The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging

In, Haejin; Ravetch, Ethan; Langdon-Embry, Marisa; Palis, Bryan E.; Ajani, Jaffer A.; Hofstetter, Wayne L.; Kelsen, David P.; Sano, Takeshi

doi:10.1007/s10120-017-0765-y

Cited by 42 publications

(32 citation statements)

References 12 publications

(13 reference statements)

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“…Despite the improvements in diagnosis and surgical techniques, the prognosis and survival of gastric adenocarcinoma patients are significantly dependent on the stage of disease at the time of diagnosis. According to the American Joint Committee on Cancer (AJCC) survival data, for a cancer staged as in our case, treated with surgery and perioperative therapy, three-year and five-year survival are, respectively, 54.8% and 46.3% [1]. One major problem is that no effective therapy for recurring gastric cancer exists at present.…”

Section: Discussionmentioning

confidence: 84%

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Long-term survival after surgical resection of locoregional gastric adenocarcinoma recurrence — a case report

et al. 2019

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Introduction. Recurrence is the leading cause of death of gastric cancer patients after curative resection. This report describes a 44-year-old woman with gastric adenocarcinoma and surgically resected locoregional recurrence, who has survived for more than 13 years after diagnosis. Case report. A 33-year-old woman was admitted to the Gastroenterology Clinic with an episode of epigastric pain and minor weight loss. Two years earlier she had been diagnosed with gastric adenocarcinoma G2 of the antrum, pT2N1M0 (IIA) stage. She had undergone total gastrectomy with D2 lymphadenectomy and Roux-en-Y anastomosis followed by postoperative chemotherapy. Further diagnostic investigation after two years revealed the presence of metastatic cancer in the gastric bed. An explorative laparotomy was performed, and the surgeons successfully excised the enlarged lymph node. Post-operative pathologic examination proved gastric cancer metastasis. Since April 2007 the patient has stayed recurrence-free, and there have been no signs of recurrence on either US or CT scan, as of April 2018. This patient represents a rare case of long-term survival of recurrent gastric adenocarcinoma successfully treated with surgery despite particularly poor prognosis.Conclusions. Surgery for gastric cancer recurrence is a valuable treatment in chosen patients, provided it is performed by a team of specialised surgeons.

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Section: Discussionmentioning

confidence: 84%

“…Gastric cancer is the fifth most common cancer worldwide and the third leading cause of cancer-related deaths [1]. Gastric adenocarcinoma comprises 95% of malignant tumours of the stomach.…”

Section: Introductionmentioning

confidence: 99%

Long-term survival after surgical resection of locoregional gastric adenocarcinoma recurrence — a case report

et al. 2019

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“…number of resected nodes following D2 lymphadenctomy is 26·6(11·9). In addition, patients in the NCDB used to validate the AJCC ypTNM staging system had both neoadjuvant chemotherapy and chemoradiotherapy. Finally, patients with complete primary tumour regression (ypT0) are not included in the AJCC ypTNM staging system and thus are left without a stage designation.…”

Section: Introductionmentioning

confidence: 99%

“…The eighth edition of the AJCC cancer staging manual for gastric adenocarcinoma introduced both a clinical staging system (cTNM) and a staging system for those receiving neoadjuvant therapy (ypTNM). The ypTNM system was validated based on the US National Cancer Database (NCDB). The mean(s.d.)…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy

Yoon

Desiderio

et al. 2019

British Journal of Surgery

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Background Neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy is commonly used for patients with locally advanced gastric adenocarcinoma. The eighth AJCC ypTNM staging system was validated based on patients undergoing more limited lymphadenectomy (less than D2). The aim of this study was to develop a system for accurate staging of patients with locally advanced gastric adenocarcinoma who receive neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy. Methods A modified system of ypTNM was developed, based on overall survival (OS) of patients receiving neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy at Memorial Sloan Kettering Cancer Center, and validated using data from an international cohort of patients who had similar treatment. Results Of 325 patients in the derivation cohort, 33 (10·2 per cent) had ypT0 N0/+ tumours, which are not classifiable under the AJCC system. The 5‐year OS rate for modified ypTNM stages I, II, IIIA and IIIB was 89, 71, 42·3 and 10 per cent respectively, compared with 82, 65·2 and 24·1 for AJCC stages I, II and III respectively. The concordance index (0·730 versus 0·709), estimated area under the curve (0·765 versus 0·740) and time‐dependent receiver operating characteristic (ROC) curve throughout the observation period were all superior for modified ypTNM staging. For the validation cohort of 186 patients, the modified system was again better at separating patients into prognostic groups for OS. Conclusion The modified ypTNM staging system improves the accuracy of OS prediction for patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy.

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“…The mean 5-year survival rates for gastric cancer in the United States by clinical stage are 57% for stage I, 47% for stage IIa, 33% for stage IIb, 26% for stage III and 5% for stage IV. 2 Lymphatic and transcoelomic metastases are common in gastric adenocarcinoma; 2 however, hematogenous spread with distant metastatatic deposits in the lungs is rare. In Asian countries, where the incidence of gastric adenocarcinoma is much higher, pulmonary metastases are reported to be present in fewer than 1% of cases.…”

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confidence: 99%

Evaluating the utility of computed tomography of the chest for gastric cancer staging

Nostedt

Gibson-Brokop

Ghosh

et al. 2020

CJS

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Evaluating the utility of computed tomography of the chest for gastric cancer staging Background: International guidelines recommend routine computed tomography (CT) of the chest for gastric cancer staging. In Asian countries, where the incidence of pulmonary metastases is less than 1%, some guidelines recommend chest CT only for gastroesophageal junction cancers. If the incidence of pulmonary metastases is also low in Canada, routine chest CT may not be beneficial. Methods: We performed a retrospective review of patients in northern Alberta with newly diagnosed gastric cancer from January 2010 to July 2016. The primary aim of the study was to determine the incidence of pulmonary metastases at the time of diagnosis in this population. A secondary aim was to identify potential predictors of pulmonary metastases. We reviewed CT reports for pulmonary metastases. Imaging data also included liver metastases, abdominal lymphadenopathy (> 1 cm), ascites and omental or peritoneal nodules. Other data recorded were age, sex, primary tumour location, histologic type and tumour grade. Results: Four hundred and sixty-two patients (311 men, 151 women) were included in the analysis. Pulmonary metastases were identified in 25 patients (5.4%) overall and in 11 of 299 patients (3.7%) whose primary cancer was not in the cardia. On univariate analysis the presence of liver metastases (odds ratio [OR] 7.72, 95% confidence interval [CI] 3.24-18.37, p < 0.001) and abdominal lymphadenopathy (OR 3.30, 95% CI 1.29-8.48, p = 0.01) was associated with an increased risk of pulmonary metastases. Liver metastases retained statistical significance on multivariate analysis (OR 6.17, 95% CI 2.53-15.03, p < 0.001). Conclusion: The incidence of pulmonary metastases at the time of gastric cancer diagnosis is higher in northern Alberta than previously reported in Asian studies. Abdominal lymphadenopathy and liver metastases confer an elevated risk of pulmonary metastases. Contexte : Les lignes directrices internationales recommandent une tomodensitométrie (TDM) thoracique de routine pour la stadification du cancer de l'estomac. Dans les pays asiatiques, où l'incidence des métastases pulmonaires est inférieure à 1 %, certaines lignes directrices recommandent la TMD thoracique seulement dans les cancers de la jonction gastro-oesophagienne. Si l'incidence des métastases pulmonaires est également faible au Canada, la TDM thoracique de routine pourrait ne pas être bénéfique. Méthodes : Nous avons procédé à une analyse rétrospective des patients du Nord de l'Alberta ayant reçu un diagnostic de cancer de l'estomac entre janvier 2010 et juillet 2016. L'objectif principal de l'étude était de déterminer l'incidence des métastases pulmonaires au moment du diagnostic chez cette population. Un objectif secondaire consistait à identifier les prédicteurs potentiels des métastases pulmonaires. Les rapports de TDM ont été passés en revue pour ce qui est des métastases pulmonaires. Les données provenant des épreuves d'imagerie incluaient aussi les métastases hépatique...

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The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging

Cited by 42 publications

References 12 publications

Long-term survival after surgical resection of locoregional gastric adenocarcinoma recurrence — a case report

Long-term survival after surgical resection of locoregional gastric adenocarcinoma recurrence — a case report

Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy

Evaluating the utility of computed tomography of the chest for gastric cancer staging

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