Yield of staging laparoscopy in gastric cancer is influenced by Laurén histologic subtype

Rawicz‐Pruszyński, Karol; Mielko, Jerzy; Pudło, Kamil; Lisiecki, Radosław; Skoczylas, Tomasz; Murawa, Dawid; Polkowski, Wojciech

doi:10.1002/jso.25711

Cited by 22 publications

(20 citation statements)

References 27 publications

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“…Our results also showed that the diffuse type of gastric adenocarcinoma was significantly associated with advanced stages compared with the intestinal type. This is also consistent with a previous report that revealed that diffuse type was an independent predictor of peritoneal metastases using staging laparoscopy (24). Although Lauren's classification has been proposed for over 50 years, this classification's clinical value remains controversial.…”

Section: A B C D E Fsupporting

confidence: 92%

Differential prognostic implications of gastric adenocarcinoma based on Lauren’s classification: a Surveillance, Epidemiology, and End Results (SEER)-based cohort study

Tang

Zhu

et al. 2021

Ann Transl Med

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Background: Our study aims to analyze the association between Lauren's classification and gastric adenocarcinoma prognosis using comprehensive statistical analyses.Methods: According to the selection criteria, patients were included from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression, propensity score matching, and a multivariate competing risk model were used to investigate the association between Lauren's classification and prognosis. Subgroup analysis was used to investigate the role of confounding factors on the association between Lauren types and prognosis.Results: After exclusion, a total of 20,218 patients from the SEER database were included, with 14,374 intestinal types and 5,844 diffuse types. The univariate Cox regression analysis revealed that the diffuse type had a poorer cancer-specific survival (CSS) rate [hazard ratio (HR), 1.44; 95% confidence interval (CI), 1.38-1.50]. After adjusting for confounding variables, the diffuse type also showed a higher risk of cancer-specific death (HR, 1.20; 95% CI,. Sensitivity analysis showed that after propensity score matching, the diffuse type had a poorer CSS rate (HR, 1.23; 95% CI, 1.10-1.36), and the competing risk model further validated these results [subdistribution HR (SHR), 1.32; 95% CI, 1.23-1.41]. Moreover, subgroup analysis demonstrated stable results in the subgroups, except for patients with T1 stage (HR, 1.06; 95% CI, 0.87-1.28) and a tumor size <2 cm (HR, 1.00; 95% CI, 0.83-1.21).Conclusions: Diffuse-type gastric adenocarcinoma had an overall poorer prognosis compared to the intestinal type. However, in patients with T1 stage and tumor size <2 cm, the diffuse type had a comparable survival rate with the intestinal type.

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Section: A B C D E Fsupporting

confidence: 92%

Differential prognostic implications of gastric adenocarcinoma based on Lauren’s classification: a Surveillance, Epidemiology, and End Results (SEER)-based cohort study

Tang

Zhu

et al. 2021

Ann Transl Med

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“…Our study identifies risk factors for the development of PC, which could offer a guideline to choose patients at high risk for peritoneal recurrence, who might profit from additional intraperitoneal chemotherapy. Our data also support the routine use of preoperative staging laparoscopy before neoadjuvant treatment to enable early diagnosis and tailored treatment of peritoneal metastasis [ 23 ].…”

Section: Discussionsupporting

confidence: 73%

Pattern of Recurrence and Patient Survival after Perioperative Chemotherapy with 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) for Locally Advanced Esophagogastric Adenocarcinoma in Patients Treated Outside Clinical Trials

Glatz

Verst

Kuvendjiska

et al. 2020

JCM

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Background: The 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) protocol provides superior oncologic results compared to other perioperative chemotherapeutic protocols for the treatment of non-metastatic esophagogastric cancer (EGAC). Survival and the pattern of recurrence of EGAC after FLOT and curative tumor resection are analyzed in a collective of patients treated outside clinical trials. Methods: Two-hundred-seventy-seven patients with EGAC (cT3-4 and/or cN+) were treated with perioperative FLOT-chemotherapy plus curative surgery between 2009 and 2018. Data were analyzed retrospectively from a prospective database. Results: Two-hundred-twenty-eight patients were included in the analysis. Postoperative in-hospital mortality was 2%. The median survival was 61–months, and median recurrence-free survival was 42 months. Multivariate analysis identified postoperative nodal status and T-stage as independent predictors of improved overall and recurrence-free survival. Administration of adjuvant chemotherapy failed to be significant for overall survival but was an independent predictor of recurrence-free survival. Recurrence occurred after a median of 9 months (range 1–46 months). Eighty-nine percent of recurrence occurred during the first 24 months. The rate of local recurrence was low. After surgery for gastric cancer, the major recurrence site was peritoneal carcinomatosis (56%), while esophageal cancer recurred mostly as metastasis to distant organs (78%). The specific site of recurrence had no impact on overall survival time. Conclusion: Real-life application of FLOT shows oncologic results comparable to clinical trials. Recurrence after FLOT and surgery for EGAC occurs predominantly early within the first two years after surgery and in the form of distant organ metastasis for esophageal tumors or peritoneal carcinomatosis for gastric tumors.

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“…• staging laparoscopy should be maintained, with informed consent to proceed to gastrectomy if the primary tumor is resectable ○ especially in non-intestinal tumors 45 • for early GC following non-radical endoscopic resection (R1), the definitive radical surgery may be postponed • neoadjuvant (radio-)chemotherapy for resectable cases deferred • upfront gastrectomy preferred if easy resectable with low risk of respiratory complications ○ major GC surgery, as recently defined by experts, 46 only in referral centers with proven low morbidity/ mortality rates, performed by experienced surgeons or under their strict supervision 47 ○ option: HIPEC for limited peritoneal dissemination (CY1; PCI<7; P1/2) should be deferred • adjuvant chemotherapy reserved only for patients with lymph node pN-positive tumors 48 • for bleeding GC, endoscopic management is the first choice option, followed by radiotherapy, and urgent gastrectomy reserved only for life-threatening hemorrhage • perforation of GC with peritonitis should be treated minimally-invasive, with peritoneal lavage and drainage, after no improvement with intravenous broadspectrum antibiotic therapy • for non-resectable or borderline resectable tumors with high risk of complications, primary radical radiochemotherapy should be proposed ○ cases with clinical response might be re-evaluated for resectability in the post-pandemic time ○ otherwise (no tumor/lymph node regression) this radiotherapy should be regarded as definitive treatment • all other loco-regionally advanced (cT4 or cN3) and metastatic (M1; including CY1 or P1-3 following staging laparoscopy) cases should be treated with palliative chemotherapy if performance status is good ○ conversion therapy (surgical resectability reevaluation) postponed to the post-pandemic era 49 Emergency presentation of GC is uncommon, usually associated with an advanced stage and lower rates of operability. The necessity to perform an emergency operation within 24 hours is exceedingly rare.…”

Section: Strategy For the Treatment Of Gc During The Covid-19 Pandemicmentioning

confidence: 99%

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Polkowski¹,

Sędłak²,

Rawicz‐Pruszyński³

2020

CMAR

Self Cite

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The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource reallocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio-and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.

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Yield of staging laparoscopy in gastric cancer is influenced by Laurén histologic subtype

Cited by 22 publications

References 27 publications

Differential prognostic implications of gastric adenocarcinoma based on Lauren’s classification: a Surveillance, Epidemiology, and End Results (SEER)-based cohort study

Differential prognostic implications of gastric adenocarcinoma based on Lauren’s classification: a Surveillance, Epidemiology, and End Results (SEER)-based cohort study

Pattern of Recurrence and Patient Survival after Perioperative Chemotherapy with 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) for Locally Advanced Esophagogastric Adenocarcinoma in Patients Treated Outside Clinical Trials

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

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