Strategy for patients with cytology positive and peritoneal dissemination from gastric cancer

The aim of this study was to evaluate the strategy for patients with cytology positive and peritoneal dissemination from gastric cancer. Thirty eight of POCY1, three of P1, eight of P2 and thirty six of P3 from advanced gastric adenocarcinoma at staging laparoscopy were studied. Gastrectomy after staging laparoscopy was performed in 10 patients (Surgery group). NAC following gastrectomy after staging laparoscopy was performed in 31 patients (NAC group) in POCY1, P1. The overall response rate was 29%, twenty of the 31 patients (65%) in the NAC group revealed no free cancer cells at the operation. The overall 5-year survival rate in 41 patients of POCY1, P1 was 15%. There was a significant deference in the overall survival curves between Surgery and NAC groups. The overall 2-year survival rate in 44 patients of P2, P3 was 9%. NAC for patients with positive cytology could lead into free cancer cells at a high rate, but not to improve their prognoses. An intensive chemotherapy including intra-abdominal chemotherapy should be necessary for these patients.     

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

Background More accurate preoperative staging is necessary to determine the treatment strategy for locally advanced gastric cancer. Laparoscopy has been suggested as an appropriate staging modality. The aim of this study was to clarify the role of staging laparoscopy in patients with locally advanced gastric cancer. Methods One hundred patients with primary gastric adenocarcinoma underwent laparoscopy with peritoneal lavage cytology. The disease stages determined were compared with those obtained by conventional methods. Results The disease stages were corrected after laparoscopy for 47 of the 100 patients (47%), with downstaging in 3 (3.0%) and upstaging in 44 (44%). Peritoneal deposits were found in 7 patients with peritoneal dissemination diagnosed by conventional examination. An unsuspected peritoneal deposit was found in 21 of 93 patients (22.6%), and unsuspected free cancer cells without deposits were found in 27 of 93 patients (29.0%). Gastrectomy after staging laparoscopy was performed in 39 patients. Laparoscopy showed no peritoneal deposits in any of these patients. Free cancer cells were found in 9 patients (23.1%), but 4 of these had peritoneal deposits at operation. R0 resection was performed in 34 of the 39 patients (87.2%). Neoadjuvant chemotherapy after staging laparoscopy was performed in 35 patients. All 35 patients underwent gastrectomy, which resulted in 27 R0 and 8 R2 resections. Of 18 patients with positive cytology at laparoscopy, 11 had no free cancer cells at operation. Neoadjuvant chemotherapy induced downstaging of the disease in 11 of the 18 patients with positive cytology (61.1%). Of 26 patients with massive peritoneal deposits, 4 underwent palliative resection because of pyloric stenosis. Twenty-two patients (22.0%) were able to avoid unnecessary laparotomy because of the staging laparoscopy. Conclusion Staging laparoscopy with peritoneal lavage cytology is a safe, effective tool in patients with locally advanced gastric cancer, especially in patients receiving neoadjuvant chemotherapy.     

Evaluation of neoadjuvant chemotherapy with paclitaxel, 5-fluorouracil and cisplatin for advanced gastric cancer with pyloric stenosis

S-1 is currently recognized as one of the standard treatments for advanced and recurrent gastric cancer in Japan. However, there are some patients who can not take oral medication due to pyloric stenosis. We performed a critical evaluation of neoadjuvant chemotherapy (NAC) with paclitaxel (PTX), 5-fluorouracil (5-FU) and cisplatin (CDDP); (PTX+FP) for patients with advanced gastric cancer with pyloric stenosis. Since September 2001, 13 patients with far advanced or non-curative respectable gastric cancer with pyloric stenosis received NAC. These patients were treated with paclitaxel 40 mg/m(2) infusions on days 1 and 8, combined with CDDP (6.5 mg/m(2)) and 5-FU (350 mg/m(2)) on days 1 through 8 followed by 2 weeks rest as one course. After at least 2 courses of treatment, the patients underwent gastrectomy with lymphadectomy. The overall response rate was 38.5% (CR: 0, PR: 5), 7 patients had SD and 1 patient had PD. Seven patients had received staging laparoscopy before NAC and 6 patients had free cancer cells in the peritoneal cavity. Of 6 patients with positive cytology at laparoscopy, 4 had no free cancer cells at operation. The MST was 405 days and one-year survival rate was 55.6%. Toxicities were generally mild, and no serious adverse reactions were observed. There were only 2 cases of grade 3 neutropenia. In conclusion, combination of PTX+FP for NAC appears to be an effective treatment for patients with advanced gastric cancer with pyloric stenosis.     

Significance of laparoscopy for response assessment of chemotherapy in gastric cancer

We performed laparoscopy before and after chemotherapy in two patients with relapsed and advanced gastric cancer, whose major metastatic sites had been diagnosed as being in the peritoneum. A change in tumor responses when assessed by laparoscopy was found. Case 1: A 63-year-old man presented with an umbilical metastasis and suspected peritoneal metastases after gastrectomy. Laparoscopy revealed peritoneal metastases before chemotherapy. After one course of chemotherapy the umbilical tumor disappeared (CR). Laparoscopy after two courses of chemotherapy revealed increasing peritoneal metastases (PD). The overall response was PD. Case 2: A 67-year-old woman was referred to our hospital with a diagnosis of type 4 gastric cancer. Staging laparoscopy revealed massive lymph node metastases and the patient was positive in peritoneal washing cytology. After four courses of chemotherapy, the primary tumor and the metastatic lymph nodes had decreased in size (PR). In contrast, laparoscopy revealed increasing peritoneal metastases (PD). The overall response was PD. CONCLUSION: In patients with peritoneal and other modes of metastasis, tumor response to chemotherapy may be misjudged by conventional imaging alone. Intraperitoneal examination by laparoscopy provides accurate information, including the tumor response to chemotherapy.     

A case of advanced gastric cancer responding remarkably to paclitaxel + low-dose FP therapy in a neoadjuvant setting

We report a 74-year-old man with advanced gastric cancer that showed a remarkable response to treatment with a combination of paclitaxel and low-dose 5-fluorouracil and cisplatin (FP) as neoadjuvant chemotherapy (NAC). The patient was admitted complaining of epigastral discomfort. Endoscopic examination revealed type 3 advanced gastric cancer with pylorus stenosis. Computed tomography (CT) revealed metastasis to group 2 lymph nodes. Staging laparoscopy was performed for accurate preoperative staging. Although peritoneal seeding was not found, peritoneal washing cytology was positive (Class V). Tumor marker of serum carcinoembryonic antigen (CEA) was elevated to 9 1.2 ng/ml. After the second course of combined chemotherapy, endoscopic examination and CT revealed marked reduction of the primary tumor and metastatic lymph nodes. Shrinkage of the primary tumor was also shown by gastrography. Distal gastrectomy with Billroth-II reconstruction was then performed. The histopathological findings showed disappearance of the carcinoma as primary lesion. Many lymph nodes whose metastatic lesions revealed a complete response, but 6 lymph nodes had remaining viable cancer cells. Paclitaxel and low-dose FP therapy are useful as NAC for advanced gastric cancer.     

A case of gastric cancer with peritoneal dissemination which showed the intraperitoneal CR by administrating TS-1 orally and paclitaxel intraperitoneally

A 66-year-old male was diagnosed with advanced gastric cancer with pylorus stenosis, and the first abdominal computed tomography (CT) revealed a large amount of ascites. A staging laparoscopy revealed peritoneal dissemination and positive cytology for numerous amounts of ascites (s-T3(SE), N0, M0, p(+), cy(+), H0, s-Stage IV). The patient received TS-1 orally and paclitaxel administered to the peritoneal cavity. After finishing the second course of the combined chemotherapy, second-look staging laparoscopy was performed, which showed the disappearance of peritoneal dissemination and negative cytology. Chemotherapy combined with oral TS-1 and paclitaxel administered to the peritoneal cavity might be an effective strategy against advanced gastric cancer with peritoneal dissemination.     

Staging laparoscopy in gastric cancer surgery. A population-based cohort study in patients undergoing gastrectomy with curative intent

BackgroundStudies on the value of a staging laparoscopy in detecting metastases in gastric cancer patients show great variation. This study investigates the avoidable surgery rate in patients with and without a staging laparoscopy scheduled for surgery with curative intent.MethodsThis population-based cohort study included all patients with an intentional resection for a potentially curable gastric adenocarcinoma, between 2011 and 2016, registered in the Dutch Upper GI Cancer audit. Patients with and without a staging laparoscopy were compared. The primary outcome was the avoidable surgery rate (detection of metastases and/or locoregional non-resectable tumor during intentional gastrectomy). Secondary outcomes were the negative predictive value, postoperative morbidity and pathology parameters.Results2849 patients who underwent an intentional gastrectomy were included. 414 of 2849 (14.5%) patients underwent a staging laparoscopy before initiation of treatment. The avoidable surgery rate was 16.2% in the staging laparoscopy group, compared to 8.5% in the non-staging group (P < 0.001), resulting in a negative predictive value of 83.8%. The avoidable surgery rate remained significantly different after correction for possible confounders. The main reason for not executing the gastrectomy was the presence of distant metastasis in both groups. cT and cN stage were significantly higher in patients who underwent a staging laparoscopy.ConclusionsThe staging laparoscopy group had a higher cTN and pTN stage, implicating selection of patients with more advanced disease for a staging laparoscopy. Despite the staging laparoscopy, a higher rate of avoidable surgery was found, suggesting a low sensitivity for detecting metastases or locoregional non-resectability in this patient group.     

外周血中CEA和CA19-9的表达水平在进展期胃癌中的预后价值

目的 探讨外周血中CEA和CA19-9的表达水平在进展期胃癌中的预后价值及进展期胃癌患者预后的影响因素。方法 选取2010年1月—2010年12月于哈尔滨医科大学附属肿瘤医院胃肠外科行R0根治术的进展期胃癌患者255例,根据CEA和CA19-9的表达水平分为A组(CEA＜2.19ng/mL且CA19-9＜10.78U/mL)、B组(CEA≥2.19ng/mL或CA19-9≥10.78U/mL)和C组(CEA≥2.19ng/mL且CA19-9≥10.78U/mL),比较三组进展期胃癌患者的临床病理资料和生存情况,并分析进展期胃癌患者预后的影响因素。结果 三组进展期胃癌患者间临床N分期、临床TNM分期和病理TNM分期的差异均具有统计学意义(P＜0.05),三组进展期胃癌患者术后中位生存时间差异无统计学意义(P＞0.05);术后1年、3年、5年生存率差异无统计学意义(P＞0.05),但A组1年、3年、5年生存率高于B组和C组。影响胃癌预后的因素包括肿瘤分化程度、病理T分期、病理TNM分期、清扫淋巴结总数、清扫淋巴结阳性数、淋巴结转移情况。结论 CEA和CA19-9联合检测对进展期胃癌患者评估预后有一定的参考价值。     

Indication of radical surgery (R2, R3) based upon the pattern of lymph node metastasis from gastric cancer

From Jan. 1980 to June. 1984, radical operation was performed in 156 patients with gastric cancer according to the "protocol" introduced by the Gastric Cancer Research Society of Japan. There were 24 early and 132 advanced gastric cancers. Seventy patients were treated by type R2, 86 by R+2 and R3. Radical distal subtotal gastrectomy was done in 116, proximal subtotal gastrectomy in 7, simple total gastrectomy in 13 and subtotal or total gastrectomy combined with neighbouring organ resection in 20. According to TNM staging, 24 (15.4%) lesions were stage I, 9 (5.8%) stage II, 100 (64.1%) stage III and 23 (14.7%) stage IV. Twenty four lesions were within the mucosa or submucosal layer, 11 in proprius muscle layer, 18 to subserosa, 15 to serosa, 46 beyond serosa, 42 involving the surrounding organs. Lymph node metastatic rate was 66% (103 cases), metastatic degree was 21.5% (558/2593). The metastatic degree of lymph node line I, II and III was 24.7%, 20% and 8.3%, respectively. Basing on lymph node metastatic rate and degree as well as the line degree, it is proposed that, in the early stage of gastric cancer, type R1 be performed for cancer limited to the mucosa, especially the minute type, R2 for cancer invading the submucosa, in which, R+2 be indicated for some isolated patients. In the advanced gastric cancer, type R+2 be performed in the majority of patients and R3 in a few. R3 or total gastrectomy combined with neighbouring organ resection be carried out only in a part of cases with the limited type infiltrating beyond the serosa or invading the neighbouring organs.     

Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings

Background

Despite recent progress in systemic chemotherapy, the prognosis of gastric cancer patients with peritoneal metastasis (P1) or positive peritoneal cytology findings (CY1) is still poor. We developed a regimen combining intraperitoneal (IP) paclitaxel (PTX) with S-1 and PTX, which can produce notable efficacy with regard to peritoneal lesions. Surgery after response to combination chemotherapy is a promising option for P1 or CY1 gastric cancer. A retrospective study was performed to evaluate the safety and efficacy.

Methods

This study enrolled 100 primary P1 or CY1 gastric cancer patients treated with IP PTX plus S-1 and PTX at the University of Tokyo Hospital between 2005 and 2011. Radical gastrectomy was performed when peritoneal cytology findings became negative, and the disappearance or obvious shrinkage of peritoneal metastasis was confirmed by laparoscopy. The same chemotherapy regimen was restarted after surgery and repeated with appropriate dose reduction.

Results

Gastrectomy was performed in 64 (P1 56, P0CY1 8) of 100 (P1 90, P0CY1 10) patients. R0 resection was achieved in 44 patients (69%). The median survival time was 30.5 months [95% confidence interval (CI) 23.6–37.7 months] from the initiation of intraperitoneal chemotherapy and 34.6 months (95% CI 26.8–39.4 months) from the diagnosis of gastric cancer. Postoperative complications included anastomotic leakage and pancreatic fistula, each in two patients, which were cured conservatively. There were no treatment-related deaths. The median survival time of the 36 patients who did not undergo surgery was 14.3 months (95% CI 10.0–17.8 months).

Conclusions

Surgery after response to intraperitoneal and systemic chemotherapy is safe and may prolong the survival of P1 and CY1 gastric cancer patients.

     

Two cases of advanced gastric cancer completely responding to S-1 neoadjuvant chemotherapy

CASE 1: A 67-year-old man had advanced gastric cancer with lymph node metastasis (cT3N1M0, cStage IIIA). S-1 120 mg was administered for 21 days as neoadjuvant chemotherapy (NAC). A month later, total gastrectomy (with splenectomy) was performed. Histopathological examination revealed no cancer cells in the gastric wall and dissected lymph nodes. CASE 2: A 62-year-old man had advanced gastric cancer with lymph node metastasis (cT4aN2M0, cStage IIIB). He was treated with daily oral administration of S-1 120 mg (28-day administration followed by 7-day rest, and then 14- day administration) as NAC. A month later, total gastrectomy was performed. Histopathological examination revealed no cancer cells in the gastric wall and dissected lymph nodes. In both cases, the pathological effect was judged as grade 3. This suggests that NAC with S-1 mono-therapy can have a distinct therapeutic value for advanced gastric cancer.     

Is Borrmann type IV gastric carcinoma a surgical disease? An old problem revisited with reference to the result of peritoneal washing cytology

BACKGROUND AND OBJECTIVES: Borrmann type IV gastric carcinoma (B-4) remains a disease with poor prognosis despite an aggressive surgical approach. Cytology examination of the peritoneal washes is an established prognostic factor for gastric carcinoma in general, and may be useful for identifying adequate treatment strategy for B-4. METHODS: Pathologic data from 70 patients with B-4 who underwent laparotomy and peritoneal washing cytology during the recent 6 years were retrieved from a prospective computer database and reviewed. Prognostic significance of the cytology examination along with other known clinicopathologic variables was evaluated by univariate and multivariate analyses. RESULTS: Long-term survivors were observed only among the patients who were treated with curative R0 resection. Prognosis of the patients with positive cytology and no other residual disease (R1) was extremely poor and was equivalent to that of the patients undergoing noncurative R2 resection. No difference in survival, either, was observed between the patients treated by R2 resection and those who did not undergo resection. Multivariate analysis identified cytology examination as an independent prognostic factor. CONCLUSIONS: Peritoneal washing cytology plays an important role in staging B4. Positive cytology findings as well as other evidence of disseminated disease may indicate that gastrectomy should be avoided.     

Role of laparoscopy in the management of stomach cancer.

The use of laparoscopy for staging and treatment of gastric cancer has evolved in the past decade along with other advanced laparoscopic procedures. Laparoscopic staging of gastric cancer, especially with the addition of laparoscopic ultrasonography, has been shown more reliable than radiologic modalities and it effectively decreases the incidence of unnecessary laparotomy. Although it is not commonly performed in Western countries, the use of laparoscopic curative resection for gastric cancer is growing, especially in Japan. Laparoscopic resection of early gastric cancer has been shown to be safe and effective in many retrospective series though no prospective randomized studies comparing it to open resection have been performed. Despite being more controversial, laparoscopic curative resection of advanced gastric cancer also has been performed at multiple institutions with encouraging early results. This review will present the current worldwide experience of laparoscopy for gastric cancer.     

Staging laparoscopy in patients with advanced gastric cancer: A single center cohort study

BackgroundMost studies exploring the role of staging laparoscopy in gastric cancer are limited by low sample size and are predominantly conducted in Asian countries. This study sets out to determine the value of staging laparoscopy in patients with advanced gastric cancer in a Western population.MethodsAll patients with gastric cancer from a tertiary referral center without definite evidence of non-curable disease after initial staging, and who underwent staging laparoscopy between 2013 and 2020, were identified from a prospectively maintained database. The proportion of patients in whom metastases or locoregional non-resectability was detected during staging laparoscopy was established. Secondary outcomes included the avoidable surgery rate (detection of non-curable disease during gastrectomy with curative intent) and diagnostic accuracy (sensitivity, specificity, accuracy, negative and positive predictive value).ResultsA total of 216 patients were included. Staging laparoscopy revealed metastatic disease in 46 (21.3 %) patients and a non-resectable tumor in three (1.4 %) patients. During intended gastrectomy, non-curable disease was revealed in 13 (8.6 %) patients. Overall sensitivity, specificity and diagnostic accuracy were 76.6 %, 100 % and 92.6 %, respectively. The positive predictive value was 100 % and the negative predictive value was 90.3 %.ConclusionStaging laparoscopy is valuable in the staging process of gastric cancer with a high accuracy in detecting non-curable disease, thereby preventing futile treatment and its associated burden.     

Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer

Background

The purpose of this study was to identify and synthesize findings from all articles on surgical and long-term outcomes in patients with gastric cancer undergoing gastrectomy combined with pancreaticoduodenectomy (PD).

Methods

Electronic literature searches were conducted using Medline, EMBASE, and Cochrane databases from January 1, 1985, to December 31, 2009.

Results

Eight retrospective case series were included, with 132 patients having PD combined with gastrectomy. PD was combined with total gastrectomy in 27 patients, and subtotal gastrectomy in 81 patients; 24 patients had undocumented gastric resection type. Clinical stage was available for 92 patients (4 stage I, 7 stage II, 26 stage III, and 55 stage IV). Five studies (98 patients having PD combined with gastrectomy) compared PD and gastrectomy to gastrectomy alone. In the four studies reporting morbidity, PD had a higher morbidity. The pooled pancreatic anastomotic leak rate was 24.5% for the seven studies in which complications were reported; however, there were no peri-operative deaths. Long-term survival (37.3% at 5 years) in gastric cancer patients with PD combined with gastrectomy was described; however, survival was poor in the setting of incurable factors. Due to heterogeneity of patients and staging techniques in the case series no recommendations can be made on the appropriate selection criteria for patients undergoing PD and gastrectomy.

Conclusion

PD for gastric cancer invading the pancreas is associated with a higher morbidity; given the heterogeneous data, defining exact selection criteria is difficult.

     

The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy

Background

Surgery for perforated gastric cancer has a dual purpose: treating life-threatening peritonitis and curing gastric cancer. An emergent one-stage gastrectomy may place an undue burden on patients with a poor general status and could impair long-term survival even if the gastric malignancy is curable. A two-stage gastrectomy, in which the initial treatment of peritonitis is followed by elective gastrectomy, can accomplish both desired purposes.

Methods

We retrospectively analyzed 514 Japanese cases of perforated gastric cancer. 376 patients underwent a one-stage gastrectomy and 54 patients underwent a two-stage gastrectomy. We evaluated patient characteristics, surgical outcomes, postoperative complications, and survival rates in both groups.

Results

The two-stage gastrectomy group saw a 78.4 % rate of curative R0 resection and 1.9 % hospital mortality rate, while corresponding rates in the one-stage gastrectomy group were 50 and 11.4 %, respectively. Among cases in which curative R0 resection was performed, there was no significant difference in overall survival between 136 one-stage gastrostomies and 40 two-stage gastrostomies. In a multivariate analysis, curative R0 resection [hazard ratio (HR) 2.937, p = 0.001] and depth of tumor invasion (HR 1.179, p = 0.016) were identified as independent prognostic factors.

Conclusions

Regardless of whether patients underwent a one-stage or two-stage gastrectomy, curative R0 resection improved survival in patients with perforated gastric cancer. When curative R0 resection cannot be performed in the initial treatment phase due to diffuse peritonitis, non-curative and palliative gastrectomy should be avoided, and a two-stage gastrectomy should be planned following peritonitis recovery and detailed examinations.     

Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings

Background

Despite recent progress in systemic chemotherapy, the prognosis of gastric cancer patients with peritoneal metastasis (P1) or positive peritoneal cytology findings (CY1) is still poor. We developed a regimen combining intraperitoneal (IP) paclitaxel (PTX) with S-1 and PTX, which can produce notable efficacy with regard to peritoneal lesions. Surgery after response to combination chemotherapy is a promising option for P1 or CY1 gastric cancer. A retrospective study was performed to evaluate the safety and efficacy.

Methods

This study enrolled 100 primary P1 or CY1 gastric cancer patients treated with IP PTX plus S-1 and PTX at the University of Tokyo Hospital between 2005 and 2011. Radical gastrectomy was performed when peritoneal cytology findings became negative, and the disappearance or obvious shrinkage of peritoneal metastasis was confirmed by laparoscopy. The same chemotherapy regimen was restarted after surgery and repeated with appropriate dose reduction.

Results

Gastrectomy was performed in 64 (P1 56, P0CY1 8) of 100 (P1 90, P0CY1 10) patients. R0 resection was achieved in 44 patients (69%). The median survival time was 30.5 months [95% confidence interval (CI) 23.6–37.7 months] from the initiation of intraperitoneal chemotherapy and 34.6 months (95% CI 26.8–39.4 months) from the diagnosis of gastric cancer. Postoperative complications included anastomotic leakage and pancreatic fistula, each in two patients, which were cured conservatively. There were no treatment-related deaths. The median survival time of the 36 patients who did not undergo surgery was 14.3 months (95% CI 10.0–17.8 months).

Conclusions

Surgery after response to intraperitoneal and systemic chemotherapy is safe and may prolong the survival of P1 and CY1 gastric cancer patients.

     

Staging laparoscopy for advanced gastric cancer

Staging laparoscopy was carried out for 12 cases of advanced primary gastric cancer to evaluate the condition of peritoneal seeding. Peritoneal seeding was indicated in five cases. Abdominal lavage sampling was positive in six cases. Among six cases with positive cytology, surgery was adopted in three cases to lessen bleeding or stricture. Chemotherapy were carried out for the other three cases. Radical lymph node resection was carried out in six cases without peritoneal seeding. Laparoscopic observation was easier and more feasible under general anesthesia than local anesthesia. Preoperative staging laparoscopy for advanced gastric carcinoma can evaluate the condition of peritoneal seeding. Based on the results, a suitable treatment plan for each patient can be determined.     

Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis

Objective:Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis.The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis.Methods:Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer (cT≥2M0).We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy,and examined the relationship between peritoneal dissemination (P) and cytology results (CY).Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis.Multivariate logistic regression analysis and receiver-operator characteristic (ROC) analysis were performed in training set to find out risk factors of intra-abdominal metastasis,and then validate it in testing set.Results:Out of 249 eM0 patients,51 (20.5％) patients with intra-abdominal metastasis were identified by diagnostic laparoscopy,including 20 (8.0％) P1CY1,17 (6.8％) P0CY1 and 14 (5.6％) P1CY0 patients.In the training set,multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography (CT) scan ≥21 mm and tumor-occupied ≥2 portions of stomach are predictive factors of metastasis.In the testing set,when diagnostic laparoscopy was performed on patients who had one or two of these risk factors,the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0％ and 32.1％,respectively.Conclusions:According to our results,depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis.     

A case of advanced gastric cancer with giant lymph node metastasis responding to S-1/CDDP neoadjuvant chemotherapy

The patient was a 66-year-old man with advanced gastric cancer and bulky lymph node metastases. Since a radical resection appeared impossible, we tried neoadjuvant chemotherapy(NAC)with S-1/CDDP, expecting down staging of the tumor. S-1(120 mg/body)was orally administered for 21 days and CDDP(40 mg/body)was administered by intravenous drip on day 8, 15 and 22. Partial response(PR)was obtained after 2 courses, and distal gastrectomy with D2 lymph node dissection was performed. The histological diagnosis revealed complete disappearance of cancer cells in stomach and a few regional lymph node metastasis(3/30). The patient was administered S-1 for one year after operation, and he is well without recurrence at one year and four months postoperatively. We considered the S-1 and CDDP in combination useful as preoperative chemotherapy for advanced gastric cancer.