Proximal Metastatic Gastric Cancer in Youth: The Mayor of São Paulo City as an Example of a Current Phenomenon

Ramos, Marcus Fernando Kodama Pertille; Barchi, Leandro Cardoso; Weston, Antônio Carlos; Zilberstein, Bruno

doi:10.1590/0102-672020200003e1536

Cited by 2 publications

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References 3 publications

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“…However, even in stage IV, surgery may still play an important role in the treatment of GC 24 . According to its indication, the procedures performed in these patients can be classified as diagnostic, palliative, cytoreductive, and even curative.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment in Clinical Stage Iv Gastric Cancer: A Comparison of Different Procedures and Survival Outcomes

Ramos

Pereira

Dias

et al. 2022

ABCD, arq. bras. cir. dig.

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- BACKGROUND: Even in clinical stage IV gastric cancer (GC), surgical procedures may be required to palliate symptoms or in an attempt to improve survival. However, the limited survival of these patients raises doubts about who really had benefits from it. AIM: This study aimed to analyze the surgical outcomes in stage IV GC treated with surgical procedures without curative intent. METHODS: Retrospective analyses of patients with stage IV GC submitted to surgical procedures including tumor resection, bypass, jejunostomy, and diagnostic laparoscopy were performed. Patients with GC undergoing curative gastrectomy served as the comparison group. RESULTS: Surgical procedures in clinical stage IV were performed in 363 patients. Compared to curative surgery (680 patients), stage IV patients had a higher rate of comorbidities and ASA III/IV classification. The surgical procedures that were performed included 107 (29.4%) bypass procedures (partitioning/gastrojejunal anastomosis), 85 (23.4%) jejunostomies, 76 (20.9%) resections, and 76 (20.9%) diagnostic laparoscopies. Regarding patients’ characteristics, resected patients had more distant metastasis (p=0.011), bypass patients were associated with disease in more than one site (p<0.001), and laparoscopy patients had more peritoneal metastasis (p<0.001). According to the type of surgery, the median overall survival was as follows: resection (13.6 months), bypass (7.8 months), jejunostomy (2.7 months), and diagnostic (7.8 months, p<0.001). On multivariate analysis, low albumin levels, in case of more than one site of disease, jejunostomy, and laparoscopy, were associated with worse survival. CONCLUSION: Stage IV resected cases have better survival, while patients submitted to jejunostomy and diagnostic laparoscopy had the worst results. The proper identification of patients who would benefit from surgical resection may improve survival and avoid futile procedures.

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Section: Introductionmentioning

confidence: 99%

Surgical Treatment in Clinical Stage Iv Gastric Cancer: A Comparison of Different Procedures and Survival Outcomes

Ramos

Pereira

Dias

et al. 2022

ABCD, arq. bras. cir. dig.

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Gastric cancer with microsatellite instability displays increased thymidylate synthase expression

Pereira

Dias

Ramos

et al. 2022

Journal of Surgical Oncology

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Background: Gastric cancer (GC) with microsatellite instability (MSI) is a less aggressive disease and associated with resistance to 5-fluorouracil (5-FU)-based chemotherapy (CMT). Thymidylate synthase (TS) is inhibited by 5-FU, and another potential mediator of therapeutic resistance to 5-FU. Therefore, we aimed to analyze the association between MSI and TS expression in GC, and its impact on disease outcomes. Methods:We retrospectively evaluated GC who underwent D2-gastrectomy. MSI and TS were analyzed by immunohistochemistry. We also investigated p53 expression, PD-L1 status, and tumor-infiltrating lymphocytes (CD4 and CD8).Results: Out of 284 GC, 60 (21.1%) were MSI. Median TS-score for all cases was 16.5. TS expression was significantly higher in MSI compared to microsatellite-stable (MSS; p < 0.001). Considering both status, GC were classified in four groups: 167 (58.8%) MSS + TS-low; 57 (20.1%) MSS + TS-High; 24 (8.5%) MSI + TS-low; and 36 (12.7%) MSI + TS-high. MSI + TS-high group had less advanced pTNM stage, higher CD8+T cells levels (p < 0.001) and PD-L1 positivity (p < 0.001). Normal p53 expression was related to MSI GC (p < 0.001). Improved survival was observed in MSI + TS-high, but no survival benefit was seen with CMT.Conclusion: MSI GC was associated with high TS levels, which may explain therapeutic resistance to 5-FU. Additionally, MSI + TS-high showed better survival, but without improvement with CMT.

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Proximal Metastatic Gastric Cancer in Youth: The Mayor of São Paulo City as an Example of a Current Phenomenon

Cited by 2 publications

References 3 publications

Surgical Treatment in Clinical Stage Iv Gastric Cancer: A Comparison of Different Procedures and Survival Outcomes

Surgical Treatment in Clinical Stage Iv Gastric Cancer: A Comparison of Different Procedures and Survival Outcomes

Gastric cancer with microsatellite instability displays increased thymidylate synthase expression

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