Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: A prospective with quality control 10-year follow-up study

Abstract

UICC classification accurately predicts overall survival but not recurrence-risk. We report here data of overall and first site-specific recurrence following curative surgery useful for the development of recurrence-oriented preventive target therapies. Patients who underwent resection for gastric cancer were stratified according to curability of surgery [curative (R0) vs non-curative resection], extent of surgery [limited (D1) vs extended (D2) node dissection] and pathological nodal/serosal status. The intent-to-treat principle, log-rank test and Cox regression analysis were used for statistical analysis of time-to-event (recurrence, death) endpoints. Curative resection only produced a chance of cure whereas survival was very poor following non-curative resection ( P < 0.0001). For D2 R0 subgroup of patients, a pathological serosa and a node state-based classification into three groups, proved to be of clinical implication. Risk of recurrence after a median follow-up of 92 months was low among patients with both serosa and node-negative cancer (first group; 11%), moderate among those with either serosa or node-positive cancer (second group; 53%) and very high among those with both serosa and node-positive cancer (third group; 83%). In multivariate analysis, the relative risks of recurrence and death from gastric cancer among patients in the second and third groups, as compared to those in the first, were 7.07 (95% CI, 2.36–21.17; P = 0.0002) and 16.19 (95% CI, 5.76–45.54; P < 0.0001) respectively. First site-specific recurrence analysis revealed: low rate of loco-regional recurrence alone (12%), serosa state determinant factor of the site-recurrence (peritoneal for serosa-positive and haematogenous for serosa-negative cancers) and dramatic increase of all types of recurrence by the presence of nodal metastases. Our findings demonstrate that a pathological serosa- and node-based classification is very simple and predicts accurately site-specific recurrence-risks. Furthermore they reveal that risk of recurrence following curative D2 surgery alone is low for serosa- and node-negative cancers, but very high in serosa- and node-positive cancers suggesting the need for new therapeutic strategies in this subgroup of patients. © 2001 Cancer Research Campaign http://www.bjcancer.com

Effect of hospital characteristics on outcome of patients with gastric cancer: A population based study in North-East Netherlands

“…In our study older age, advanced or unknown stage, poorly differentiated tumours and proximal location resulted in lower probability of resection. Moreover in gastric cancer both tumour (T) and nodal (N) status are important elements in determining treatment plans and independent prognostic factors of long-term survival [12][13][14]. Better outcome was also found in specialised centres [15][16][17][18].…”

βig-h3 supports gastric cancer cell adhesion, migration and proliferation in peritoneal carcinomatosis

“…In this study, we observed the expression of βig-h3 in peritoneal mesothelial cells and the positive rate of βig-h3 was significantly higher in the more invasive and advanced serous-type subgroups. Previously, the depth of invasion and the serosal changes were reported to be significant risk factors for the prediction of peritoneal recurrence (15,17). Thus, we proposed the hypothesis that the βig-h3 expression in peritoneal mesothelial cells in gastric cancer patients may be a marker of the biological behavior of gastric cancer and could predict peritoneal metastasis.…”

“…The cytologic examination of the lavage fluid obtained during surgery is a conventional method to detect free cancer cells in the peritoneal space and is considered a gold standard for predicting peritoneal metastasis (18). In recent years, however, some investigations have demonstrated that the CEA RT-PCR analysis of peritoneal lavage fluids was more sensitive than conventional cytology (17,19). Thus, both examinations were performed.…”

Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

“…Whether early stage GC received the same benefit of NAC remains unclear since serosa-negative gastric cancer in Japan exhibited 83% DFS and 86% OS by a D2 LND without adjuvant CTx (JCOG9206-1) (Nashimoto et al, 2003). Similar favorable survival results by qualified surgery in earlier stage GC were also reported from the West (Roukos et al, 2001;Siewert et al, 1998), suggesting that patients with a low risk of recurrence can be cured with adequate surgery alone (Roukos, 2004). The benefit of NAC is also influenced by the quality of surgery.…”