Proposal to Subclassify Stage IV Gastric Cancer Into IVA, IVB, and IVM

An, Ji Yeong; Ha, Tae Kyung; Noh, Jae Hyung; Sohn, Tae Sung; Kim, Sung Hoon

doi:10.1001/archsurg.2008.502

Cited by 31 publications

(21 citation statements)

References 13 publications

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“…Recent studies in large-volume hospitals in Korea and China have shown clinical and survival differences among subgroups of patients with stage IV GC. Patients with stage IV (M 0 ) GC have a longer OS than those with stage IV (M 1 ) GC [25,26]. Therefore, we excluded stage IV (M 0 ) patients in our study to obtain a more homogeneous group.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

et al. 2011

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Background This study was performed to investigate the role of surgery in patients with gastric cancer and distant metastases who had received systemic chemotherapy. Methods Patients with newly diagnosed gastric cancer and synchronous distant metastases who had received chemotherapy (n = 274) were categorized into 3 groups according to the surgical treatment rendered: complete gross resection of both primary and metastatic sites (group A; n = 42); debulking gastrectomy (group B; n = 47); and chemotherapy without debulking (group C; n = 185). Results The median overall survival of all patients was 11.8 months. The median overall survival and 3-year survival rates were 28.0, 15.5, and 9.0 months and 42.8, 8.1, and 3.5% in groups A, B, and C, respectively. In group A, patients with peritoneal seeding, intra-abdominal distant lymph nodes, or ovarian or hepatic metastases underwent complete gross resection, and 12 (29%) were disease-free at the time of the last analysis (median follow-up duration, 29.1 months). On multivariate analysis, the adjusted hazard ratios for death were 0.27 (P \ 0.001) and 0.64 (P = 0.024) for groups A and B, respectively, as compared to group C.Conclusions Our study suggests survival benefits of debulking gastrectomy or gastrectomy plus metastasectomy in gastric cancer patients with distant metastases receiving systemic chemotherapy. Prolonged disease-free survival was observed after complete resection (gastrectomy plus metastasectomy) that may lead to cure in some patients. Well-designed prospective trials of the role of multidisciplinary approaches combining chemotherapy and surgery are needed to confirm the observations of our study.

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Section: Discussionmentioning

confidence: 99%

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

et al. 2011

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“…Authors recorded procedure-related morbidity in 12 articles (Table 1) [12,13,18,26,27,31,45,[56][57][58][65][66][67]. Morbidity was generally defined as those complications, excluding death, occurring during the hospital stay that related to the operation performed.…”

Section: Procedure-related Morbidity and Mortalitymentioning

confidence: 99%

A systematic review of surgery for non-curative gastric cancer

et al. 2011

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Background Most gastric cancer patients present with advanced stage disease precluding curative surgical treatment. These patients may be considered for palliative resection or bypass in the presence of major symptoms; however, the utility of surgery for non-curative, asymptomatic advanced disease is debated and the appropriate treatment strategy unclear. Purpose To evaluate the non-curative surgical literature to better understand the limitations and benefits of noncurative surgery for advanced gastric cancer.Methods A literature search for non-curative surgical interventions in gastric cancer was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases from 1 January 1985 to 1 December 2009. All abstracts were independently rated for relevance by a minimum of two reviewers. Outcomes of interest were procedure-related morbidity, mortality, and survival. Results Fifty-nine articles were included; the majority were retrospective, single institution case series. Definitions describing the treatment intent for gastrectomy were incomplete in most studies. Only five were truly performed with relief of symptoms as the primary indication for surgery, while the majority were considered non-curative or not otherwise specified. High rates of procedure-related morbidity and mortality were demonstrated for all surgeries across the majority of studies and treatment-intent categories. Median and 1-year survival were poor, and values ranged widely within surgical approaches and across studies. Conclusions A lack of transparent documentation of disease burden and symptoms limits the surgical literature in non-curative gastric cancer. Improved survival is not evident for all patients receiving non-curative gastrectomy. Further prospective research is required to determine the optimal intervention for palliative gastric cancer patients.

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“…Definitive diagnosis requires gastroscopic or surgical biopsy, with histology reported by an experienced pathologist according to WHO criteria. Surgery is the only potentially curative treatment, but even when surgical resection is possible, long-term survival occurs only in a minority of patients, with overall 5-year survival of less than 30% after gastrectomy (445,446 ).…”

Section: Introductionmentioning

confidence: 99%

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric Cancers

et al. 2010

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Background: Updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed. Methods: Published reports relevant to use of tumor markers for 4 cancer sites—liver, bladder, cervical, and gastric—were critically reviewed. Results: α-Fetoprotein (AFP) may be used in conjunction with abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or cirrhosis associated with hepatitis B or C virus infection. AFP concentrations >200 μg/L in cirrhotic patients with typical hypervascular lesions >2 cm in size are consistent with HCC. After a diagnosis of HCC, posttreatment monitoring with AFP is recommended as an adjunct to imaging, especially in the absence of measurable disease. Although several urine markers have been proposed for bladder cancer, none at present can replace routine cystoscopy and cytology in the management of patients with this malignancy. Some may, however, be used as complementary adjuncts to direct more effective use of clinical procedures. Although carcinoembryonic antigen and CA 19-9 have been proposed for use gastric cancer and squamous cell carcinoma antigen for use in cervical cancer, none of these markers can currently be recommended for routine clinical use. Conclusions: Implementation of these recommendations should encourage optimal use of tumor markers for patients with liver, bladder, cervical, or gastric cancers.

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Proposal to Subclassify Stage IV Gastric Cancer Into IVA, IVB, and IVM

Cited by 31 publications

References 13 publications

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

A systematic review of surgery for non-curative gastric cancer

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric Cancers

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