Prognostic Significance of Microscopic Positive Margins for Gastric Cancer Patients with Potentially Curative Resection

Background  

Most previous studies concerning the impact of positive margins on patient outcomes were based on patients with D1 lymphadenectomy. The prognostic significance of positive margins for patients with D2/D3 lymphadenectomy has not been investigated.     

The Node Ratio as Prognostic Factor after Curative Resection for Gastric Cancer

Introduction

The depth of the tumor invasion and nodal involvement are the two main prognostic factors in gastric cancer. Staging systems differ among countries and new tools are needed to interpret and compare results and to reduce stage migration. The node ratio (NR) has been proposed as a new prognostic factor.

Materials and Methods

We retrospectively reviewed 282 patients who underwent curative resection for gastric cancer at Parma University Hospital between 2000 and 2007. TNM stage, NR, overall survival, survival according to nodal status, and survival according to the total number of nodes retrieved were calculated.

Results

At univariate analysis, the TNM stage, number of metastatic nodes, NR, and depth of tumor invasion, but not the number of nodes retrieved, were significant prognosis factors. Patients with more than 15 nodes retrieved in the specimen survived significantly longer (p?<?0.04). This was confirmed for all N or NR classes within N groups. There was a correlation between the number of nodes retrieved and N but not with the NR category. NR was an independent prognostic factor at Cox regression.

Conclusion

NR is a reliable and sensitive tool to differentiate patients with similar characteristics, probably more so than the TNM system. NR is not strictly related to the number of nodes retrieved and this may potentially decrease the stage migration phenomenon. More trials are needed to validate this factor.     

Prognostic Significance of Perineural Invasion in Patients with Gastric Cancer Who Underwent Curative Resection

Background

The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection.

Materials and Methods

We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis.

Results

PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12–3.13) as were classical clinicopathological features.

Conclusion

Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.     

胃癌手术后并发症的防治策略

胃癌在我国各种恶性肿瘤中发病率居首位.根治性手术切除是治愈肿瘤的重要方法,姑息性切除可以改善患者的生存质量.积极的手术治疗是胃癌治疗的关键.但胃癌手术后并发症不可忽视,其发生率因术式的不同而有所差别,在15%～40%之间.胃癌术后并发症近期有感染、出血、吻合口瘘、肠梗阻、胰腺炎、心肺等器官损害、耐甲氧西林金葡菌(methicillin-resistant staphylococcus aureus, MRSA)肠炎等,远期可有吻合口狭窄、倾倒综合征、营养不良等.术后并发症的发生给治疗带来了困难,直接影响患者的预后.因此,减少或防止并发症的发生非常重要.笔者结合多年的临床诊治经验,对胃癌手术后并发症的防治提出几点策略.     

Clinical Significance of the Glasgow Prognostic Score for Survival after Colorectal Cancer Surgery

Glasgow prognostic score (GPS) has been found to be a useful tool in various cancer types. Our aim was to evaluate the significance of GPS in patients operated on for colorectal cancer (CRC). Patients with CRC who underwent radical resections between April 2010 and January 2015 were retrospectively evaluated. GPS was estimated based on the preoperative measurement of C-reactive protein and serum albumin levels. Data including demographics, laboratory and pathological parameters, surgical outcomes, and late-term follow-up results were analyzed. The study group of 115 patients consisted of 51 (44 %) women and 64 (56 %) men with a median age of 66 (range 32–91) years. The mean follow-up period was 20 (range 7–41) months. Tumor size and wound infection rates were significantly increased in patients with higher GPS (p?=?0.019 and p?=?0.003, respectively). According to multivariate analyses, CEA and GPS were found to be independent risk factors significantly effecting mortality (p?=?0.001 and p?=?0.009, respectively). At the end of the late-term follow-up period, it was detected that cancer-specific survival significantly decreased as the GPS increased (p?=?0.016). The GPS is a significant prognostic factor in CRC and should be included in the routine preoperative assessment of all surgically treated CRC patients.     

Incidence and Factors Associated with Recurrence Patterns after Intended Curative Surgery for Gastric Cancer

Abstract Recurrence after curative resection for gastric cancer remains high. We examined its incidence and factors related to recurrence pattern, while trying to avoid the interaction of various factors. A total of 611 gastric cancer patients after resection for curative intent (1988–1995) were analyzed. The result showed that 245 patients had recurrence (40.1%). Cumulative recurrence rates were 53.5%, 80%, 89.0%, 94.7%, 96.3%, 98%, and 99.5% at 1, 2, 3, 4, 5, 6, and 7 years, respectively. Over half of patients with recurrence (123; 50.2%) had an initial single recurrence. Taking single and multiple recurrence together, most recurrences (213; 86.9%) were distant metastases, 110 recurrences (44.9%) were local relapses, and 78 recurrences (49.8%) were both local and distant. Among the distant metastases, 131 patients (53.5%) had peritoneal dissemination, 106 patients (43.3%) had hematogenous metastases, and 70 patients (28.6%) had distant lymphatic spread. Scirrhous-type stromal reaction, serosa invasion, and female gender were factors negatively related to peritoneal recurrence. Medullary-type stromal reaction and male gender showed a preference for locoregional recurrence, and expanding growth tumor commonly led to hematogenous metastasis. Patients who had paraaortic lymph node metastasis were at high risk of developing distant lymphatic recurrence. It is conceivable that the patterns of recurrence and the times to recurrence provide a biological basis for clinical monitoring of patients with the aim of modifying therapeutic modalities.     

Prognostic Significance of Epidermal Growth Factor Receptor Expression in Colon Cancer Patients Undergoing Curative Surgery

Background To investigate the role of epidermal growth factor receptor (EGFR) expression as a prognostic marker for prediction of cancer behavior and clinical outcomes in colon cancer patients undergoing potentially curative surgery. Methods EGFR determination using a commercially available immunohistochemistry kit was performed in tissues from 149 colon cancer patients receiving primary surgical treatment and in 25 normal colon mucosa specimens from noncancer patients. EGFR positivity was correlated in univariate and multivariate analyses with disease recurrence and survival. In addition, p27, p53, and vascular endothelial growth factor expression were assessed by immunohistochemistry in 104 patients and correlated with EGFR tumor expression and clinical outcome. Results EGFR expression was detected in approximately one third of colon cancer patients (53 of 149; 35.6%). In 126 curatively treated patients, EGFR expression was correlated with disease recurrence and worse survival in both univariate and multivariate analyses. In a multivariate model for predicting recurrence and survival, Dukes’ staging, p27, and EGFR expression were the only independent covariates. In particular, in Dukes’ A and B patients the 5-year survival probability was 96% for EGFR-negative and high p27 expression cases and was 30.7% for EGFR-positive and low p27 expression cases. Conclusions EGFR expression was an independent prognostic indicator of disease recurrence and poor survival in colon cancer patients undergoing curative surgery. In the context of novel therapeutic options such as molecularly targeted therapies, these findings suggest that anti-EGFR drugs could be evaluated in the adjuvant treatment of EGFR-positive colon cancer patients.     

Significance of the Inflammation-Based Glasgow Prognostic Score for Short- and Long-Term Outcomes After Curative Resection of Gastric Cancer

Background

The Glasgow prognostic score (GPS) is a patient-related measure to determine long-term outcomes in cancer patients. This study examined the impact of GPS on outcomes including postoperative complications after curative resection of gastric cancer.

Methods

The systemic inflammatory response was assessed by GPS, and the severity of postoperative complications was evaluated according to the Clavien?CDindo classification. Survival analysis was performed by the Kaplan?CMeier method and the log rank test. Multivariate analysis was performed to determine significant associations with complications by a logistic regression model and the independent prognostic values by Cox??s proportional hazards model.

Results

Study patients (n?=?1017) were allocated as follows: 904 (88.9?%) to GPS 0, 92 (9.0?%) to GPS 1, and 21 (2.1?%) to GPS 2. One hundred sixty-three patients (16.0?%) had postoperative complications of ?? grade 2. Multivariate logistic analysis identified gender, body mass index, tumor location, tumor depth, blood transfusion, and comorbidity as significantly correlated with postoperative complications. However, GPS was not associated with the incidence of complication. On the other hand, multivariate analysis for overall survival identified GPS as an independent prognostic factor.

Conclusions

GPS is a significant predictor of long-term survival in curable gastric cancer surgery but not of short-term outcomes.     

淋巴清扫在胃癌治疗中的意义

目的　探讨淋巴结清扫术在胃癌手术中的价值。　方法　回顾性分析 485例胃癌切除病例 ,按淋巴结清扫范围分为广泛淋巴清扫组及非广泛淋巴清扫组 ,比较两组间的 5年生存率 ,并用Cox比例风险模型分析影响胃癌手术预后的因素。　结果　总体 5年生存率为 3 7.8% ,行广泛淋巴清扫术、非广泛淋巴清扫术后 5年生存率分别为 43 .3 %和16.4% (P <0 .0 0 1)。多元分析表明淋巴清扫程度是影响预后的一个重要因素。　结论　广泛淋巴清扫术可以提高胃癌手术的 5年生存率 ,因而对胃癌应努力开展广泛性淋巴清扫术。     

Prognostic Significance of Serum Inflammatory Markers in Gastric Cancer

Background

The aim of this study was to assess the relative prognostic value of biomarkers to measure the systemic inflammatory response (SIR) and improve prognostic modeling in a cohort of patients undergoing potentially curative surgery for gastric adenocarcinoma. The hypothesis was that a single SIR biomarker would be associated with the most prognostic value.

Methods

Consecutive 331 patients undergoing surgery for gastric cancer between 2004 and 2016 within a regional UK cancer network were identified. Serum measurements of hemoglobin, C-reactive protein, albumin, modified Glasgow Prognostic Score, and differential white cell counts were obtained before surgery, and correlated with histopathological factors (pTNM stage, differentiation, and vascular invasion) and survival. Primary outcome measures were disease-free (DFS) and overall survival (OS).

Results

Consecutive 331 patients were identified and 291 underwent potentially curative gastrectomy for adenocarcinoma. On univariable DFS analysis, female gender (p = 0.027), proximal location (p = 0.018), pT stage (p < 0.001), pN stage (p < 0.001), pTNM stage (p < 0.001), vascular invasion (p < 0.001), poor differentiation (p = 0.001), lymph node ratio (p < 0.001), R1 status (p < 0.001), platelet count (p = 0.038), and mGPS (p = 0.001) were significantly associated with poor survival. The mGPS was associated with advanced pT stage (p = 0.001), pTNM stage (p = 0.013), and poor differentiation (p = 0.030). On multivariable DFS analysis, mGPS [hazard ratio (HR) 2.51, 95% confidence interval (CI) 1.35–4.65, p = 0.011] was the only inflammatory marker to retain independent significance. Multivariable OS analysis revealed similar findings; mGPS (HR 2.75, (95% CI 1.65–4.59), p < 0.001).

Conclusion

mGPS is an important and only SIR-related prognostic biomarker independently associated with both DFS and OS in gastric cancer.

     

Gallstone Formation after Gastric Cancer Surgery

Background  

Gallstone formation is one of the most common complications after gastric cancer surgery, but the mechanism and etiology for such formation are unclear because of a lack of collective clinical investigation.     

CT三维重建对胃癌术后复发的诊断意义

目的探讨CT三维重建技术对胃癌术后复发的诊断意义。方法对哈尔滨医科大学附属第三医院2004年12月至2008年12月期间经手术或临床证实的39例胃癌根治术后复发的患者行多层螺旋CT扫描,在工作站进行三维重建,用CT轴位图像和三维后处理图像分别对胃癌术后复发患者进行诊断。结果 CT轴位图像和三维后处理图像对病变形态、侵犯范围、淋巴结转移及远处转移情况的检出率分别为82.1%(23/28)和100%(28/28),62.5%(10/16)和93.8%(15/16),66.7%(10/15)和93.3%(14/15),87.5%(7/8)和87.5%(7/8)。结论 CT三维重建对于增厚胃壁垂直厚度的测量、周围组织的浸润情况的观察及对淋巴结整体形态的变化可更直观、立体地进行诊断,对于胃癌术后复发的诊断优于单纯轴位图像,为复发肿瘤进一步治疗提供资料。     

Decreased Expression of RASSF6 Is a Novel Independent Prognostic Marker of a Worse Outcome in Gastric Cancer Patients after Curative Surgery

Background  

Our previous study observed that the expression of RASSF6, a member of the Ras-association domain family, was down-regulated in gastric cancer cells. The present study further investigated the clinical significance of RASSF6 in gastric cancer.     

Follow-Up Surveillance for Recurrence After Curative Gastric Cancer Surgery Lacks Survival Benefit

Background: Although routine follow-up to detect asymptomatic recurrence after surgery for gastric cancer is recommended, the effect of such reassessment on survival has not been evaluated.Methods: Clinical records of patients developing recurrent disease after potentially curative resection between 1985 and 1996 were retrieved. Among these patients, 197 were in our follow-up program. We analyzed survival in these patients according to the presence or absence of cancer-related symptoms when recurrent disease was diagnosed.Results: Of all patients with recurrent disease, 50% were diagnosed within 1 year and 75% within 2 years of surgery. Asymptomatic recurrence, detected in 88 patients (45%), frequently represented distant metastasis. Although early detection significantly improved survival after detection of recurrent disease, disease-free survival for this subset was shorter. Thus, no significant difference in overall survival was observed.Conclusions: Early detection of asymptomatic gastric cancer recurrence did not improve overall survival of patients with recurrence after curative resection. Until development of more effective treatment for this disease, close follow-up may offer no survival benefit.     

Outcome After Curative Surgery for Gastric Cancer Patients with Type 2 Diabetes

Background

Bariatric surgery has been adapted to the management of morbid obesity, leading to not only loss of body weight but also improvement of type 2 diabetes mellitus (DM). The goal of our study was to evaluate the effect of gastrectomy in gastric cancer patients with type 2 DM.

Methods

From 1989 to 2011, a total of 69 gastric cancer patients receiving curative surgery were enrolled in this study. They were diagnosed with type 2 DM preoperatively and all are alive without tumor recurrence. The clinical characteristics were compared between groups with improved or unimproved DM, and groups were also analyzed based on the extent of gastrectomy and different reconstruction methods.

Results

Of the 69 patients, 58 received subtotal gastrectomy and 11 received total gastrectomy. The frequency of DM improvement was significantly higher after total gastrectomy than subtotal gastrectomy (81.8 vs. 36.2 %; p = 0.007). Patients with DM duration of less than 5 years tended to experience DM improvement after surgery more frequently than patients with DM duration of more than 5 years (p = 0.028). Roux-en-Y esophagojejunostomy (R-Ye) led to a higher rate of DM improvement than did R-Y gastrojejunostomy (R-Yg), especially in patients with DM duration more than 5 years. Among patients receiving duodenal bypass after gastrectomy, R-Ye was associated with a higher frequency of DM improvement than R-Yg and B-II.

Conclusions

The extent of gastrectomy rather than the reconstruction method played an important role in DM improvement after curative surgery for gastric cancer.     

Prognostic Significance of Tumor Size in T3 Gastric Cancer

Background  Clinical significance of tumor size remains elusive in gastric cancer. The aim of this study was to evaluate the prognostic value of tumor size in T3 gastric cancer. Methods  A total of 273 patients with T3 gastric cancer who underwent curative D2 gastrectomy between 1996 and 2005 were evaluated. In terms of average value of tumor size, patients were divided into two groups according to tumor size: small-size group (SSG, tumor ≤6 cm) and large-size group (LSG, tumor >6 cm). The prognostic value of tumor size and the correlation between tumor size and other clinicopathologic factors were investigated. Results  LSG accounted for 34.8% in all patients. Tumor size was correlated with histological type, lymphatic invasion, venous invasion, and resection type. The prognosis of LSG patients was worse than that of SSG patients. Multivariate analysis showed that type of resection, status of lymph nodes, metastatic lymph node ratio, and tumor size were defined as independent prognostic factors for patients with T3 gastric cancer. A comparison between LSG patients and SSG patients showed differences in the survival of those with stage IIIB and IV disease. Conclusions  Tumor size is a simple and reliable prognostic factor for patients with T3 gastric cancer; it might be a candidate for the gastric cancer staging system.