Re‐emerging role of macroscopic appearance in treatment strategy for gastric cancer

Abstract

Pathological outcomes are definitely the most important prognostic factors in gastric cancer, but they can be obtained only after surgical resection. Use of preoperative adjuvant chemotherapy is becoming widespread for aggressive human cancer, so clinical factors such as macroscopic features are important as they are highly predictive for patient prognosis. In gastric cancer, the macroscopic type represents a distinct prognosis; Type 0 represents early gastric cancer with excellent prognosis, but, among advanced tumors, giant Type III and Type IV tumors have a dismal prognosis. Japan Clinical Oncology Group (JCOG) Stomach Cancer Study Group adopted macroscopic features as high‐risk entities in clinical trials. It makes sense for risk classification to use macroscopic phenotypes because The Cancer Genome Atlas (TCGA) Network has lately subcategorized different histologies associated with specific macroscopic types by the molecular features of the whole genome. Dismal prognosis of Type IV gastric cancer is notorious, but similar prognosis was seen in giant Type III gastric cancer defined as 8 cm or beyond, both of which are unique for their propensity of peritoneal dissemination. In this review, clinical relevance including prognosis of such macroscopic high‐risk features will be separately debated in the context of precision medicine and updated prognostic outcomes will be presented under the present standard therapy of curative surgery followed by postoperative S‐1 chemotherapy. Moreover, promising emerging novel therapeutic strategies including trimodal potent regimens or intraperitoneal chemotherapy will be described for such aggressive gastric cancer.

Nomogram Based on Preoperative Fibrinogen and Systemic Immune-Inflammation Index Predicting Recurrence and Prognosis of Patients with Borrmann Type III Advanced Gastric Cancer

“…The proportion of Borrmann III accounts for 40.6%-58.9% of AGC and the five-year survival rate was 46.0%-51.6%. 7,8 When the diameter of the tumor is greater than 8cm or the combined vascular infiltration, the prognosis of Borrmann III is similar to Borrmann IV. 10,26,27 Thus, we still need to develop a new biomarker evaluation Borrmann III AGC patients' prognosis.…”

“…2,3 In order to evaluate the AGC patients prognosis, experts have proposed a variety of classification methods according to tumor biological characteristics. 4,5 Since 1926, the Borrmann classification according to tumor macroscopic characteristics, 6 and the most common macro type of AGC is Borrmann III, 7,8 which has significant prognostic differences according to different clinicopathological features. Hosoda et al 9 considered that tumor size was related to the prognosis of AGC with Borrmann III.…”

Prospective study to validate the clinical utility of DNA diagnosis of peritoneal fluid cytology test in gastric cancer

“…Advanced GC defined as pathological tumor depth (pT) 2 or beyond has still poor survival outcomes despite progress in multidisciplinary therapy 2‐5 . Among advanced GCs, tumors with macroscopic features of type III and type IV exhibited dismal prognosis as compared with type I/II/V tumors predominantly due to peritoneal recurrence including microscopic peritoneal dissemination representing positive peritoneal cytology test (CY1) 6 . CY1 was recently acknowledged as a stage IV factor from a prognostic point of view in both the eastern and western countries 7‐9 .…”

“…[2][3][4][5] Among advanced GCs, tumors with macroscopic features of type III and type IV exhibited dismal prognosis as compared with type I/II/V tumors predominantly due to peritoneal recurrence including microscopic peritoneal dissemination representing positive peritoneal cytology test (CY1). 6 CY1 was recently acknowledged as a stage IV factor from a prognostic point of view in both the eastern and western countries. [7][8][9] Despite pathological CY0 confirmation after curative surgery, many tumors with macroscopic features of type III and type IV encountered peritoneal recurrences, suggesting that pathological CY0 is not sufficient to guarantee microscopic tumor-free status in GC clinics.…”