Salvage surgery after chemotherapy with S-1 plus cisplatin for α-fetoprotein-producing gastric cancer with a portal vein tumor thrombus: a case report

Nakao, Shigetomi; Nakata, Bunzo; Tendo, Masashige; Kuroda, Kenji; Hori, Takeshi; Inaba, Mayumi; Hirakawa, Kosei; Ishikawa, Tetsuro

doi:10.1186/1471-2482-15-5

Cited by 16 publications

(20 citation statements)

References 22 publications

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“…As a disease similar to HCC, alpha-fetoprotein (AFP) producing gastric cancer, namely hepatoid adenocarcinoma with hepatic differentiation, sometimes produces PVTT. 3,4 However, in our case, immunohistochemistry of the resected tissue specimen stained negative for AFP.…”

Section: Discussioncontrasting

confidence: 46%

“…There have been some reports describing cases with a long-term survival, but all of these cases achieved R0 resection with no distant metastases, or had metastases controllable by chemotherapy. [4][5][6][7] Even in highly advanced gastric cancer cases with PVTT, if other poor prognostic factors do not exist or are under control, aiming at R0 resection is thought to be the only way to achieve a cure. Although careful preoperative diagnosis is necessary, in cases in where R0 resection is judged to be possible, a surgical approach should be attempted.…”

Section: Discussionmentioning

confidence: 99%

“…There are a few reports in which splenic metastasis or PVTT has disappeared in response to chemotherapy, and long-term survival was obtained by then applying conversion surgery. 4,5 However, according to the report by Eom et al, 1 although chemotherapy was performed in 43 of 51 cases, the median survival was only 5.4 months, and therefore the effect of chemotherapy for gastric cancer patients with PVTT is thought to be limited. Nonetheless, in inoperable cases, there is no treatment other than chemotherapy, and new regimens and drugs are necessary.…”

Section: Discussionmentioning

confidence: 99%

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Successful Management of Advanced Gastric Cancer With Bulky Lymph Node Metastases and Tumor Thrombus in the Portal Vein System: A Case Report

Yamagata

Saito

Hirano

et al. 2019

International Surgery

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Background Gastric cancer cases with tumor thrombus in the portal vein system (PVTT) are rare, frequently develop liver metastasis, and have a very poor prognosis. Case presentation A 65-year-old man presented to a physician with a complaint of upper abdominal pain persisting for 2 months. Esophagogastroduodenoscopy revealed a Borrman type 2 tumor, and he was referred to our hospital. Computed tomography (CT) showed wall thickening of the stomach, bulky swelling of lymph nodes in the lesser curvature and along the pancreas body, tumor thrombus in the splenic to the portal vein. CT showed no liver or lung metastases, ascites, or peritoneal nodules. Staging laparoscopy revealed P0CY0. We planned to administer neoadjuvant chemotherapy (NAC), consisting of two courses of TS-1 and cisplatin combined chemotherapy. However, the second course of the chemotherapy was canceled on day 8 because of influenza. CT after chemotherapy showed no remarkable change, but we decided to undertake the planned operation. Total gastrectomy and pancreaticosplenectomy, along with lymphadenectomy, thrombectomy, and cholecystectomy was performed. The patient was discharged on the 12th day after the operation, without complications. Histopathological examination showed a well to moderately differentiated adenocarcinoma with 45 lymph node metastases. The specimen of the tumor thrombus also showed a moderately differentiated adenocarcinoma. Because he did not want additional chemotherapy, we selected follow-up observation. The patient has remained disease-free for 36 months after the operation. Conclusion We described a patient with advanced gastric cancer with PVTT, who could undergo R0 resection with a good clinical course.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Successful Management of Advanced Gastric Cancer With Bulky Lymph Node Metastases and Tumor Thrombus in the Portal Vein System: A Case Report

Yamagata

Saito

Hirano

et al. 2019

International Surgery

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“…[ 4 , 19 , 20 ] Adjuvant chemotherapy treatments have been employed, but it remains to be shown which drugs or combinations of drugs should be used, and the evidence is weak based on the limited clinical experience. [ 14 , 19 , 45 ] The same applies for neoadjuvant chemotherapy [ 46 , 47 ] and palliative systemic treatments,[ 48 , 49 ] which have been offered to a small number of patients.…”

Section: Discussionmentioning

confidence: 99%

Hepatoid adenocarcinoma of the stomach – proper identification and treatment remain a challenge

Søreide

Greve

Gudlaugsson

et al. 2016

Scandinavian Journal of Gastroenterology

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Objective The term hepatoid adenocarcinoma (HAC) of the stomach was introduced three decades ago with the observation of high serum α-fetoprotein (AFP) levels in some gastric adenocarcinoma patients. This very rare gastric cancer patient subgroup is likely frequently misdiagnosed. Material Two patients who were recently diagnosed with HAC of the stomach at our institution are presented. We also performed a structured literature search and reviewed pertinent articles to provide knowledge to improve the proper identification, diagnosis and management of patients with gastric HAC. Results HAC is a rare subgroup of gastric carcinoma with poor prognosis. Clinical management of this population may be challenging. The scientific literature is largely based on very small patient series or case reports, and the evidence for proper decision making and management is considered weak. Conclusion All physicians involved in the diagnosis and treatment of patients with gastric cancer should pay attention to this rare subgroup to improve identification.

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“…The statistical results might have been affected by the small sizes of the subgroups for the degrees of differentiation and types of therapy received; thus, larger sample sizes should be used in sub-sequent studies. Thus far, the main reasons for the poor prognosis of HAS have been reported to likely include the high lymphatic (54.8%) and distant (25.8%) metastasis rates before surgery, 22 particularly the early 34 , 35 and frequent 2 , 17 development of liver metastasis and portal vein tumor thrombus (PVTT). 3 HAS is more aggressive than other types of adenocarcinoma 3 , 29 because it begins as an aggressive clone featuring extensive loss of heterozygosity (LOH) and high fractional allelic loss.…”

Section: Discussionmentioning

confidence: 99%

PRISMA-Compliant Article

et al. 2016

Medicine

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Most previous studies have been single case reports, and studies with large samples are presently lacking. In addition, no studies have investigated the associations between the clinical characteristics and prognosis of hepatoid adenocarcinoma of the stomach (HAS).The aim of this study was to explore the associations of different clinical characteristics with the ages, serum alpha-fetoprotein (AFP) levels, and survival times of HAS patients.The present study was conducted using the CBM disc, HowNet, Wanfang and VIP data resource systems, and PubMed. According to the PRISMA Flow Diagram, certain case reports from the same center, those that did not provide patient age or sex, and those that did not report serum AFP levels or AFP immunohistochemistry results were excluded. A total of 131 relevant articles, including 124 case reports, 5 reviews, and 2 postgraduate Master's theses, were reported in the above-mentioned five databases. We applied inclusion criteria to case reports on the clinical characteristics and prognosis of HAS, which resulted in the ultimate inclusion of 180 patients from 62 case reports for statistical analyses.The main finding was that the age of the men was significantly higher than that of the women (P = 0.004). In addition, the serum AFP levels of the participants with antral disease were significantly higher than those with nonantral disease (P = 0.001). The median serum AFP levels and survival times significantly differed among the patients with the three lesion types (P = 0.001 and 0.019, respectively). The serum AFP levels of the participants with ulcerative-upheaval-type tumors and purely ulcerative tumors were significantly higher than those with upheaval-type tumors (P = 0.000 and 0.017, respectively). In addition, the serum AFP levels of the participants with ulcerative-upheaval-type tumors were significantly higher than those with ulcerative-type tumors (P = 0.019), and their survival time was also significantly higher (P = 0.000). The serum AFP levels of the participants without metastasis or liver metastasis were significantly lower than those with metastasis or liver metastasis (P = 0.000 and 0.000, respectively), and their survival time was significantly longer (P = 0.000 and 0.001, respectively). Finally, the survival time of the participants treated with surgery was significantly longer than those treated using nonsurgical methods (P = 0.046). However, survival analysis revealed that the survival time was only significantly associated with the presence of metastasis (P = 0.002) and liver metastasis (P = 0.036).The main limitations of this study are as follows: it was a retrospective analysis of published case reports, the clinical data were incomplete, and the cases included in subgroup analyses were different.Our study results have demonstrated that the prognosis of HAS patients is poor. In addition, the survival time is significantly negatively correlated with the presence of metastasis and liver metastasis.

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Salvage surgery after chemotherapy with S-1 plus cisplatin for α-fetoprotein-producing gastric cancer with a portal vein tumor thrombus: a case report

Cited by 16 publications

References 22 publications

Successful Management of Advanced Gastric Cancer With Bulky Lymph Node Metastases and Tumor Thrombus in the Portal Vein System: A Case Report

Successful Management of Advanced Gastric Cancer With Bulky Lymph Node Metastases and Tumor Thrombus in the Portal Vein System: A Case Report

Hepatoid adenocarcinoma of the stomach – proper identification and treatment remain a challenge

PRISMA-Compliant Article

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