Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry

Carmona-Bayonas, Alberto; Jiménez‐Fonseca, Paula; Echavarría, Isabel; Cánovas, Manuel Sánchez; Aguado, Gema; Gállego, Javier; Custodio, Ana; Hernández, R; Viúdez, A.; Cano, Juana María; Castro, Eva Martínez de; Macías, Ismael; Carnicero, Alfonso Martín; Garrido, Marcelo; Mangas, Monserrat; Manceñido, Felipe Álvarez; Visa, Laura; Azkárate, Aitor; Ramchandani, Avinash; Montes, Ana; Longo, Federico; Sánchez, Á. Tejido; Pimentel, Paola; Limón, María Luisa; Arias, David; Lavin, Diego Cacho; Bayona, R. Sánchez; Cerdá, Paula; Alfonso, Pilar

doi:10.1016/j.ejso.2018.03.019

Cited by 47 publications

(36 citation statements)

References 32 publications

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“…Moreover, intestinal histology was only present in 36% of cases and our patients received suboptimal chemotherapy regimens, since the FLOT protocol was introduced only in the later phase of the study period. The results of a recent Spanish study [26] are completely in line with ours, and reported a median OS from surgery including metastasectomy of 16.7 months, which compared favorably to the median OS of 10.4 months of the full series, while 3-year survival was 30.6% versus 8.4% in the overall population. In our series, median OS was 10.9 months and the 3-year survival rate after surgery was 19.8%, yet in the subgroup of R0 patients, the median OS was 14 months and the 3-year survival rate was 26.8%, with 5-year survival above 18%.…”

Section: Survival Performance After R0 or Palliative Surgerysupporting

confidence: 87%

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Ministrini

Bencivenga

Solaini

et al. 2020

Cancers

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Background/Aim: This work explored the prognostic role of curative versus non-curative surgery, the prognostic value of the various localizations of metastatic disease, and the possibility of identifying patients to be submitted to aggressive therapies. Patients and Methods: Retrospective chart review of stage IV patients operated on in our institutions. Results: Two hundred and eighty-two patients were considered; 73.4% had a single metastatic presentation. In 117 cases, a curative (R0) resection of primary and metastases was possible; 75 received a R1 resection and 90 a palliative R2 gastrectomy. Surgery was integrated with chemotherapy in multiple forms: conversion therapy, HIPEC, neo-adjuvant and adjuvant treatment. Median overall survival (OS) of the entire cohort was 10.9 months, with 14 months for the R0 subgroup. There was no correlation between metastasis site and survival. At multivariate analysis, several variables associated with the lymphatic sphere showed prognostic value, as well as tumor histology and the curativity of the surgical procedure, with a worse prognosis associated with a low number of resected nodes, D1 lymphectomy, pN3, non-intestinal histology, and R+ surgery. Considering the subgroup of R0 patients, the variables pT, pN and D displayed an independent prognostic role with a cumulative effect, showing that patients with no more than 1 risk factor can reach a median survival of 33 months. Conclusions: Our data show that the possibility of effective care also exists for Western patients with stage IV gastric cancer.

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Section: Survival Performance After R0 or Palliative Surgerysupporting

confidence: 87%

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Ministrini

Bencivenga

Solaini

et al. 2020

Cancers

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“…In a retrospective study including 96 patients, Wang et al [15] reported that a small subset of 14 patients who were treated with a multimodal approach including liver resection showed a more favorable prognosis compared to patients who did not undergo surgery. Similarly, Carmona-Bayonas et al [24] reported that 92 patients who underwent surgery for EC metastasis had a higher survival rate than patients who did not undergo metastasectomy (30% versus 8%). The most common surgeries were represented by peritoneal (29%), hepatic (24%), and distant lymph nodes (11%) resection.…”

Section: Surgerymentioning

confidence: 89%

“…We found some studies regarding synchronous disease [14,15,[23][24][25]. Van Daele et al [14] reported an overall survival (OS) and disease-free survival (DFS) of 50% and 33% at a median follow-up of 22 months after surgery, respectively.…”

Section: Surgerymentioning

confidence: 99%

Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments

Procopio

Maranò

Gentile

et al. 2019

Cancers

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Esophageal cancer (EC) is an aggressive disease that is associated with a poor prognosis. Since metastastic EC is usually considered suitable only for palliative therapy with an estimated 5-year overall survival (OS) less than 5%, the optimal management of patients with liver oligometastatic EC (LOEC) is still undefined. The aim of this review is to provide an overview of the different treatment options for LOEC. A literature search was conducted using PubMed, Embase, and Cochrane to identify articles evaluating different treatment strategies for LOEC. Among 828 records that were identified, 20 articles met the inclusion criteria. These studies included patients who have undergone any type of surgical procedure and/or loco-regional therapy. Liver resection resulted in the best survival for patients with low tumor burden (3 lesions): 5-year OS 30-50% versus 8-12% after only chemotherapy (CHT). The 5-year OS of loco-regional therapies was 23% with a local recurrence risk ranging 0-8% for small lesions (2 to 3 cm). An aggressive multidisciplinary approach for LOEC patients may improve survival. Surgery seems to be the treatment of choice for resectable LOEC. If unfeasible, loco-regional therapies may be considered. In order to better select these patients and offer a chance of cure, prospective trials and a definition of treatment protocols are needed.

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“…The participants are from the AGAMENON registry in which 34 Spanish and one Chilean center participate and that recruit consecutive cases of locally advanced, unresectable or metastatic adenocarcinoma of the stomach, gastroesophageal junction, or distal esophagus [12,[16][17][18][19][20][21][22][23][24].…”

Section: Patients and Study Designmentioning

confidence: 99%

External validity of docetaxel triplet trials in advanced gastric cancer: are there patients who still benefit?

et al. 2020

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Background The purpose of our study was to develop an online calculator to estimate the effect of docetaxel triplets (DPF) in first line of advanced gastric cancer (AGC), and to assess the external validity of docetaxel trials in individual patients. Methods The study includes patients with HER2(-) AGC treated with platin and fluoropyrimidine (PF) or with DPF in first line. Treatment effect and interactions were assessed using Bayesian accelerated failure time models. Result The series comprises 1376 patients; 238 treated with DPF and 1138 with PF between 2008 and 2019. DPF was associated with increased progression-free survival (PFS) and overall survival (OS) with time ratio (TR) 1.27 (95% credible interval [CrI], 1.15–1.40), and TR 1.19 (95% CrI, 1.09–1.27), respectively. Serious adverse events were more common with DPF, particularly hematological effects (32% vs 22%). Younger participants received greater DPF dose density without achieving greater disease control, while severe toxicity was likewise higher. DPF yielded superior OS in Lauren intestinal (TR 1.27, 95% CrI, 1.08–1.11) vs diffuse subtype (TR 1.17, 95% CrI, 1.09–1.24) and the probability of increasing OS > 15% was 90% vs 67% in each subtype, respectively. The effect dwindles over time, which can be attributed to pathological changes and clinical practice changes. Conclusion Our study confirms the effect of DPF is highly dependent on several clinical–pathological variables, with discreet and gradually declining benefit over platinum doublets in later years, at the expense of increased toxicity. These results may help to underpin the idea that external validity of AGC trials should be revised regularly.

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Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry

Cited by 47 publications

References 32 publications

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments

External validity of docetaxel triplet trials in advanced gastric cancer: are there patients who still benefit?

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