrectomy/trendsABSTRACT
Introdução: O carcinoma gástrico, também conhecido como câncer de estômago é um dos tipos de câncer com grande incidência no Brasil, segundo dados do INCA. As formas de tratamento para carcinomas gástricos estão relacionadas ao estágio em que a doença se encontra, podem variar de cirurgias, ressecções a gastrectomias e linfadenectomias, podendo ser necessária a presença de quimioterapia. Sabe-se que alguns dos muitos tipos de cânceres podem levar à apresentação de algum quadro de disfagia, caracterizada pelas alterações no processo de deglutição. Objetivo: verificar qual o impacto do câncer gástrico na disfagia. Material e Método: Buscas de artigos nas bases de dados Medline (Pubmed), Cochrane Library, SciELO, LILACS e MEDLINE sem restrição de localização ou idiomas, publicados no período de janeiro de 2010 até agosto de 2018. A pesquisa foi realizada na base de dados com os descritores ("Deglutition Disorders" or "Dysphagia" or "Esophageal Dysphagia" or "Oropharyngeal Dysphagia" or "Swallowing Disorders") and ("Stomach Neoplasms" or "Cancer of Stomach" or "Cancer of the Stomach" or "Gastric Cancer" or "Gastric Cancer, Familial Diffuse" or "Gastric Neoplasms" or "Neoplasms, Gastric or Neoplasms", "Stomach" or "Stomach Cancer"). Resultados: A relação entre o câncer gástrico e a disfagia é abordada como uma importante consequência dos tipos de tratamentos. Foram encontrados cinco estudos que responderam a pergunta norteadora. Três dos cinco estudos selecionados tratam da qualidade de vida dos pacientes posteriormente ao tratamento. Conclusão: Foi verificado que a disfagia é observada como uma possível consequência do carcinoma gástrico e seu tratamento.
Introduction: Gastric carcinoma, also known as stomach cancer, is one of the types of cancer with great incidence in Brazil, according to INCA data. The forms of treatment for gastric carcinomas are related to the stage in which the disease is, may vary from surgeries, resections to gastrectomies and lymphadenectomies, and the presence of chemotherapy may be necessary. It is known that some of the many types of cancers can lead to the presentation of some dysphagia, characterized by changes in the swallowing process. Objective: to verify the impact of gastric cancer on dysphagia. Material and Method: Searches for articles in the Medline (Pubmed), Cochrane Library, SciELO, LILACS and MEDLINE databases without restrictions on location or languages, published between January 2010 and August 2018. The research was carried out on the basis of data with descriptors ("Deglutition Disorders" or "Dysphagia" or "Esophageal Dysphagia" or "Oropharyngeal Dysphagia" or "Swallowing Disorders") and ("Stomach Neoplasms" or "Cancer of Stomach" or "Cancer of the Stomach" or " Gastric Cancer "or" Gastric Cancer, Familial Diffuse "or" Gastric Neoplasms "or" Neoplasms, Gastric or Neoplasms "," Stomach "or" Stomach Cancer "). Results: The relationship between gastric cancer and dysphagia is addressed as an important consequence of the types of treatments. Five studies were found that answered the guiding question. Three of the five selected studies deal with patients' quality of life after treatment. Conclusion: It was found that dysphagia is seen as a consequence of gastric carcinoma and its treatment.
Introducción: el carcinoma gástrico, también conocido como cáncer de estómago, es uno de los tipos de cáncer con gran incidencia en Brasil, según datos de INCA. Las formas de tratamiento para los carcinomas gástricos están relacionadas con la etapa en que se encuentra la enfermedad, pueden variar de cirugías, resecciones a gastrectomías y linfadenectomías, y puede ser necesaria la presencia de quimioterapia. Se sabe que algunos de los muchos tipos de cáncer pueden conducir a la presentación de cierta disfagia, caracterizada por cambios en el proceso de deglución. Objetivo: verificar el impacto del cáncer gástrico en la disfagia. Material y método: búsquedas de artículos en las bases de datos Medline (Pubmed), Cochrane Library, SciELO, LILACS y MEDLINE sin restricciones de ubicación o idiomas, publicadas entre enero de 2010 y agosto de 2018. La investigación se realizó sobre la base de datos con descriptores ("Trastornos de la deglución" o "Disfagia" o "Disfagia esofágica" o "Disfagia orofaríngea" o "Trastornos de la deglución") y ("Neoplasias estomacales" o "Cáncer de estómago" o "Cáncer de estómago" o " Cáncer gástrico "o" Cáncer gástrico, difuso familiar "o" Neoplasias gástricas "o" Neoplasias, gástricas o neoplasias "," Estómago "o" Cáncer de estómago "). Resultados: la relación entre el cáncer gástrico y la disfagia se aborda como una consecuencia importante de los tipos de tratamientos. Se encontraron cinco estudios que respondieron a la pregunta guía. Tres de los cinco estudios seleccionados abordan la calidad de vida de los pacientes después del tratamiento. Conclusión: se encontró que la disfagia se considera una posible consecuencia del carcinoma gástrico y su tratamiento.
Subject(s)
Humans , Stomach Neoplasms/complications , Deglutition Disorders/etiology , Quality of LifeABSTRACT
Gastric cancer is a common type of malignant tumor. Recently, a growing number of clinical researches initiated by investigators have provided valuable evidence for clinical practice. Here we review the perioperative treatment of locally advanced gastric cancer, and summarize the optimization of neoadjuvant treatment regimens, the exploration of new combinational treatment models and new adjuvant chemotherapy schemes, and the changes in the status of chemoradiotherapy in adjuvant therapy. At the same time, for the comprehensive treatment of advanced gastric cancer, the advances in the optimization of first-line chemotherapy regimens, emerging immunotherapy and targeted therapy are reviewed as well. Gastric cancer is a highly heterogeneous tumor. For further development of precision medicine represented by targeted therapy and immunotherapy, genetic testing-guided precise molecular subtyping will be the direction.
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Objective: To construct a predictive model to assess the completeness of cytoreduction (CC) and help guiding selection for cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) in patients with gastric cancer with peritoneal metastasis (GCPM). Methods: GCPM patients treated with CRS+HIPEC at Beijing Shijitan Hospital were enrolled in this study. The major clinicopathologic and therapeutic characteristics were compared between those with complete CRS (CCRS) and incomplete CRS (ICRS). A nomogram based on a Logistic regression model was constructed for predicting the risk of ICRS. The nomogram was evaluated using area under receiver operating characteristic curve (AUC) and validated using the bootstrap resampling method. The probability of CCRS was predicted using the nomogram. Results: Among the included 125 patients with GCPM, 52 had CC0 cytoreduction and 73 had CC1-3 cytoreduction. The median overall survival (mOS) was 30.0 (95% CI: 16.8-43.3) months in the CC0 group, which was significantly longer than the mOS of 7.3 (95% CI: 5.8-8.8) months in the CC1-3 group (P<0.001). As there were no significant differences in OS among the CC1, CC2, and CC3 groups, CC0 patients were included in the CCRS group and CC1-3 patients were included in the ICRS group. Multivariate Logistic regression demonstrated that the time of peritoneal metastasis development (OR=14, 95% CI: 2.0-97.9, P= 0.008), preoperative tumor markers (TM) (OR=6.5, 95% CI: 2.1-37.8, P=0.037), and peritoneal cancer index (PCI) (OR=1.5, 95% CI: 1.3-1.8, P<0.001) were independent predictive factors for ICRS. The AUC of the nomogram was 0.985. Internal validation displayed good accuracy and consistency between the predictions and the actual observations. The cutoffs of PCI, with the probability of CCRS set at ≥ 50%, were ≤16, ≤12, ≤10, and ≤5 for synchronous GCPM with normal TM, synchronous GCPM with abnormal TM, metachronous GCPM with normal TM, and metachronous GCPM with abnormal TM, respectively. Conclusions: Complete CRS+HIPEC improves the survival of some patients with GCPM. A selection strategy based on PCI combined with the time of peritoneal metastasis development and TM may be a practical way for selecting patients with GCPM eligible for CCRS.
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BACKGROUND/AIMS: Cooperation of patients plays an essential role during gastric endoscopic submucosal dissection (ESD) for successful outcomes. We aimed to assess the efficacy and safety of a patient-positioning device (EZ-FIX®) during ESD for gastric epithelial neoplasm.MATERIALS AND METHODS: In this prospective study, 86 consecutive patients with gastric epithelial neoplasm scheduled for ESD at the Pusan National University Hospital were included and randomly assigned to the EZ-FIX® (n=44) or non-EZ-FIX® (n=42) groups. The primary outcomes measured were endoscopist satisfaction profiles and contribution level of EZ-FIX® to the procedure.RESULTS: No significant differences were observed between the two groups regarding patients' clinicopathologic characteristics, though the mean procedure time was longer in the EZ-FIX® group (P=0.044). In the EZ-FIX® group, 16 patients (36.4%) were categorized as a contribution group. Subgroup analysis between the contribution and non-contribution groups revealed that the contribution group had a larger lesion size (P=0.043) and a longer procedure time (P=0.037) and showed a higher patient's movement score (P < 0.001) with a higher dosage of propofol (P=0.004) and pethidine (P=0.001) required. Endoscopist satisfaction scores on sedation (P < 0.001) and overall procedure (P=0.010) were lower in the contribution group.CONCLUSIONS: Thus, EZ-FIX® might be helpful especially for patients who are expected to exhibit uncooperative sedation or those with a large lesion size, which would necessitate a longer procedure time.
Subject(s)
Humans , Meperidine , Neoplasms, Glandular and Epithelial , Patient Positioning , Propofol , Prospective Studies , Stomach NeoplasmsABSTRACT
PURPOSE: Few studies have evaluated changes in quality of life (QoL) in relation to changes in body mass index (BMI) after gastrectomy. This study aimed to evaluate the impact of postoperative changes in BMI on QoL after distal gastrectomy in gastric cancer patients. METHODS: QoL data from the European Organization for the Research and Treatment of Cancer (EORTC) gathered via the QLQ-C30 and QLQ-STO22 questionnaires were obtained from 1,036 patients preoperatively and at 1 year postoperatively. The patients were divided into 2 groups: group 1 - decreased postoperative BMI and group 2 - unchanged or increased postoperative BMI. RESULTS: There were 577 patients in group 1 and 459 in group 2. According to global health status and functional scales, emotional functioning (P = 0.035) was significantly worse in group 1 than in group 2 at 1 year postoperatively. Furthermore, there were significant decreases in QoL symptom scale scores, including fatigue (P = 0.016), nausea and vomiting (P = 0.002), and appetite loss (P = 0.001) scores, in group 1 compared with group 2. Regarding QLQ-STO22, reflux symptoms (P = 0.020), anxiety (P = 0.003), and body image (P = 0.003) were significantly worse in group 1 than in group 2 at 1 year after surgery. CONCLUSION: BMI changes after distal gastrectomy influence QoL. Focus on controlling gastrointestinal symptoms and providing psychological support is essential in patients with decreased BMI after surgery. Patients should be offered follow-up care to assist them in maintaining BMI, for example, through dietary-behavior modifications and via intensive nutritional support, to prevent QoL deterioration after distal gastrectomy.
Subject(s)
Humans , Anxiety , Appetite , Body Image , Body Mass Index , Fatigue , Follow-Up Studies , Gastrectomy , Global Health , Nausea , Nutritional Support , Quality of Life , Stomach Neoplasms , Vomiting , Weights and MeasuresABSTRACT
Objectives@#To construct a prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.@*Methods@#The clinical data and follow-up results of gastric cancer with peritoneal carcinomatosis patients treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at our center from 2005 to 2017 were collected for log-rank test and multivariate COX proportional regression model analysis. A prognostic predictive nomogram was constructed and internally validated.@*Results@#115 patients were included. The median overall survival was 13.1 months, and 1-, 2-, 3-, and 5-year survival rates being 56.5%, 25.3%, 12.6%, and 8.1% respectively. Univariate and the following multivariate analysis identified completeness of cytoreduction, temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy as independent prognostic factors on overall survival. The nomogram using these three factors showed a concordance index of 0.721 (95% CI: 0.669-0.773). The calibration curves for 1-, 2- and 3 -year survival probability showed a good consistency between actual observation and prediction.@*Conclusions@#The nomogram based on completeness of cytoreduction, temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy can effectively predict the survival probability for gastric cancer with peritoneal carcinomatosis patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.
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Objectives To construct a prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.Methods The clinical data and follow-up results of gastric cancer with peritoneal carcinomatosis patients treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at our center from 2005 to 2017 were collected for log-rank test and multivariate COX proportional regression model analysis.A prognostic predictive nomogram was constructed and internally validated.Results 115 patients were included.The median overall survival was 13.1 months,and 1-,2-,3-,and 5-year survival rates being 56.5％,25.3％,12.6％,and 8.1％ respectively.Univariate and the following multivariate analysis identified completeness of cytoreduction,temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy as independent prognostic factors on overall survival.The nomogram using these three factors showed a concordance index of 0.721 (95％ CI:0.669-0.773).The calibration curves for 1-,2-and 3-year survival probability showed a good consistency between actual observation and prediction.Conclusions The nomogram based on completeness of cytoreduction,temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy can effectively predict the survival probability for gastric cancer with peritoneal carcinomatosis patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.
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Objective To investigate the expression and clinical significance of pro-inflammation S100A9 protein in intestinal type gastric cancer.Methods We retrospectively analyzed the clinicopathological materials of the 278 patients who were diagnosed as Lauren classification intestinal gastric cancer and underwent surgical treatment between January and December 2008 at the Department of General Surgery,Zhongshan Hospital Fudan University.Immunohistochemistry was used to analyze the expression of S100A9 protein in tumor tissues and para-tumor tissues.Results High expression of S100A9 protein was associated with the depth of tumor invasion (P =0.013),lymph node metastasis (81.4％,53.9％,47.3％ vs.84.7％,69.3％,60.7％,x2 =4.220,P =0.041) and TNM stage (P =0.010).The overall survival rate of these patients with high expression of S100A9 protein was significantly lower than those with low expression of S100A9 protein.In stage Ⅲ/Ⅳ patients,the overall survival rate of these patients with high expression of S100A9 protein was significantly lower than those with low expression of S100A9 protein.Moreover,for those patients who received postoperative chemotherapy,the prognosis of the patients with high expression of S100A9 protein was poorer than those with low expression.By multivariable analysis,the expression of S100A9 protein was not an independent risk factor for the prognosis of intestinal gastric cancer patients.Conclusions High expression of S100A9 protein in intestinal gastric cancer was associated with poor prognosis.
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Objective To compare the diagnostic accuracy of white light endoscopy ( WLE ) and magnifying endoscopy combined with narrow-band imaging ( ME-NBI) for intestinal-type gastric adenoma in benign lesions. Methods Data of patients with suspected early gastric neoplastic lesions diagnosed with WLE were collected from Shanghai Renji Hospital from January 2016 to December 2017. Patients with suspected early gastric neoplastic lesions by WLE were examined with WLE, ME-NBI and targeted biopsy again within 2 weeks. The results of WLE, ME-NBI and biopsy were recorded. Using pathological diagnosis as the golden standard, diagnostic efficacy of WLE and ME-NBI for intestinal-type gastric adenoma and other non-adenoma lesions was evaluated. Results A total of 232 patients ( 232 lesions) were included, i. e. , 124 intestinal-type gastric adenoma and 108 other non-adenoma lesions such as atrophy, ulcers, hyperplasia, low-grade intraepithelial neoplasia, etc. . The sensitivity, negative predictive value and accuracy of ME-NBI in intestinal-type gastric adenoma were higher than those of WLE ( 92. 7％ VS 71. 8％, 91. 6％ VS 73. 7％, 91. 8％ VS 80. 6％, all P <0. 01 ) . The specificity was consistent ( both 90. 7％) . There was no significant difference in the positive predictive value between WLE and ME-NBI ( 92. 0％ VS 89. 9％, P>0. 05 ) . Conclusion Diagnostic efficacy of ME-NBI in intestinal-type gastric adenoma from other non-adenoma lesions is significantly higher than that of WLE.
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Objective To explore the clinical value of a new scoring system for gastric cancer screening in hospital visits.Methods A new scoring system for gastric cancer screening was used to retrospectively analyze data of patients who visited Wenzhou Central Hospital for various digestive symptoms from April 2017 to August 2018 and met the screening requirements.All patients were divided into three groups according to the grading results of the new scoring system:low-risk group (0-11 points),medium-risk group (12-16 points) and high-risk group (17-23 points).A comparative analysis was performed on the detection of gastric cancer and gastric precancerous conditions among the three groups.Results A total of 2 674 patients were included in this study,1 694(63.35％) in the low-risk group,833(31.15％) in the medium-risk group,and 147(5.50％) in the high-risk group.The total detection rate of gastric cancer was 2.73％ (73/2 674).The detection rates were 1.06％ (18/1 694),4.32％ (36/833) and 12.93％ (19/147) in the three groups,respectively.There were significant differences in the detection rate of gastric cancer between any two of the three groups (all P ＜ 0.05).The detection rates of early gastric cancer in medium-risk group [2.04％ (17/833)] and high-risk group [4.08 ％ (6/147)] were significantly higher than that in the low-risk group[0.35％(6/1 694),all P＜0.05].Conclusion The new gastric cancer screening scoring system can not only significantly improve the detection rate of gastric cancer in hospital visits,but also improve the diagnostic rate of early gastric cancer.
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Objective: To investigate clinicopathological features, risk of lymph node metastasis, and indications of endoscopic submu-cosal dissection (ESD) in young patients with intramucosal early gastric cancer (EGC). Methods: In total, 325 EGC patients who under-went radical gastrectomy and had complete clinicopathological data in Anhui Provincial Hospital from March 2009 to December 2016 were retrospectively evaluated. All patients were confirmed to have intramucosal cancer based on their postoperative pathology re-sults. The patients were assigned into two groups according to their age: young group (≤40 years) and old group (>40 years). The clini-copathological features and safety of ESD in the youth group were analyzed. Results: Among all patients with intramucosal EGC, 30 (9.2%) were in the youth group. Intramucosal cancer in the youth group occurred predominantly in women, and the pathological types were mainly undifferentiated and mixed, which were more likely to metastasize to the lymph nodes. In the youth group, EGC patients with intramucosal differentiated type, who had ESD indications, had no risk of lymph node metastasis. However, the rate of lymph node metastasis was up to 25% in intramucosal undifferentiated-type EGC patients who had expanded ESD indications. Conclusions:Young patients with intramucosal EGC have poor pathological differentiation and strong invasiveness, and ESD may be considered for the treatment of differentiated intramucosal cancer.
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Purpose To investigate the expression status and their clinical significances of c-MET, epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor-2 (HER-2) in gastric adenocarcinoma (GC). Methods Tissue samples from 442 cases of GC in patients who accepted D2/D3 radical gastrectomy with R0 resection were stained by immunohistochemistry against c-MET, EGFR and HER-2.Results Over expression of c-MET, EGFR and HER-2 was identified in 195/442 (44.1％), 47/442 (10.6％) and 152/442 (34.4％) GC patients, respectively. Over expression of cMET was more often identified in GC patients with deeper T (P= 0.016), nerve involvement (P = 0.006) and the Lauren diffuse type (P = 0.029). EGFR in cases with vessel permeation (P = 0.012), and HER-2 in cases of distant metastasis (P =0.031), non-nerve involvement (P = 0.024), the Lauren intestinal type (P < 0.001) and G1/G2 grade (P < 0.001). Conclusion The receptors tyrosine kinase (RTKs) markers of cMET, EGFR and HER-2 might involve in the advance of GC, such as invasion and metastasis. The expression status of them could be used as the risk prediction and even the basis for future personalized therapy, especially for tyrosine kinase inhibitor (TKI) therapy, for GC patients.