scholarly journals Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Chang-Fang Chiu ◽  
Horng-Ren Yang ◽  
Mei-Due Yang ◽  
Long-Bin Jeng ◽  
Tse-Yen Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Performance Status ◽  
Metastatic Gastric Cancer ◽  
Palliative Gastrectomy ◽  
Cast Doubt ◽  
Gastric Cancer Patients ◽  
Univariate Analyses

Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n=137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months, P=0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P=0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9. Conclusions. Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.

scholarly journals Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 198
Author(s):  
Ji Yeon Park ◽  
Byunghyuk Yu ◽  
Ki Bum Park ◽  
Oh Kyoung Kwon ◽  
Seung Soo Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Resection ◽  
Palliative Resection ◽  
Primary Tumors ◽  
Palliative Intent ◽  
Palliative Gastrectomy ◽  
Gastric Cancer Patients ◽  
The Impact

Background and Objectives: The prognosis of metastatic or unresectable gastric cancer is dismal, and the benefits of the palliative resection of primary tumors with noncurative intent remain controversial. This study aimed to evaluate the impact of palliative gastrectomy (PG) on overall survival in gastric cancer patients. Materials and Methods: One hundred forty-eight gastric cancer patients who underwent PG or a nonresection (NR) procedure between January 2011 and 2017 were retrospectively reviewed to select and analyze clinicopathological factors that affected prognosis. Results: Fifty-five patients underwent primary tumor resection with palliative intent, and 93 underwent NR procedures owing to the presence of metastatic or unresectable disease. The PG group was younger and more female dominant. In the PG group, R1 and R2 resection were performed in two patients (3.6%) and 53 patients (96.4%), respectively. The PG group had a significantly longer median overall survival than the NR group (28.4 vs. 7.7 months, p < 0.001). Multivariate analyses revealed that the overall survival was significantly better after palliative resection (hazard ratio (HR), 0.169; 95% confidence interval (CI), 0.088–0.324; p < 0.001) in patients with American Society of Anesthesiologists Physical Status (ASA) scores ≤1 (HR, 0.506; 95% CI, 0.291–0.878; p = 0.015) and those who received postoperative chemotherapy (HR, 0.487; 95% CI, 0.296–0.799; p = 0.004). Among the patients undergoing palliative resection, the presence of <15 positive lymph nodes was the only significant predictor of better overall survival (HR, 0.329; 95% CI, 0.121–0.895; p = 0.030). Conclusions: PG might lead to the prolonged survival of certain patients with incurable gastric cancer, particularly those with less-extensive lymph-node metastasis.

scholarly journals ELISA study of matrix metalloproteinases 2, 7, 9 and their type 2 tissue inhibitor in the tumors of gastric cancer patients: clinical and pathologic correlations

2018 ◽  
Vol 46 (4) ◽  
pp. 323-329
Author(s):  
E. S. Gershtein ◽  
A. A. Ivannikov ◽  
V. L. Chang ◽  
N. A. Ognerubov ◽  
М. M. Davydov ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Matrix Metalloproteinases ◽  
Tumor Progression ◽  
Cancer Patients ◽  
Univariate Analysis ◽  
Gastric Cancer Tissue ◽  
Cancer Tissue ◽  
Gastric Cancer Patients

Background: Over the last 10 years the incidence of gastric cancer has declined significantly. Nevertheless, it remains one of the most prevalent malignancies both in Russia and worldwide. Therefore, the problems of early diagnostics, prognosis and individualized treatment choice are still on the agenda. Much attention is paid to the evaluation of molecular biological characteristics of the tumor, as well as to the development of multiparametric prognostic systems for gastric cancer based on its identified characteristics. An important place among potential tumor biological markers belongs to matrix metalloproteinases (MMPs) involved into all the stages of tumor progression, first of all, into the regulation of invasion and metastasizing.Aim: Comparative quantitative evaluation of some MMP family members (MMP-2, 7, and 9) and one of the tissue MMP inhibitors (TIMP-2) levels in the tumors and adjacent histologically unchanged mucosa in gastric cancer patients, the analysis of their associations with the main clinical and pathological features of the disease and its prognosis.Materials and methods: Sixty six (66) primary gastric cancer patients (32 male and 34 female) aged 24 to 82 years (median, 61 year) were recruited into the study. Twenty two (22) patients were with stage I of the disease, 11 with stage II, 28 with stage III, and 5 with stage IV. The concentrations of the proteins studied were measured in the tumor and unchanged mucosa extracts by standard direct ELISA kits (Quantikine®, R&D Systems, USA).Results: Tumor MMP-2, 7 and 9 levels were significantly increased, compared to those in the adjacent histologically unchanged mucosa, in 80, 70 and 72% of gastric cancer patients, respectively, while the increase of TIMP-2 level found in 61% of the tumors was not statistically significant. Tumor MMP-2 and TIMP-2 content was increasing significantly with higher T index – size and advancement of the primary tumor (p < 0.01 and p < 0.05 respectively). Tumor MMP-2 level was also increasing in parallel with the N index (regional lymph node involvement; p < 0.01); it was significantly higher in the patients with distant metastases than in those without them (p < 0.05). Tumor MMP-9 and MMP-7 concentrations were not significantly associated with the indices of the tumor progression. The patients were followed up for 1 to 85 months (median, 18.3 months). According to the univariate analysis, high (> 32.6 ng/mg protein) MMP-2 and low MMP-7 (< 1.1 ng/mg protein) levels in the gastric cancer tissue represent statistically significant unfavorable prognostic factors for overall survival. Increased TIMP-2 level is associated with a non-significant decrease in the overall survival (p > 0.05), whereas the MMP-9 level was unrelated to the gastric cancer prognosis. Only T index (p = 0.0034) and tumor MMP-7 content (p = 0.026) remained independent prognostic factors in the multivariate regression analysis.Conclusion: The majority of gastric cancer patients demonstrate a significant increase in the expression of three MMP family members, i.e. gelatinases (MMP-2 and 9), and matrilysin (MMP-7), in the tumors, as compared to adjacent histologically unchanged mucosa. Only MMP-2 levels were associated with the disease progression, increasing with higher TNM system indices. High MMP-2 and low MMP-7 content in the gastric cancer tissue are significant unfavorable prognostic factors for the overall survival in the univariate analysis, but only MMP-7 has retained its independent prognostic value in the multivariate assessment.

scholarly journals Effectiveness and Healthcare Cost of Adding Trastuzumab to Standard Chemotherapy for First-Line Treatment of Metastatic Gastric Cancer: A Population-Based Cohort Study

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1691
Author(s):  
Matteo Franchi ◽  
Roberta Tritto ◽  
Lorena Torroni ◽  
Chiara Reno ◽  
Carlo La Vecchia ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Growth Factor Receptor ◽  
Cost Effective ◽  
Metastatic Gastric Cancer ◽  
Population Based ◽  
Standard Chemotherapy ◽  
Epidermal Growth ◽  
Gastric Cancer Patients

A randomized clinical trial showed that trastuzumab, added to traditional chemotherapy, significantly improved overall survival in human epidermal growth factor receptor 2 (HER2)-overexpressing metastatic gastric cancer patients. This population-based study aimed at evaluating both the clinical and economic impact of trastuzumab in a real-world setting. By using the healthcare utilization databases of Lombardy, Italy, a cohort of patients newly diagnosed with metastatic gastric cancer during the period 2011–2016 was selected. Among these, patients initially treated with either trastuzumab-based chemotherapy or standard chemotherapy alone were followed up until death, migration in other regions or June 2018. Overall survival and average cumulative costs were estimated and compared between the two treatment arms. Among the 1198 metastatic gastric cancer patients who started therapy within six months after metastasis detection, 87 were initially treated with trastuzumab-based chemotherapy and 1111 with standard chemotherapy. Median overall survival and restricted mean survival were 10.2 and 7.4 months, and 14.9 and 11.4 months, respectively, in the two treatment arms. The adjusted hazard ratio of death was 0.73 (95% CI 0.57–0.93). The average per capita cumulative healthcare costs were, respectively, EUR 39,337 and 26,504, corresponding to an incremental cost-effectiveness ratio of EUR 43,998 for each year of survival gained. Our study shows that adding trastuzumab to conventional chemotherapy is effective and cost-effective.

MET amplification occurrence and prediction of unfavorable clinical outcomes in patients with recurrent/metastatic gastric cancer after chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15047-e15047 ◽  
Author(s):  
Yu-hong Li ◽  
Xin An ◽  
Fang Wang ◽  
Qiong Shao ◽  
Feng-Hua Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Protein Expression ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Performance Status ◽  
Progression Free Survival ◽  
Metastatic Gastric Cancer ◽  
Poor Performance Status ◽  
Met Amplification ◽  
Gastric Cancer Patients

e15047 Background: Several large studies have reported an extremely low incidence of MET gene amplification (GA) in patients with radically resected gastric cancer. The aim of our study was to evaluate the prevalence and prognostic role of MET GA and protein expression in recurrent/metastatic gastric cancer patients who received chemotherapy. Methods: This retrospective study included 232 recurrent/metastatic gastric cancer patients. MET GA and protein expression were evaluated by fluorescent in-situ hybridization (FISH) and immunohistochemistry (IHC), respectively.Results: MET GA and strong protein expression were observed in 8.3% and 9.6% of patients, respectively. MET IHC 3+ was significantly correlated with GA. Patients with MET GA more frequently had a poor performance status (P < 0.001) and poorly differentiate tumors (P = 0.015) than those without MET GA. Both MET GA and IHC 3+ expression were associated with substantially shorter median progression free survival (PFS) and overall survival (OS). The median OS and PFS for patients with MET GA positive vs. MET GA negative were 5.7 vs. 15.5 months (P < 0.001) and 3.6 vs. 6.9 months (P < 0.001), respectively.The median OS and PFS for patients with MET IHC 3+ vs. IHC (0 to 2+) were 6.3 vs. 15.1 months (P < 0.001) and 3.6 vs. 7.0 months (P < 0.001), respectively. Conclusions: In recurrent/metastatic gastric cancer, MET amplification and strong protein expression are not rare and significantly associated with unfavorable clinical outcomes.

Subcutaneous Therapy with Low-Dose Interleukin-2 plus the Neurohormone Melatonin in Metastatic Gastric Cancer Patients with Low Performance Status

1993 ◽  
Vol 79 (6) ◽  
pp. 401-404 ◽  
Author(s):  
Paolo Lissoni ◽  
Fernando Brivio ◽  
Antonio Ardizzoia ◽  
Gabriele Tancini ◽  
Sandro Barni
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Low Dose ◽  
Tumor Regression ◽  
Performance Status ◽  
Interleukin 2 ◽  
Biological Response ◽  
Metastatic Gastric Cancer ◽  
Low Performance ◽  
Gastric Cancer Patients

Aims and background Patients with disseminated gastric cancer are generally in very bad clinical conditions, which make them not eligible for potentially active polychemotherapies. This justifies the development of less toxic therapies such as the use of biological response modifiers. Unfortunately, IL-2, one of the most promising cytokines, does not seem to be effective in gastric cancer. Our previous studies have shown that the pineal hormone melatonin (MLT) may amplify IL-2 activity, which becomes biologically effective also at very low doses. Based on these considerations, a pilot study was performed with low-dose subcutaneous IL-2 in combination with MLT in metastatic gastric cancer patients with low performance status. Methods The study included 14 patients with metastatic gastric cancer who received IL-2 at a dose of 3 million IU/day at 8.00 p.m. subcutaneously for 6 days/week for 4 weeks. MLT was given orally at a dose of 50 mg/day at 8.00 p.m. every day starting 7 days before IL-2. In patients in whom the disease did not progress, a second cycle was given after a rest period of 21 days. Results A tumor regression was obtained in 3/14 (21 %) patients, complete response in 1 and partial in 2, with a median duration of 13+ months. The disease stabilized in 6/14 (43 %) patients and progressed in the remaining 5 (36 %). Survival was significantly longer in patients with response or stable disease than in those with progression. Toxicity was low in all cases. Conclusions These preliminary results show that the combination on of low-dose subcutaneous IL-2 and the pineal hormone MLT may represent a new well tolerated biotherapy, capable of inducing objective tumor regression also in patients with metastatic gastric cancer and low performance status.

scholarly journals A real-world evidence of efficacy of palliative gastrectomy plus chemotherapy in metastatic gastric cancer patients

2019 ◽  
Vol Volume 11 ◽  
pp. 3993-4003
Author(s):  
Lu-Ping Yang ◽  
Zi-Xian Wang ◽  
Ming-Ming He ◽  
Hao-Xiang Wu ◽  
Shu-Qiang Yuan ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Real World ◽  
Metastatic Gastric Cancer ◽  
Palliative Gastrectomy ◽  
Real World Evidence ◽  
Gastric Cancer Patients

scholarly journals Efficacy and Outcomes of Intraoperative Extensive Lavage Plus Surgery Versus Surgery Alone in Patients with Advanced Gastric Cancer: A Multicenter Randomized Controlled Trial

2021 ◽  
Author(s):  
Li-xiang Zhang ◽  
Chuan-hong Li ◽  
Jun Ma ◽  
Lei Chen ◽  
Zhi-jian Wei ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Advanced Gastric Cancer ◽  
Cancer Patients ◽  
Survival Curve ◽  
Recurrence Free Survival ◽  
Abdominal Abscess ◽  
Free Survival ◽  
Gastric Cancer Patients

Abstract Objective: This randomized study aims to evaluate the efficacy and long-term outcome of advanced gastric cancer patients with extensive intraoperative peritoneal lavage (EIPL). Methods: A total of 150 patients with advanced gastric cancer were enrolled in this study, the patients were randomly allocated to 2 groups: the group of surgery alone (non-EIPL group), the group of surgery plus EIPL (EIPL group). The surviving rate analysis was compared by the Kaplan–Meier method. The prognostic factors were carried out using the Cox appropriate hazard pattern. Results: Symptom of ileus and abdominal abscess appeared more frequently in the non-EIPL group(p<0.05). The overall survival (OS) curve and the recurrence free survival (RFS) curve of the EIPL group was better than the non-EIPL group (p<0.05). The EIPL, tumor size, vascular invasion, N stage and T stage were independent prognostic factors of overall survival. The independent risk factors of recurrence free survival (RFS) include EIPL and tumor size. Conclusions: The present study revealed that EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess. Besides, the overall survival curve and recurrence free survival curve are better in the EIPL group. This technique is easy and not-expensive, therefore EIPL can benefit advanced gastric cancer patients a lot and would be a promising therapeutic strategy in the future.Trial Registration: Clinical Trials.gov, identifier: NCT02745509, Registered 28 March2016,https://clinicaltrials.gov/ct2/show/NCT02745509?cond=NCT02745509&draw=2&rank=1.

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