Extended Lymph-Node Dissection for Gastric Cancer

Bonenkamp, Johannes J.; Hermans, J.; Sasako, Mitsuru; Velde, Cornelis Jh van de; Welvaart, K; Songun, Ilfet; Meyer, S.; Plukker, John; Elk, P. van; Obertop, H.; Gouma, D. J.; Lanschot, Jan J. van; Taat, C. W.; Graaf, Peter W. de; Meyenfeldt, M.F. von; Tilanus, Hugo W.

doi:10.1056/nejm199903253401202

Cited by 1,453 publications

(927 citation statements)

References 18 publications

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“…However, the improvement in results obtained with that operation in Japan have not been confirmed in Western countries. 44,45 The evidence for the efficacy of gastric cancer screening in Japan in preventing advanced disease as well as death from gastric cancer rests on the results of observational studies, so the contribution of selection bias to any favorable effect (low-risk individuals choosing to be screened) is hard to evaluate. Only one randomized trial has been reported, 33 and, although no results were available at the time, it is highly unlikely that, given the small difference in screening experience between intervention and control groups, any benefit could emerge later.…”

Section: Respective Roles Of Lifestyle and Screeningmentioning

confidence: 99%

Incidence and mortality from stomach cancer in Japan, Slovenia and the USA

Lambert

Guilloux

Oshima

et al. 2001

Intl Journal of Cancer

105

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The mortality and incidence from stomach cancer were compared in Japan (a country with a high incidence where there was full application of mass screening during this period) and 2 countries with no screening policy: the USA (with a very low incidence) and Slovenia (with an intermediate rate). The registered cases of stomach cancer were from the Osaka Cancer Registry, the Slovenian National Cancer Registry and the Surveillance, Epidemiology, and End Results (SEER) registries in the USA. In the period 1975-95, the age-adjusted incidence rate (/100,000) of stomach cancer declined in the 3 countries, as follows: Japan, from 76.0 to 53.0 in men and 38.4 to 21.3 in women; Slovenia, from 40.2 to 24.1 in men and 16.6 to 10.8 in women; and the USA, from 9.5 to 6.9 in men and 4.3 to 2.9 in women. During the same period, the age-adjusted mortality rate declined, as follows: Japan, from 60.2 to 34.2 in men and 30.5 to 14.1 in women; Slovenia, from 37.7 to 21.2 in men and 13.8 to 9.0 in women; the USA, from 5.6 to 4.7 in men and 2.5 to 2.3 in women. In the period studied, specific trends on incidence and mortality with a cohort effect occurred only in Japan: analysis by the age period-cohort model confirmed that the decline has occurred since the generations born in 1910. The trend therefore corresponds to unplanned prevention through changes in environmental factors occurring since the early 20 th century. The study of stage-specific incidence rates confirmed the declining trend for regional cancer, whereas there was an increase in the incidence of localized cancer, associated with a period effect in 1975-95. This is attributed to the policy of early detection of stomach cancer, with the inclusion of intramucosal lesions of favorable prognosis and explains why mortality decreased faster than incidence during the period.

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Section: Respective Roles Of Lifestyle and Screeningmentioning

confidence: 99%

Incidence and mortality from stomach cancer in Japan, Slovenia and the USA

Lambert

Guilloux

Oshima

et al. 2001

Intl Journal of Cancer

105

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“…While a decreased incidence of gastric adenocarcinoma has been observed for several decades in Western countries, this has been accompanied by an increase in the incidence of tumours of the gastro-oesophageal junction and a simultaneous shift towards poorly differentiated adenocarcinomas (Blot et al, 1991). Most gastric tumours are diagnosed at an advanced stage, and surgery, even if performed with curative intent, gives disappointing results with an overall 5-year survival of 10% (Maruyama et al, 1987;Wanebo et al, 1993;Bonenkamp et al, 1999). The causes of surgical failure are a combination of local recurrence and distant metastases.…”

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confidence: 99%

Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial

et al. 2003

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To assess the response rate and the tolerance of irinotecan as first-line therapy, 40 patients with metastatic gastric cancer received irinotecan 350 mg m À2 every 3 weeks administered as a 30 min infusion. Among the 35 patients evaluable for response, two complete and five partial responses were recorded (response rate: 20.0% (95% CI:8.4 -36.9%)). In total, 16 patients achieved stable disease and 12 progressive disease. In all, 66 percent of the patients benefited from tumour growth control. The median time to progression was 3.0 months (95% CI: 2.3 -4.4%). The median overall survival was 7.1 months (95% CI: 5.2 -9.0%). The probability of being alive at 6 months and 9 months was 61.0 and 32.4%, respectively. The median number of cycles per patient was 3 (range 1 -14), and the relative dose intensity was 0.98. The most common grade 3 -4 toxicities by patients were diarrhoea 20%, asthenia 10%, nausea 7.5%, vomiting 5.0%, abdominal pain 5%, neutropenia 38.5%, leucopenia 28.2%, anaemia 12.8% and thrombocytopenia 5.1%. Febrile neutropenia occurred in 12.5% of patients. These findings indicate that irinotecan is active and well tolerated in patients with metastatic gastric adenocarcinoma and warrants further evaluation in this clinical setting.

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“…This was thought to be a consequence of distal pancreatectomy and splenectomy, which were an integral part of most D 2 procedures when these trials were designed. Long-term results of both trials have since failed to show a significant survival benefit to D 2 surgery (Bonenkamp et al, 1999;Cuschieri et al, 1999). …”

mentioning

confidence: 99%

Influence of pathological tumour variables on long-term survival in resectable gastric cancer

2002

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Although tumour stage and nodal status are established prognostic factors for resectable gastric cancer, the relative importance of other pathological characteristics remains unclear. This study reports univariate and multivariate analyses of the prognostic value of various pathological and staging factors based on 324 patients entered into the MRC randomised surgical trial for gastric cancer. In the univariate analysis tumour stage, nodal status, UICC clinical stage, number of involved nodes, WHO predominant type, mixed Lauren type, Ming type, tumour differentiation, lymphocytic and tumour stromal eosinophilic infiltration were all found to have a significant impact on survival (logrank test, 5% level). In the multivariate analysis, UICC clinical stage and eosinophilic infiltration were found to have a significant influence. Risk of death increased for UICC stage II and III patients (Hazard Ratio for stage II compared to stage I=2.0, 95% Confidence Interval (CI) 1.4 -2.9; Hazard Ratio for stage III compared to stage I=3.5, 95% CI 2.5 -4.8). Patients with numerous eosinophils had a lower risk of death than those with none (Hazard Ratio=0.5, 95% CI 0.3 -0.8). This association between survival and eosinophilic infiltration merits further study.

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Extended Lymph-Node Dissection for Gastric Cancer

Abstract: Our results in Dutch patients do not support the routine use of D2 lymph-node dissection in patients with gastric cancer.

Cited by 1,453 publications

References 18 publications

Incidence and mortality from stomach cancer in Japan, Slovenia and the USA

Incidence and mortality from stomach cancer in Japan, Slovenia and the USA

Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial

Influence of pathological tumour variables on long-term survival in resectable gastric cancer

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