Postoperative immunochemotherapy (BCG + 5-FU) in advanced gastric cancer

Three hundred and twenty-two patients with locally advanced (stages III and IVA) and disseminated (stage IVB) gastric cancer were included in a randomized trial to assess the effect of immunochemotherapy (BCG and 5-fluorouracil,5-FU). The survival of patients receiving chemoimmunotherapy was compared to chemotherapy (5-FU) or no further treatment (control) groups. Patients with stage III underwent radical surgery (subtotal or total resection), stage IVA palliative resection, while explorative laparotomy or bypass was performed in stage IVB. Patients with stage III and IVA receiving immunochemotherapy had significantly (p less than 0.05) prolonged survival in comparison to chemotherapy or control groups. Prolongation of survival was more pronounced in patients with diffuse type carcinoma than in patients with intestinal type of tumour according to Lauren's classification. The survival of patients receiving chemotherapy was somewhat shorter than that of the control group, but the differences were not statistically significant. There was no effect of either immunochemotherapy or chemotherapy in patients with stage IVB. No serious side effects of immunochemotherapy were noted. These results indicate that immunochemotherapy may be a safe form of adjuvant treatment in patients with operable gastric cancer.     

Postoperative adjuvant immunochemotherapy and infiltration of dendritic cells for patients with advanced gastric cancer.

To determine the group of patients for whom a biological response modifier is useful, the efficacy of postoperative adjuvant immunotherapy was investigated with regard to infiltration of dendritic cells (DC) in patients with advanced gastric cancer who underwent absolute curative resection. The infiltration of DC was classified into marked and slight. The chemotherapy group was prescribed mitomycin C and tegafur, while for the immunochemotherapy group a biological response modifier, PSK, was also prescribed in survival between the chemotherapy and immunochemotherapy groups. In patients with slight infiltration, however, the 5 - year survival rates were 0% in the chemotherapy and 15% in the immunochemotherapy group. Patients given PSK survived longer than those given chemotherapy only (P less than 0.05). Therefore, adjuvant immunotherapy may be considered for patients with advanced gastric cancer with slight infiltration of DC.     

Outcomes after adjuvant chemotherapy in the treatment of high-risk urothelial carcinoma of the upper urinary tract (UUT-UC): results from a large multicenter collaborative study

BACKGROUND:

Urothelial carcinoma of the upper urinary tract (UUT‐UC) was a rare, aggressive urologic cancer with a propensity for multifocality, local recurrence, and metastasis. High‐risk patients had poor outcomes. Because of the rarity of these tumors, randomized clinical trials and data regarding adjuvant chemotherapy in locally advanced tumors are currently unavailable. Our objective was to assess the effect of adjuvant chemotherapy and the impact of potential prognostic factors on survival in high‐risk, postsurgical UUT‐UC patients.

METHODS:

Using a multi‐institutional, international retrospective database, identified were 627 patients with high risk UUT‐UCs (pT3N0, pT4N0 and/or N+ and/or M+) who underwent surgical removal. Only patients who received adjuvant chemotherapy were included.

RESULTS:

Overall, 140 patients (22.6%) with a median age of 67 years were included. The median follow‐up was 22.5 months. The 5‐year, overall survival for the entire cohort was 43%, the 5‐year recurrence‐free survival was 54%, and metastasis‐free survival was 53% at 5 years. Positive surgical margins were an independent prognostic factor for recurrence (P = .06), cancer‐specific mortality (P = .05), and overall mortality (P = .02) of any cause. Adjuvant chemotherapy was not linked with overall or cancer‐specific survival in patients with high risk disease (adjuvant chemotherapy [n = 140] vs no treatment [n = 487]) (P >.5).

CONCLUSIONS:

Adjuvant postoperative chemotherapy did not offer any significant benefit to overall survival in our population. Additional data were necessary, and studies enrolling patients at high risk in clinical trials investigating neoadjuvant chemotherapy in conjunction with chemotherapy should have been highly encouraged. Cancer 2011;. © 2011 American Cancer Society.     

Ⅲ期胃癌术后辅助免疫化疗的疗效观察

目的 探讨云芝多糖(PSK)+丝裂霉素(MMC)+氟脲嘧啶(FT-207)免疫化疗方案对Ⅲ期胃癌患者的术后辅助治疗效果。方法 将126例治愈根治性切除的Ⅲ期胃癌病例,术后随机分为两组:对照组(66例)术后辅助MMC+FT-207方案化疗,试验组(60例)术后辅助PSK+MMC+FT-207方案免疫化疗。分别观察患者一般状态、骨髓抑制、肝功能、T细胞亚群及生存率情况。结果 (1)治疗组全身乏力、面色苍白、食少纳差、恶心呕吐、腹胀、腹泻等症状明显好于对照组(P<0.05),同时治疗组化疗后外周血中白细胞减少及血小板减少均少于对照组,尤其是2级以上的的骨髓抑制也少于对照组。(2)化疗后对照组免疫功能略有下降,但试验组T细胞亚群不下降,反而略升高。同时对照组的丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)升高、总蛋白及白蛋白降低均较试验组高,说明PSK具有保护药物对肝的损伤作用。(3)试验组与对照组3年生存率分别为51.7％(31/60)和53.0％(35/66),差别不大。但前者5年生存率为46.7％(28/60),显著高于后者31.8％(21/66,P<0.05)。结论MMC+FT-207+PSK免疫化疗可提高胃癌患者对化疗的耐受性、改善生活质量及延长生存时间。     

Potent effects of adjuvant chemotherapy using 5-fluorouracil + leucovorin on DNA aneuploid colorectal cancer

Background The relationship between DNA ploidy of colorectal cancer cells and sensitivity to adjuvant chemotherapy, using 5-fluorouracil+leucovorin was investigated. Methods Seventy-five patients with Duke's B or C colorectal cancer, who underwent potentially curative resection, were randomly allocated to 2 groups. Thirty-eight patients received adjuvant chemotherapy using 5-fluorouracil+leucovorin (chemotherapy group), and 37 patients received no adjuvant chemotherapies (no-chemotherapy group). Tumor cell ploidy of all patients was analyzed using paraffin-embedded samples. Results There was no statistically significant difference in overall survival between patients who received chemotherapy and those who did not. Among the patients with diploid tumors (n=39), there was no significant difference in survival between the chemotherapy group (n=20, 5-year survival rate of 34.3%) and the no-chemotherapy group (n=19, 5-year survival rate of 27.1%). By contrast, among the aptients with aneuploid tumors (n=36), the survival rate was significantly better in the chemotherapy group (n=18, 5-year survival rate of 77.8%), than in the no-chemotherapy group (n=18, 5-year survival rate of 43.7%) (P=0.023). Conclusion These results suggest that aneuploid tumors are more sensitive to adjuvant chemotherapy, using 5-fluorouracil+leucovorin, than are diploid tumors.     

Extramural extension as indicator for postoperative adjuvant chemotherapy in Stage IIA (pT3N0) colon cancer

The usefulness of adjuvant chemotherapy (CMT) in patients with Stage IIA colon cancer remains unclear. The present study aimed to investigate extramural extension as an indicator for adjuvant CMT. Data were reviewed from 202 consecutive patients with Stage IIA colon cancer that underwent curative surgery between 1995 and 2007. The distance of the extramural extension (DEE) was measured histologically. The optimal prognostic cut‐off point of the DEE for oncologic outcomes was statistically determined. The eligible surviving patients had been followed for a median period of 75 months (range: 2–210 months). Patients were subdivided into two groups according to the optimal cut‐off point; DEE ≤5 mm (pT3a) and DEE >5 mm (pT3b). The pT3b was the most powerful independent risk factor for postoperative recurrence (P = 0.0324, HR: 3.04, 95% CI: 1.098–8.408), and was significantly correlated with distant metastasis (P = 0.0161 HR: 5.19, 95% CI: 1.765–15.239). The recurrence‐free and cancer‐specific 5‐year survival rates in patients with pT3b were significantly lower than in patients with pT3a (81.5% vs. 95.4%, P = 0.0003 and 85.9% vs. 97.4%, P = 0.0007, respectively). pT3b could be an important risk factor for distant metastasis in Stage IIA colon cancer. Postoperative adjuvant CMT may be indicated for patients with pT3b. J. Surg. Oncol. 2013; 108:358–363. © 2013 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.     

Prognostic significance of gastrin expression in patients undergoing R0 gastrectomy for adenocarcinoma

Background Gastrointestinal (GI) hormones regulate several GI functions, including the proliferation and repair of normal mucosa, and hormone receptors may therefore be implicated in the growth, invasion, and metastasis of cancers of the GI tract. The aim of this study was to determine the cellular distribution of gastrin in intestinal-type gastric cancers, and to determine its relationship to outcomes after R0 gastrectomy. Methods Eighty-six consecutive patients undergoing R0 gastrectomy for adenocarcinoma were studied. Normal gastric mucosa and tumor were stained for gastrin and their specific cellular distribution was determined. Results The duration of survival of patients whose tumors exhibited well-differentiated gastrin-positive tumor (GPT) cells (n = 12) was significantly poorer than that of patients whose tumors were GPT-negative (5-year survival, 30% vs 54%; P = 0.037). Patients with GPT-positive intestinal-type gastric cancer (5 of 47 patients) had the poorest survival of all (median, 14 months; 5-year survival, 0%; P = 0.006). In a multivariate analysis, only lymph node metastases (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.2 to 3.79; P = 0.01) and the presence of GPT cells (HR, 6.61; 95% CI, 1.74 to 25.09; P = 0.01) were independently and significantly associated with durations of survival in patients with intestinal-type gastric cancer. Conclusion The presence of GPT cells in patients with gastric adenocarcinoma is a significant and independent prognostic indicator. An original article presented in the Moynihan Prize session at the Associations of Surgeons of Great Britain and Ireland, Edinburgh, May 2006.     

High recurrence risk and use of adjuvant trastuzumab in patients with small, HER2-positive, node-negative breast cancers

Background

Five randomized trials of adjuvant trastuzumab have reported significant improvements in recurrence-free survival (RFS) and overall survival. However, patients with node-negative tumors 1?cm or smaller were excluded from these trials. We assessed the recurrence risk and benefit of adjuvant therapy in such patients with small tumors.

Methods

We identified patients with node-negative breast tumors 1?cm or smaller between April 2003 and December 2007. Patients were categorized according to HER2 status and pathological tumor size (pT <5?mm vs. 5?C10?mm), hormone receptor (HR) status and adjuvant chemotherapy. The primary endpoint was RFS.

Results

Of 267 patients included in the analysis, 42 had HER2-positive tumors. The median follow-up was 4.3?years. RFS was worse in patients with HER2-positive tumors than HER2-negative tumors (90.5 vs. 97.7% at 5?years; P?=?0.031). In the group with HER2-positive tumors, there were no recurrences in patients with pT<5?mm, but 4 recurrences in those with pT 5?C10?mm. RFS was worse in patients with pT 5?C10?mm than pT <5?mm (79.0 vs. 100%, P?=?0.025). Furthermore 3 recurrences occurred in patients without adjuvant trastuzumab, and 1 recurrence occurred as soon as adjuvant trastuzumab was finished. Our results appear to establish the efficacy of adjuvant trastuzumab therapy. HR status and use of adjuvant chemotherapy were not significantly associated with RFS.

Conclusions

Patients with HER2-positive, node-negative breast tumors 1?cm or smaller (especially 0.5?C1.0?cm) have a significant recurrence risk and the decision to employ adjuvant trastuzumab therapy should be discussed with patients based on our results and those of other studies.     

Use of adjuvant chemotherapy in stage C (III) rectal cancer: Comparison of data from matched patients in a teaching hospital's clinico‐pathological database

Aims: Controversy continues regarding the treatment of patients with resectable rectal cancer, particularly in regard to the effects of adjuvant therapies on long‐term survival. The benefits of adjuvant chemotherapy alone in patients with stage III rectal cancer after curative resection remain unclear. The aim of this study was to compare the overall survival of patients who had received adjuvant chemotherapy after resection of a stage III rectal cancer (111 patients) with the survival of a historical control group who had surgery alone before chemotherapy was introduced (129 patients). Methods: Treatment and outcomes data were drawn from a prospective hospital registry of consecutive patients who had a resection for stage III rectal cancer. Results: The estimated Kaplan–Meier overall 5‐year survival rate in patients who received chemotherapy (68.7%, 95% CI 58.3–77.1%, log‐rank P < 0.001) was improved compared with the historical controls (40.5%, 95% CI 31.4–49.5%, log–rank P < 0.001 ). No systematic differences between the treated and control group were found. Conclusion: This study has shown improved survival after adjuvant chemotherapy in patients with stage III rectal cancer as compared with historical controls treated by surgery alone. Hence, there could be subsets of patients whom when treated with surgery in a specialized surgical unit, may benefit from chemotherapy and spared the toxicities of adjuvant radiotherapy. This should be explored further in a cooperative trial group setting.     

A phase III randomized trial of 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil and mitomycin C versus 5-fluorouracil alone in curatively resected gastric cancer.

BACKGROUND: A phase III single-center randomized trial was performed in order to determine whether the addition of mitomycin C (MMC) and/or doxorubicin to 5-fluorouracil (5-FU) as adjuvant chemotherapy could influence survival in patients with curatively resected gastric cancer. PATIENTS AND METHODS: A total of 416 patients who had undergone curative resection for stage IB-IIIB gastric adenocarcinoma were stratified according to the stage and type of surgery, and then randomized to receive one of the three chemotherapy regimens, 5-FU alone (F) or 5-FU and MMC (FM) or 5-FU, doxorubicin and MMC (FAM) within 5 weeks after surgery. RESULTS: Of 416 patients registered, 395 (133 in F, 131 in FM and 131 in FAM) were assessable. Median follow-up duration was 91 months. Five-year overall survival rates were 67.2% for F, 67.0% for FM and 66.7% for FAM (P = 0.97). Five-year disease-free survival rates were 62.1% for F, 63.3% for FM and 62.5% for FAM (P = 0.83). Hematological toxicities were more frequent in the FM and FAM groups, whereas stomatitis was more common in the F group. CONCLUSIONS: Compared with adjuvant 5-FU alone, the addition of MMC and/or doxorubicin to 5-FU did not influence survival in patients with resected gastric cancer.     

The effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy

EROGLU C., ORHAN O., KARACA H., UNAL D., DIKILITAS M., OZKAN M. & KAPLAN B. (2013) European Journal of Cancer Care 22 , 133–140 The effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy The aim of this study was to examine the effect of being overweight on survival in patients with gastric cancer undergoing adjuvant chemoradiotherapy and chemotherapy. In this study 152 patients were evaluated. Radiotherapy dose was 45 Gy given in 5 weeks. 5-FU 425 mg/m² and folinic acid 20 mg/m² were administered weekly during the radiotherapy and four cycles with 4-week intervals as consolidation chemotherapy after radiotherapy. Patients were assigned into two groups according to their body mass index: overweight (body mass index ≥25 kg/m²) and normal weight (body mass index <25.0 kg/m²). The median overall survival was 39 months vs. 18 months and median disease-free survival was 27 months vs. 13 months in the overweight and normal-weight groups respectively (P= 0.004 and P= 0.006 respectively). The 5-year survival was better in the patients with overweight than those with normal weight (42% vs. 17%; P= 0.004). The overall survival was significantly better with being overweight and early pathological stage (P= 0.016 and P= 0001 respectively). Overall survival, disease-free survival and long-term survival in patients with gastric cancer undergoing adjuvant treatment were better in overweight than normal-weight patients. Moreover, it was shown that body mass index and pathological stage were associated to survival and prognosis.     

胃癌根治术后早期腹腔置管腔内化疗的临床意义

 目的 观察根治术后早期经皮腹腔置管腔内化疗对胃癌术后患者生存情况的影响。方法 40例Ⅲ期以上胃癌根治术后患者分为治疗组和对照组，每组20例。治疗组在术后1个月内先行经皮腹腔保留置管，腹腔内顺铂80 mg、氟脲苷1 g灌注2 ~ 3次，随后行以FOLFOX4为主的全身化疗。对照组在术后仅行全身化疗。结果 治疗组1年无病生存率为60 ％，较对照组（25 ％）增高（P＜0.05）；中位无病生存、总生存、腹盆腔复发转移出现时间较对照组延长，1年总生存率为85 ％，较对照组（70 ％）略增高，但差异无统计学意义（P＞0.05）。治疗组化疗不良反应与对照组无明显差异，未出现与腹腔灌注治疗相关的出血、感染、化疗药外漏、胃肠穿孔和发热等并发症。结论 胃癌根治术后早期腹腔置管腔内化疗可提高患者1年无病生存率，延长生存期，并发症少，耐受性好，具有一定的实用性及可行性，但需进一步扩大临床验证。     

Postoperative chemotherapy for gastric cancer

INTRODUCTION: Adjuvant chemotherapy for gastric cancer after potentially curative surgery has been under clinical investigation for more than four decades. However, potentially curative resection can be performed in only 30%-50% of patients. The objective of this article is to review briefly the clinical trials available in the current literature using adjuvant cytotoxic chemotherapy in patients with gastric cancer after potentially curative surgical resection. METHODS: Computerized (MEDLINE) and manual searches were performed to identify papers published on this topic between 1965 and 2005. Only articles with an English abstract were reviewed for inclusion; information abstracted included histologic proof of diagnosis, number of patients, dose and modality of treatment, survival duration, and side effects. RESULTS: Forty-three reports were identified. Single-agent chemotherapy was evaluated in four clinical trials, and postoperative combination chemotherapy was evaluated in 33 trials. Furthermore, we identified five meta-analyses. Five-year survival rates ranged from 12%-91.2%, and the median survival durations were 13-60+ months. Adjuvant chemotherapy, when compared with surgery alone, seems to result in longer survival. CONCLUSION: The high rate of recurrence, even in patients undergoing state-of-the art curative resection, suggests that effective adjuvant chemotherapy might indeed be an attractive concept to improve the overall outcome of patients with gastric cancer. However, because there is no standard regimen for postoperative treatment at the moment, patients with R0-resected (no residual tumors) gastric cancer should be offered the opportunity to participate in prospective clinical trials.     

Clinicopathologic characteristics and prognostic factors in 10 783 patients with gastric cancer

Background. Although the results of gastric cancer treatment have markedly improved, this disease remains the most common cause of cancer death in Korea. Methods. Clinicopathologic characteristics were analyzed for 10 783 consecutive patients who underwent operation for gastric cancer at the Department of Surgery, Seoul National University Hospital, from 1970 to 1996. We also evaluated survival and prognostic factors for 9262 consecutive patients operated from 1981 to 1996. The clinicopathologic variables for evaluating prognostic values were classified as patient-, tumor-, and treatment-related factors. The prognostic significance of treatment modality [surgery alone, surgery + chemotherapy, surgery + immunotherapy + chemotherapy (immunochemosurgery)] was evaluated in patients with stage III gastric cancer (according to the International Union Against Cancer TNM classification of 1987). For the assessment of lymph node metastasis, both the number of involved lymph nodes and the ratio of involved to resected lymph nodes were analyzed, as a quantitative system. Results. The mean age of the 10 783 patients was 53.5 years and the male-to-female ratio was 2.07 : 1. Resection was performed in 9058 patients (84.0% resection rate). The 5-year survival rates were 55.9% for all patients and 64.8% for patients who received curative resection. Age, sex, preoperative hemoglobin and albumin levels, type of operation, curability of operation, tumor location, Borrmann type, tumor size, histologic differentiation, Lauren's classification, perineural invasion, lymphatic invasion, vascular invasion, depth of invasion, number of involved lymph nodes, ratio of involved to resected lymph nodes, and distant metastasis had prognostic significance on univariate analysis. Radical lymph node dissection, with more than 25 resected lymph nodes improved survival in patients with stage II and IIIa disease. As postoperative adjuvant therapy, immunochemotherapy was most effective in patients with stage III disease. Patients with identical numbers of lymph nodes -either the number of involved lymph nodes or the number of resected lymph nodes- were divided according to their ratios of involved-to-resected lymph nodes. In each numeric group, there were significant survival differences according to the ratio of involved-to-resected lymph nodes. However, patients who had the same involved-to-resected lymph node ratio did not show significant differences in survival rate according to either the number of involved or the number of resected lymph nodes. On multivariate analysis, curability of operation, depth of invasion, and ratio of involved to resected lymph nodes were independent significant prognostic factors. Conclusions. Curative resection, depth of invasion, and lymph node metastasis were the most significant prognostic factors in gastric cancer. With regard to the status of lymph node metastasis, the ratio of involved to resected lymph nodes had a more precise and comprehensive prognostic value than only the number of involved or resected lymph nodes. Early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy, particularly in patients with stage III gastric cancer should be the standard treatment in principle, for patients with gastric cancer. Received for publication on Apr. 13, 1998; accepted on Oct. 22, 1998     

Result of 11,946 gastric cancer treatment with immunochemosurgery

Although the therapeutic results of gastric cancer have markedly improved, it still remains the most common of cancer deaths in Korea. Annually more than 700, and all together 11,946, gastric cancer patients were surgically treated from 1970 to 1998 at Seoul National University Hospital. Stage III gastric cancer is already a systemic disease, Radical surgery alone cannot cure the patient, and about 35% recurred within 2-3 years. To improve the prognosis of advanced gastric cancer, systemic treatment such as immunotherapy and chemotherapy is required in the early postoperative period to kill the micrometastatic or remaining cancer cells after curative resection. We evaluated the survival rate and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The clinicopathologic variables used for evaluating prognostic values were classified into patient, -tumor- and treatment-related factors. The prognostic significance of treatment modality was evaluated in stage III gastric cancer. The five-year survival rates were 55.9% for overall patients and 64.8% for patients who received curative resection. Radical lymph node dissection was found to produce survival gains in patients with stage II and IIIa. For postoperative adjuvant therapy, immunochemotherapy was most effective in patients with stage III. In multivariate analysis, curability of operation, depth of invasion, and ratio of involved-to-resected lymph nodes were the significant prognostic factors. Consequently, early detection and real curative resection with radical lymph node dissection, followed by immunochemotherapy (particularly in patients with stage III gastric cancer) should be recommended as a standard treatment principle for patients with gastric cancer.     

Role of surgery in the management of primary lymphoma of the gastrointestinal tract

The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. We retrospectively reviewed the management and outcome of 107 patients with the diagnosis of gastrointestinal lymphoma treated at the UCLA Medical Center during the period 1956–1990. Sixty-four patients underwent surgical exploration at the UCLA Medical Center: 35 of these underwent resection for cure. Sixteen of these 35 patients received no postoperative adjuvant therapy. Twenty-nine patients underwent palliative or “noncurative” resection. There were five postoperative deaths (mortality rate 8%). The overall morbidity rate was 48%. There were 3 perforations in a total of 53 patients receiving multiagent chemotherapy. Five-year actuarial survival was as follows: 59% for curative resection alone, 51% for curative resection plus adjuvant therapy, and 28% for “noncurative” resection (P < 0.05). Multivariate analysis revealed that stage of disease (P < 0.01) and resection for cure (P < 0.05) were independent predictors of survival. These results suggest that patients undergoing resection for cure have improved survival. The apparent low risk of perforation during chemotherapy, along with the considerable risk of morbidity and mortality associated with operation, suggests that a policy of debulking large tumors prior to chemotherapy is unwarranted. © 1996 Wiley-Liss, Inc.     

Surgical treatment of gastric cancer in Latvia: Results of centralized experience

Background

Although the mortality for gastric cancer is decreasing in Western Europe and United States, it still remains high in Eastern Europe. This study was aimed at evaluating short- and long-term results of surgical treatment of gastric cancer performed in Latvia Oncology Center.

Methods

Retrospectively collected data from 461 patients who underwent gastrectomy with curative intent in Latvia Oncology Center from January 2001 to December 2005 were analyzed statistically.

Results

An average (range) of 92.2 (81–102) R0–R1 gastrectomies was performed each year. Post-operative complications occurred in 75 patients (16.3%); in-hospital mortality was 3.3%. The overall 5-year survival was 50.8%. In 444 cases (96.3%) there was histopathologic confirmation of R0-resection with a 5-year survival of 52.5% (P < 0.001). Considering pT category, 5-year survival was 88.6% for pT1 patients, 65% for pT2, 42.3% for pT3 and 27% for pT4 (P < 0.001). Considering pN category, 5-year survival was 67% for pN0 patients, 30% for pN1 and 29% for pN2-3 (P < 0.001).

Conclusions

Clinico-pathologic characteristics of patients who underwent resection with curative intent are comparable to other Western experiences. Short- as well as long-term results are also similar if not for pN+ patients where no difference between pN1 and pN2 cases was observed.     

Invasive ductal carcinoma and invasive lobular carcinoma of breast differ in response following neoadjuvant therapy with epidoxorubicin and docetaxel + G-CSF

Purpose Preoperative chemotherapy in patients with primary breast cancer treated with anthracyclines and taxanes results in high response rates, allowing breast conserving surgery (BCS) in patients primarily not suitable for this procedure. Pathological responses are important prognostic parameters for progression free and overall survival. We questioned the impact of histologic type invasive ductal carcinoma (IDC) versus invasive lobular carcinoma (ILC) on response to primary chemotherapy. Patients and Methods 161 patients with breast cancer received preoperative chemotherapy consisted of epidoxorubicin 75 mg/m² and docetaxel 75 mg/m² administered in combination with granulocyte-colony stimulating factor (G-CSF) on days 3–10 (ED + G). Pathological complete response (pCR), biological markers and type of surgery as well as progression free and overall survival were compared between IDC and ILC. Results Out of 161 patients, 124 patients presented with IDC and 37 with ILC. Patients with ILC were less likely to have a pCR (3% vs. 20%, P < 0.009) and breast conserving surgeries (51% vs. 79%, P < 0.001). Patients with ILC tended to have oestrogen receptor positive tumors (86% vs. 52%, P < 0.0001), HER 2 negative tumors (69% vs. 84%), and lower nuclear grade (nuclear grade 3, 16% vs. 46%, P < 0.001). Patients with ILC tended to have longer time to progression (TTP) (42 months vs. 26 months) and overall survival (69 months vs. 65 months). Conclusions Our results indicate that patients with ILC achieved a lower pCR rate and ineligibility for BCS to preoperative chemotherapy, but this did not result in a survival disadvantage. Because of these results new strategies to achieve a pCR are warranted.     

The Survival Benefit From the Addition of Radiation to Chemotherapy in Gastric Cancer Patients Following Surgical Resection

AimsThe survival benefit of radiation therapy in gastric cancer patients who underwent curative resection remains contentious.Materials and methodsGastric cancer patients who underwent curative resection followed by adjuvant chemotherapy or chemoradiation therapy (CRT) between 2004 and 2014 were identified from the National Cancer Database. Survival analyses were carried out with the Kaplan–Meier method and the Cox regression model.ResultsIn total, 4347 patients were included in this study. Of these patients, 1185 patients received postoperative chemotherapy alone and 3162 patients received postoperative CRT. For all patients included in the analysis, patients who received CRT had significantly better overall survival than those who received chemotherapy alone (5-year overall survival: 54.8% versus 46.8%, P < 0.001). The survival benefit primarily occurred in patients with stage II (5-year overall survival: 58.7% versus 53.8%, P = 0.03), stage III (42.5% versus 30.3%, P < 0.001) and lymph node-positive (5-year overall survival: 52.2% versus 41.9%, P = 0.03) gastric cancer. Multivariable analysis confirmed the improvement in overall survival in patients who received postoperative CRT (hazard ratio = 0.78; 95% confidence interval, 0.661–0.926; P < 0.001) was independent of all known prognostic factors. For lymph node-positive patients with lymphovascular invasion (LVI), postoperative CRT significantly improved overall survival compared with chemotherapy alone (5-year overall survival: 49.0% versus 39.4%, P = 0.001). However, there was no survival difference between CRT and chemotherapy alone if lymph node-positive patients had no LVI (5-year overall survival: 54.5% versus 52.7%, P = 0.55).ConclusionThe current study suggests that postoperative CRT provides a survival benefit in gastric cancer patients with concurrent lymph node-positive and LVI-positive disease. A randomised clinical trial may further evaluate the benefit of adjuvant CRT in this subgroup.