The Impact of Positive Margins on Outcome Among Patients With Gastric Cancer Treated With Radiation

Schoenfeld, Jonathan D.; Wo, Jennifer Y.; Mamon, Harvey J.; Kwak, Eunice L.; Mullen, John; Enzinger, Peter; Blaskowsky, Lawrence S.; Ryan, David P.; Hong, Theodore S.

doi:10.1097/coc.0000000000000047

Cited by 5 publications

(10 citation statements)

References 22 publications

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“…Multiple prospective randomized trials regarding the influence of the R1 margin on gastric cancer survival have been conducted in Asian and Western populations, but the results have been controversial [66][67][68]. Several authors found that positive margins are an independent risk factor for survival following gastric resection for cancer [69].…”

Section: Influence Of Positive Resection Margins and Re-resectionmentioning

confidence: 99%

“…A multivariate regression analysis performed by Bickenbach [70] showed that R1 margins were associated with poor survival, but this association was only observed in patients with fewer than three positive lymph nodes or T1-2 disease. Schoenfeld et al [68] showed that R1 margins were associated with a lower disease-free interval, but overall survival rates were comparable to those for R0. Regarding the opportunity for a re-resection following R1, Raziee et al [69] obtained controversial results via a systematic review, but they agreed that re-resection should be performed to eliminate the R1 margin whenever feasible [71].…”

Section: Influence Of Positive Resection Margins and Re-resectionmentioning

confidence: 99%

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Surgical Management of Gastric Cancer: A Systematic Review

Mocan

2021

JCM

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Gastric cancer is the fifth most common cancer worldwide, and it is responsible for 7.7% of all cancer deaths. Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy (G) or primary surgical resection followed by chemotherapy. Such an approach, combined with early detection and better screening, has led to a decrease in the overall incidence of gastric cancer. Unfortunately, malignant tumors of the stomach are often diagnosed in locally advanced or metastatic stages when the median overall survival remains poor. Surgical care in these cases must be provided by a multidisciplinary team in a high-volume center. Important surgical aspects such as optimum resection margins, surgical technique, and number of harvested lymph nodes are important factors for patient outcomes. The standardization of surgical treatment of gastric cancer in accordance with the patient’s profile is of decisive importance for a better outcome. This review aims to summarize the current standards in the surgical treatment of gastric cancer.

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Section: Influence Of Positive Resection Margins and Re-resectionmentioning

confidence: 99%

Section: Influence Of Positive Resection Margins and Re-resectionmentioning

confidence: 99%

Surgical Management of Gastric Cancer: A Systematic Review

Mocan

2021

JCM

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“…Twelve studies 3 , 12 , 15 , 16 , 17 , 22 , 43 – 45 , 47 – 49 reported HRs, and the necessary statistics were extracted from the Kaplan–Meier curves in two studies. 8 , 9 Adding these, 14 studies were selected to estimate pooled HR.…”

Section: Overall Survivalmentioning

confidence: 99%

“… 5 , 6 Although the impact of microscopically positive (R1) margins (cancer cells present at the resection margin on pathological examination) on survival in GC has been discussed in many studies, inconsistent conclusions have been reported. 2 , 5 , 7 - 16 Kim et al 15 and Postlewait et al 12 found that R1 margin was not independently associated with survival, while Woo et al 12 and Nagata et al 5 revealed that it boded ill for survival. Bickenbach et al 10 reported that R1 margin was an independent predictor of worse survival but not in patients with more than three positive nodes or T3–4 disease.…”

Section: Introductionmentioning

confidence: 99%

Impact of Surgical Margin Status on Survival in Gastric Cancer: A Systematic Review and Meta-Analysis

et al. 2021

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Background It is inconclusive whether R1 margin determined by postoperative pathological examination indicates worse long-term survival in gastric cancer (GC) patients after curative intent resection (CIR). Hence, we aimed to systematically pool the conflicting evidence to fill this gap. Methods The present study was performed according to the published protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published studies examining the impact of microscopic margin status on overall survival (OS) and 5-year OS rate in GC were systematically searched in PubMed, Embase, and Cochrane Library databases. RevMan 5.3 was used to conduct statistical analysis, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of evidence for each outcome. Results Twenty-three retrospective cohort studies including 19 992 patients were analyzed. The pooled hazard ratio for OS of 14 studies was 2.06 (95% confidence interval [CI]: 1.61–2.65, low certainty), indicating that R1 margin predicted inferior OS. Subgroup and sensitivity analyses upheld the statistical stability of this finding. The pooled odds ratio (OR) of 14 studies was .21 (95% CI: .17–.26, moderate certainty), demonstrating that the presence of R1 margins was associated with a poorer 5-year OS rate. Sensitivity analyses and most of the subgroup analyses confirmed this finding, except the “esophagogastric junction (EGJ) cancers” subgroup, which included two studies with a pooled OR of .41 (95% CI: .10–1.61). Conclusion R1 margin detected by pathological examination might exhibit a high correlation with poorer OS and 5-year OS rate in GC (except EGJ cancers) patients who underwent CIR. To figure out the effect of R1 margin on survival of different stages and histological types need prospective studies with large sample sizes and standardized methods. What is the best treatment for R1 margin patients also need more in-depth and special research.

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“…Bickenbach et al 11 found that R1 margin was an independent predictor of worse survival, but not in patients with >3 positive nodes or T3–4 disease. Schoenfeld et al 18 found R1 margins were associated with disease-free survival (DFS) but not overall survival (OS).…”

Section: Introductionmentioning

confidence: 99%

Impact of surgical margin status on the survival outcome after surgical resection of gastric cancer: a protocol for systematic review and meta-analysis

et al. 2020

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IntroductionGenerally, complete resection with cancer cell negative (R0) margin has been accepted as the most effective treatment of gastric cancer and positive resection (R1/R2) margin has been associated with decreased survival to varied degrees. However, the independent impact of microscopical positive (R1) margin on long-term survival may be confounded. No meta-analysis has worked at the association between R1 margin and outcomes of gastric cancer and the available evidence are scant. Therefore, we plan to conduct a systematic review and meta-analysis to quantitatively explore the role of R1 margin on gastric (including oesophagogastric junction) cancer survival after curative intent resection.Methods and analysisThe protocol was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search of PubMed, Embase and the Cochrane Central Register of Controlled Trials databases will be performed from their inceptions to 30 April 2020 to identify randomised controlled trials (RCTs), cohort studies and case–control studies focusing on the impact of R1 margin on survival of gastric cancer after curative intent resection. The primary outcome will be the overall survival (OS) and disease-free survival (DFS) and the secondary outcomes will be 5-year OS rate and 5-year DFS rate. The Cochrane tool for bias assessment in randomised trials and Risk Of Bias In Non-randomised Studies-I for the assessment of bias in non-randomised studies (NRS) will be used. Statistical heterogeneity will be assessed by visual inspection of forest plots and measured using the I2 statistics. A fixed-effect model will be used when heterogeneity is low, otherwise, a random-effect model will be chosen. Publication bias will be assessed by funnel plots, subgroup analysis and sensitivity analysis will be performed in the right context. For each outcome, we will perform data synthesis separately for RCTs and NRS using Rev Man V.5.3 software and compile ‘summary of findings’ tables separately for RCTs and NRS using GRADEpro software. Grading of Recommendations, Assessment, Development and Evaluations considerations will also be used to make an overall assessment of the quality of evidence.Ethics and disseminationThere is no requirement for ethics approval because no patient data will be collected at an individual level in this systematic review and meta-analysis.The results of this systematic review will be published in a peer-reviewed journal and presented at relevant conferences, any deviations from the protocol will be clearly documented and explained in its final report.PROSPERO registration numberCRD42020165110.

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The Impact of Positive Margins on Outcome Among Patients With Gastric Cancer Treated With Radiation

Abstract: Positive margins were associated with recurrence despite aggressive multimodality therapy including radiotherapy and the selective use of chemotherapy. Thus, additional consideration is warranted for strategies such as neoadjuvant chemoradiation intended to facilitate complete resection.

Cited by 5 publications

References 22 publications

Surgical Management of Gastric Cancer: A Systematic Review

Surgical Management of Gastric Cancer: A Systematic Review

Impact of Surgical Margin Status on Survival in Gastric Cancer: A Systematic Review and Meta-Analysis

Impact of surgical margin status on the survival outcome after surgical resection of gastric cancer: a protocol for systematic review and meta-analysis

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