|
1
|
Schiefer S, Crnovrsanin N, Kalkum E, Vey JA, Nienhüser H, Rompen IF, Haag GM, Müller-Stich B, Billmann F, Schmidt T, Probst P, Klotz R, Sisic L. Is neoadjuvant chemotherapy followed by surgery the appropriate treatment for esophagogastric signet ring cell carcinomas? A systematic review and meta-analysis. Front Surg 2024; 11:1382039. [PMID: 38770165 PMCID: PMC11102960 DOI: 10.3389/fsurg.2024.1382039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Background The impact of neoadjuvant chemotherapy (nCTX) on survival and tumor response in patients with esophagogastric signet ring cell carcinoma (SRCC) is still controversial. Methods Two independent reviewers performed a systematic literature search in Medline, CENTRAL, and Web of Science including prospective and retrospective two-arm non-randomized and randomized controlled studies (RCTs). Data was extracted on overall survival (OS) and tumor regression in resected esophagogastric SRCC patients with or without nCTX. Survival data was analyzed using published hazard ratios (HR) if available or determined it from other survival data or survival curves. OS and histopathological response rates by type of tumor (SRCC vs. non-SRCC) were also investigated. Results Out of 559 studies, ten (1 RCT, 9 non-RCTs) were included in this meta-analysis (PROSPERO CRD42022298743) investigating 3,653 patients in total. The four studies investigating survival in SRCC patients treated with nCTX + surgery vs. surgery alone showed no survival benefit for neither intervention, but heterogeneity was considerable (HR, 1.01; 95% CI, 0.61-1.67; p = 0.98; I2 = 89%). In patients treated by nCTX + surgery SRCC patients showed worse survival (HR, 1.45; 95% CI, 1.21-1.74; p < 0.01) and lower rate of major histopathological response than non-SRCC patients (OR, 2.47; 95% CI, 1.78-3.44; p < 0.01). Conclusion The current meta-analysis could not demonstrate beneficial effects of nCTX for SRCC patients. Histopathological response to and survival benefits of non-taxane-based nCTX seem to be lower in comparison to non-SRC esophagogastric cancer. However, certainty of evidence is low due to the scarcity of high-quality trials. Further research is necessary to determine optimal treatment for SRCC patients. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022298743).
Collapse
Affiliation(s)
- Sabine Schiefer
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Nerma Crnovrsanin
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Department of Pathology, Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | - Eva Kalkum
- Study Center of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes A. Vey
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingmar F. Rompen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg M. Haag
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Franck Billmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, Münsterlingen, Switzerland
| | - Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery (SDGC), University Hospital Heidelberg, Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
|
2
|
Geraedts TCM, Weijs TJ, Berkelmans GHK, Fransen LFC, Kouwenhoven EA, van Det MJ, Nilsson M, Lagarde SM, van Hillegersberg R, Markar SR, Nieuwenhuijzen GAP, Luyer MDP. Long-Term Survival Associated with Direct Oral Feeding Following Minimally Invasive Esophagectomy: Results from a Randomized Controlled Trial (NUTRIENT II). Cancers (Basel) 2023; 15:4856. [PMID: 37835550 PMCID: PMC10571988 DOI: 10.3390/cancers15194856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
Advancements in perioperative care have improved postoperative morbidity and recovery after esophagectomy. The direct start of oral intake can also enhance short-term outcomes following minimally invasive Ivor Lewis esophagectomy (MIE-IL). Subsequently, short-term outcomes may affect long-term survival. This planned sub-study of the NUTRIENT II trial, a multicenter randomized controlled trial, investigated the long-term survival of direct versus delayed oral feeding following MIE-IL. The outcomes included 3- and 5-year overall survival (OS) and disease-free survival (DFS), and the influence of complications and caloric intake on OS. After excluding cases of 90-day mortality, 145 participants were analyzed. Of these, 63 patients (43.4%) received direct oral feeding. At 3 years, OS was significantly better in the direct oral feeding group (p = 0.027), but not at 5 years (p = 0.115). Moreover, 5-year DFS was significantly better in the direct oral feeding group (p = 0.047) and a trend towards improved DFS was shown at 3 years (p = 0.079). Postoperative complications and caloric intake on day 5 did not impact OS. The results of this study show a tendency of improved 3-year OS and 5-year DFS, suggesting a potential long-term survival benefit in patients receiving direct oral feeding after esophagectomy. However, the findings should be further explored in larger future trials.
Collapse
Affiliation(s)
- Tessa C. M. Geraedts
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Teus J. Weijs
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Gijs H. K. Berkelmans
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Laura F. C. Fransen
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Ewout A. Kouwenhoven
- Department of Surgery, ZGT Hospital Group Twente, 7609 PP Almelo, The Netherlands; (E.A.K.); (M.J.v.D.)
| | - Marc J. van Det
- Department of Surgery, ZGT Hospital Group Twente, 7609 PP Almelo, The Netherlands; (E.A.K.); (M.J.v.D.)
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141-86 Stockholm, Sweden;
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 171-77 Stockholm, Sweden
| | - Sjoerd M. Lagarde
- Department of Surgery, Eramus Medical Center, 3015 CN Rotterdam, The Netherlands;
| | | | - Sheraz R. Markar
- Nuffield Department of Surgery, University of Oxford, Oxford OX3 9DU, UK;
| | - Grard A. P. Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Misha D. P. Luyer
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| |
Collapse
|
|
3
|
Shao P, Nima S, Tse Y, Suolang Z, Pubu C. Multimodal treatments for resectable esophagogastric junction cancer: A Bayesian network meta-analysis. Langenbecks Arch Surg 2023; 408:123. [PMID: 36934163 DOI: 10.1007/s00423-023-02862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE To comprehensively investigate the optimal multimodal treatment of resectable esophagogastric junction (EGJ) cancer. METHODS PubMed, Embase, Cochrane Library and Web of Science were searched until March 11, 2022. The outcomes were overall survival (OS), locoregional and distant recurrence, and R0 resection. Network plots, forest plots and league tables were drawn for each outcome. Rank probabilities for different treatments in each outcome were also depicted. RESULTS A total of 23 studies with 18,319 EGJ participants were included. No significant differences in OS between any two of the 6 treatments. Perioperative chemoradiotherapy (pCRT) had the highest probability (36.03%) to be the optimal treatment as regards OS. Patients undergoing pCRT had a significantly lower incidence of locoregional recurrence than those undergoing adjuvant chemotherapy (aCT), neoadjuvant chemotherapy (nCT), perioperative chemotherapy (pCT), or surgery alone (S). Patients with pCRT had the greatest likelihood (68.86%) to have the lowest incidence of locoregional recurrence. Comparable impacts of the 6 treatments on the incidence of distant recurrence, and pCRT was most likely (46.65%) to be the optimal treatment with respect to distant recurrence. Neoadjuvant CRT (nCRT) was associated with a significantly increased incidence of R0 resection compared with nCT or S, and nCRT had the highest probability (97.68%) to be the best therapy regarding R0 resection. CONCLUSION For patients with resectable EGJ cancer, pCRT may be the optimal multimodal treatment regarding survival and recurrence.
Collapse
Affiliation(s)
- Pengfei Shao
- Gastroenterology Department, Lhasa People's Hospital, No.1 Beijing East Road, Chengguan District, Lhasa, 850000, Tibet Autonomous Region, China
| | - Shazhen Nima
- Gastroenterology Department, Lhasa People's Hospital, No.1 Beijing East Road, Chengguan District, Lhasa, 850000, Tibet Autonomous Region, China
| | - Yang Tse
- Gastroenterology Department, Lhasa People's Hospital, No.1 Beijing East Road, Chengguan District, Lhasa, 850000, Tibet Autonomous Region, China
| | - Zhuoma Suolang
- Gastroenterology Department, Lhasa People's Hospital, No.1 Beijing East Road, Chengguan District, Lhasa, 850000, Tibet Autonomous Region, China
| | - Cangjue Pubu
- Gastroenterology Department, Lhasa People's Hospital, No.1 Beijing East Road, Chengguan District, Lhasa, 850000, Tibet Autonomous Region, China.
| |
Collapse
|
|
4
|
Wang K, Li E, Busuttil RA, Kong JC, Pattison S, Sung JJY, Yu J, El-Omar EM, Simpson JA, Boussioutas A. A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer. Ther Adv Med Oncol 2020; 12:1758835920930359. [PMID: 32754227 PMCID: PMC7378722 DOI: 10.1177/1758835920930359] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background The association between the survival or efficacy of chemotherapy and the Lauren subtype of gastric cancer (GC) remains unclear. We aimed to clarify whether patients with different Lauren subtypes have different survival after treatment with systemic chemotherapy: intestinal gastric cancer (IGC) patients survived better than patients with mixed type gastric cancer (MGC) or diffuse gastric cancer (DGC) after treatment with systemic chemotherapy. Patients & methods Relevant studies for the meta-analysis were identified through searching Pubmed, Embase, Cochrane and Ovid up to March 2020. We also included our own prospectively collected cohort of patients that were followed over a 10-year period. Sub-group and sensitivity analyses were also performed. Results In our prospective cohort, the overall survival (OS) of IGC patients receiving systemic chemotherapy (chemoIGC) [median OS 5.01 years, interquartile range (IQR) 2.63-6.71] was significantly higher than that of DGC patients receiving the same chemotherapy (chemoDGC) (median OS 1.33 years, IQR 0.78-3.33, p = 0.0001). After adjusting for age, gender and cancer stage, there was a significant difference in OS in patients treated with chemotherapy based on the Lauren classification of GC {hazard ratio (HR) for OS of the IGC versus DGC 0.33, [95% confidence interval (CI), 0.17-0.65; p < 0.001]}. In the IGC patients, the adjusted HR associated with chemotherapy was 0.26 (95% CI, 0.12-0.56; p = 0.001), whereas the association was 0.64 (95% CI, 0.30-1.33; p = 0.23) in the DGC patient group.In our meta-analysis, 33 studies comprising 10,246 patients treated with systemic chemotherapy (chemoIGC n = 4888, chemoDGC n = 5358) met all the selection criteria. While we accounted for much of the heterogeneity in these studies, we found that chemoIGC patients showed significantly improved OS [HR, 0.76 (95% CI, 0.71-0.82); p < 0.00001] when compared with similarly treated chemoDGC patients. Conclusion Our results support the consideration of Lauren subtype when prescribing systemic chemotherapy for GC, particularly for MGC or DGC, which may not benefit from chemotherapy. Lauren classification should be considered to stratify chemotherapy regimens to GC patients in future clinical trials, with particular relevance to MGC or DGC, which is more difficult to treat with current regimens.
Collapse
Affiliation(s)
- Kunning Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Enxiao Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Rita A Busuttil
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Joseph C Kong
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Sharon Pattison
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun Yu
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Emad M El-Omar
- Department of Medicine, St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Alex Boussioutas
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
|
5
|
Janssen HJ, Fransen LF, Ponten JE, Nieuwenhuijzen GA, Luyer MD. Micronutrient Deficiencies Following Minimally Invasive Esophagectomy for Cancer. Nutrients 2020; 12:778. [PMID: 32183492 PMCID: PMC7146612 DOI: 10.3390/nu12030778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
Over the past decades, survival rates for patients with resectable esophageal cancer have improved significantly. Consequently, the sequelae of having a gastric conduit, such as development of micronutrient deficiencies, become increasingly apparent. This study investigated postoperative micronutrient trends in the follow-up of patients following a minimally invasive esophagectomy (MIE) for cancer. Patients were included if they had at least one postoperative evaluation of iron, ferritin, vitamins B1, B6, B12, D, folate or methylmalonic acid. Data were available in 83 of 95 patients. Of these, 78.3% (65/83) had at least one and 37.3% (31/83) had more than one micronutrient deficiency at a median of 6.1 months (interquartile range (IQR) 5.4-7.5) of follow-up. Similar to the results found in previous studies, most common deficiencies identified were: iron, vitamin B12 and vitamin D. In addition, folate deficiency and anemia were detected in a substantial amount of patients in this cohort. At 24.8 months (IQR 19.4-33.1) of follow-up, micronutrient deficiencies were still common, however, most deficiencies normalized following supplementation on indication. In conclusion, patients undergoing a MIE are at risk of developing micronutrient deficiencies as early as 6 up to 24 months after surgery and should therefore be routinely checked and supplemented when needed.
Collapse
Affiliation(s)
| | | | | | | | - Misha D.P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| |
Collapse
|
|
6
|
Göbel HH, Büttner-Herold MJ, Fuhrich N, Aigner T, Grabenbauer GG, Distel LVR. Cytotoxic and immunosuppressive inflammatory cells predict regression and prognosis following neoadjuvant radiochemotherapy of oesophageal adenocarcinoma. Radiother Oncol 2020; 146:151-160. [PMID: 32169773 DOI: 10.1016/j.radonc.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Tumour infiltrating lymphocytes (TIL) and tumour associated macrophages (TAM) play a key role in anticancer immunosurveillance. We studied their influence on response to neoadjuvant radiochemotherapy (RCT) and prognosis in patients with oesophageal adenocarcinoma (OAC). MATERIALS AND METHODS Between 10/2004 and 06/2018, pre-RCT biopsy-specimens were available from 76 patients with locally advanced, non-metastatic OAC scheduled for trimodality therapy. We evaluated intra- and peritumoural expression of FoxP3+-, CD8+-TIL and CD68+-, CD163+-TAM, contemplating cell density, cell ratios and cell-to-cell distances to determine a possible influence on tumour regression grade (TRG) and survival. Median follow-up time for all patients was 18 months (IQR 9-43), and 54 months (25-97) for surviving patients. Data were analysed using risk analysis, logrank test and Cox regression. RESULTS Poor tumour regression was detected for cN+ (RR 0.77 [95% CI 0.66-0.90], p = 0.001), low intratumoural FoxP3+/CD8+ ratio (RR 0.75 [0.60-0.96], p = 0.020), high peritumoural CD163+/CD68+ ratio (RR 0.77 [0.60-0.99], p = 0.045) and high intratumoural TAM density (RD -0.44 [-0.82 to -0.06], p = 0.023). Apart from poor resection quality and TRG, pretherapeutic high peritumoural CD8+ infiltration (HR 2.36 [1.21-4.61], p = 0.012) and short intratumoural FoxP3+ to CD8+ cell-to-cell distances in middle ranged CD8+ density (HR 2.55 [1.00-6.52], p = 0.050) were significant unfavourable prognostic factors in multivariate analysis. CONCLUSIONS Immunologic parameters, such as CD8+-, FoxP3+-TIL and CD68+-, CD163+-TAM, were identified to be of independent predictive and prognostic value in patients with OAC. Further and independent validation of these biomarkers by a large size dataset may urgently be contemplated.
Collapse
Affiliation(s)
- Holger H Göbel
- Department of Gastroenterology, REGIOMED Klinikum Lichtenfels, Germany; University of Split, School of Medicine, Croatia.
| | - Maike J Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Nicole Fuhrich
- Institute of Pathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Thomas Aigner
- Department of Pathology, REGIOMED Klinikum Coburg, Germany
| | - Gerhard G Grabenbauer
- Department of Radiation Oncology, REGIOMED Klinikum Coburg, Germany; University of Split, School of Medicine, Croatia
| | - Luitpold V R Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| |
Collapse
|
|
7
|
Cheng L, Wang Q, Tao X, Qin Y, Wu Q, Zheng D, Chai D, Zhang Y, Lu D, Ci H, Wang Z, Ma J, Wang D, Cheng Z, Wu S, Tao Y. FOXM 1 induces Vasculogenic mimicry in esophageal cancer through β-catenin /Tcf4 signaling. Diagn Pathol 2020; 15:14. [PMID: 32035486 PMCID: PMC7007660 DOI: 10.1186/s13000-020-00929-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the role of FOXM1, β-catenin and TCF4 in esophageal cancer (EC) and their relationship to VM (Vasculogenic Mimicry). Methods CCK-8 were performed to examine EC cell proliferation in FOXM1 silenced cells. EC cell migration and invasion were investigated through wound healing and Transwell assays, respectively. The formation of pipe like structures were assessed in 3D cultures. The expression of Foxm1, β-catenin, Tcf4 and E-cadherin were investigated through western blot, RT-qPCR and immunohistochemistry (IHC) staining. The relationship between FOXM1 expression, clinic-pathological features, and overall survival (OS) were further analyzed. Results A loss of FOXM1 expression correlated with the OS of ESCC patients. FOXM1 silencing led to a loss of cell growth and suppressed cell migration and invasion in ESCC cells. VM structures were identified in ESCC tissues and human EC cell lines. Mechanistically, FOXM1 was found to promote tumorigenesis through the regulation of β-catenin, Tcf4, and E-cadherin in EC cells, leading to the formation of VM structures. Conclusions These findings highlight FoxM1 as a novel therapeutic target in ESCC.
Collapse
Affiliation(s)
- Lili Cheng
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Qi Wang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Xiaoying Tao
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Yanzi Qin
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Qiong Wu
- Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Dafang Zheng
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Damin Chai
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Yong Zhang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Dongbing Lu
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Hongfei Ci
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Zhiwei Wang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China
| | - Jia Ma
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China
| | - Danna Wang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Zenong Cheng
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Shiwu Wu
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China.,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China
| | - Yisheng Tao
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu, Anhui, 233000, People's Republic of China. .,Department of Pathology, Bengbu Medical College, 2600 Donghai Avenue, Bengbu, Anhui Province, China.
| |
Collapse
|
|
8
|
Wang F, Liu S, Liu J, Feng F, Guo Y, Zhang W, Zheng G, Wang Q, Cai L, Guo M, Lian X, Xu G, Zhang H. SP promotes cell proliferation in esophageal squamous cell carcinoma through the NK1R/Hes1 axis. Biochem Biophys Res Commun 2019; 514:1210-1216. [PMID: 31109645 DOI: 10.1016/j.bbrc.2019.05.092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 01/20/2023]
|
|
9
|
Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach. J Gastric Cancer 2019; 19:1-48. [PMID: 30944757 PMCID: PMC6441770 DOI: 10.5230/jgc.2019.19.e8] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
|
|
10
|
Meng X, Wang L, Zhao Y, Zhu B, Sun T, Zhang T, Gu X, Zheng Z. Neoadjuvant Chemoradiation Treatment for Resectable Esophago-Gastric Cancer: A Systematic Review and Meta-Analysis. J Cancer 2019; 10:192-204. [PMID: 30662540 PMCID: PMC6329872 DOI: 10.7150/jca.25915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Neoadjuvant chemoradiation (CRT) remains controversial in the treatment of the oesophagus or gastro-oesophageal junction (GOJ) carcinomas. Methods: We conducted a meta-analysis to assess the efficacy and safety of Neoadjuvant CRT plus surgery comparing with neoadjuvant CT plus surgery or surgery alone. Feasible studies were searched from electronic databases. The outcomes of survival, R0 resection rate and adverse effects were analyzed. The outcomes were measured with relative risk (RR) and odds ratio(OR). Results: Seventeen records including 4095 patients were included. Neoadjuvant CRT improved 1-,2-,3-and 5-year survival. The relative risk (RR) [95% confidence interval (CI),P value] was respectively 1.08(1.03-1.14,0.002), 1.21(1.12-1.32,<0.00001),1.31(1.09-1.58,0.004),1.38(1.17-1.62, <0.001).In subgroup analysis, patients with squamous cell carcinoma benefited more survival advantage from neoadjuvant CRT than those with adenocarcinoma[1.23(1.15-1.33)vs1.11 (1.03-1.19)]. A significant advantage was observed in analysis of neoadjuvant CRT for PFS [1.32 (1.22-1.44),<0.00001]. Tests for DFS between neoadjuvant CRT and neoadjuvant CT or surgery alone were not statistically significant[1.06 (0.97-1.17,0.19)]. Neoadjuvant CRT was associated with higher R0 resection [2.58(1.75-3.82),<0.00001] and pCR rate [4.37(2.68-7.13),<0.00001]. Neoadjuvant CRT lowered the local recurrence rate [0.52(0.39-0.69),<0.00001] and didn't control distant metastasis rate[0.85(0.67-1.08),0.19].There was no evidence that neoadjuvant CRT increased the treatment-related mortality[1.27(0.95-1.71),0.11]. Neoadjuvant CRT plus surgery did not increase the risk of adverse events morbidity[1.14(0.99-1.32),0.08]. Conclusion: Patients with oesophagus or GOJ carcinomas can obtain a survival advantage from neoadjuvant CRT. The addition of radiation was efficacy and safe in range. However, these results need further high-quality prospective RCTs confirmation.
Collapse
Affiliation(s)
- Xiangyu Meng
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Lu Wang
- Department of Ultrasonography, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Zhao
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Bo Zhu
- Department of Information Management, the Information Center, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Ting Sun
- Department of Information Management, the Information Center, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Tao Zhang
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Xiaohu Gu
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Zhichao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| |
Collapse
|
|
11
|
Zhang N, Fei Q, Gu J, Yin L, He X. Progress of preoperative and postoperative radiotherapy in gastric cancer. World J Surg Oncol 2018; 16:187. [PMID: 30213266 PMCID: PMC6137719 DOI: 10.1186/s12957-018-1490-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gastric carcinoma, a highly common malignant tumor, is treated mainly by surgery. Meanwhile, radiotherapy is attracting increased attention as a crucial locoregional therapy. However, the application of radiotherapy in gastric carcinoma is still limited and radiation standards remain debatable. MAIN BODY The use of preoperative radiotherapy for treating gastroesophageal junction cancer has advanced. However, additional phase III clinical trials are needed to further verify the therapeutic value of preoperative radiotherapy for gastric cancer. Patients with D1 or D1 plus lymphadenectomy can benefit from postoperative radiotherapy obviously, and postoperative radiotherapy may be effective for patients with D2 lymphadenectomy with a high N stage. The target volume delineation of preoperative and postoperative radiotherapy should be based on clinical experience and the characteristics of lymphatic drainage. CONCLUSIONS With the advancement of radiotherapy technology, preoperative and postoperative radiotherapy are becoming increasingly accepted as important auxiliary treatments for gastric cancer.
Collapse
Affiliation(s)
- Nan Zhang
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing Medical University Affiliated Cancer Hospital, 42 Baiziting, Nanjing, 210009 Jiangsu China
| | - Qian Fei
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing Medical University Affiliated Cancer Hospital, 42 Baiziting, Nanjing, 210009 Jiangsu China
- The Fourth Clinical School of Nanjing Medical University, Nanjing, China
| | - Jiajia Gu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing Medical University Affiliated Cancer Hospital, 42 Baiziting, Nanjing, 210009 Jiangsu China
| | - Li Yin
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing Medical University Affiliated Cancer Hospital, 42 Baiziting, Nanjing, 210009 Jiangsu China
- The Fourth Clinical School of Nanjing Medical University, Nanjing, China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing Medical University Affiliated Cancer Hospital, 42 Baiziting, Nanjing, 210009 Jiangsu China
- The Fourth Clinical School of Nanjing Medical University, Nanjing, China
| |
Collapse
|
|
12
|
Biondi A, Agnes A, Del Coco F, Pozzo C, Strippoli A, D'Ugo D, Persiani R. Preoperative therapy and long-term survival in gastric cancer: One size does not fit all. Surg Oncol 2018; 27:575-583. [PMID: 30217321 DOI: 10.1016/j.suronc.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The administration of perioperative chemotherapy represents the Western standard of care for patients with locally advanced gastric cancer. The aim of this study is to determine if the administration of the preoperative component of the perioperative regimen is beneficial in the entire population of patients with locally advanced gastric cancer. METHODS Seventy patients undergoing preoperative therapy were compared with 347 patients undergoing upfront gastrectomy. Survival analyses were conducted with Kaplan-Meier curves and Cox regression. Patients undergoing preoperative therapy or undergoing upfront gastrectomy were matched 1:1 using the propensity score matching (PSM) method, and a survival analysis was conducted on matched patients. A subgroup analysis was conducted by tumor location and Lauren histotype. RESULTS In patients undergoing preoperative therapy, factors significantly associated with survival were T and N downstaging, type of gastrectomy, resection status and Lauren histotype. Preoperative therapy was not significantly associated with survival (p = 0,761 before PSM and p = 0,519 after PSM). After PSM, the independent variables significantly associated with survival were type of gastrectomy, type of lymphadenectomy, R status and postoperative therapy. In the subgroup analysis, preoperative therapy demonstrated a selective association with the location of the tumor (p = 0,055) and with Lauren intestinal histotype (p = 0,002). CONCLUSIONS Preoperative therapy had a non-significant impact on survival in the entire population of gastric cancer patients. The advantage of preoperative therapy seems to be limited to patients with proximal tumors and an intestinal histology. Future studies should better evaluate the diverse response of the different phenotypes of gastric cancer to preoperative therapy.
Collapse
Affiliation(s)
- Alberto Biondi
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Annamaria Agnes
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy.
| | - Federica Del Coco
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Carmelo Pozzo
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Antonia Strippoli
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Domenico D'Ugo
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| | - Roberto Persiani
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy
| |
Collapse
|
|
13
|
Siedek F, Giese D, Weiss K, Ekdawi S, Brinkmann S, Schroeder W, Bruns C, Chang DH, Persigehl T, Maintz D, Haneder S. 4D flow MRI for the analysis of celiac trunk and mesenteric artery stenoses. Magn Reson Imaging 2018; 53:52-62. [PMID: 30008436 DOI: 10.1016/j.mri.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/31/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aims to assess the feasibility of 4D flow MRI measurements in complex vascular territories; namely, the celiac artery (CA) and superior mesenteric artery (SMA). MATERIALS AND METHODS In this prospective study, 22 healthy volunteers and 10 patients were scanned at 3 T. Blood flow parameters were compared between healthy volunteers and patients with stenosis of the CA and/or SMA as a function of stenosis grade characterized by prior contrast-enhanced computed tomography (CE-CT). The 4D flow MRI acquisition covered the CA, SMA and adjusting parts of the abdominal aorta (AO). Measurements of velocity- (peak velocity [PV], average velocity [AV]) and volume-related parameters (peak flow [PF], stroke volume [SV]) were conducted. Further, stenosis grade and wall shear stress in the CA, SMA and AO were evaluated. RESULTS In patients, prior evaluation by CE-CT revealed 11 low- and 5 mid-grade stenoses of the CA and/or SMA. PV and AV were significantly higher in patients than in healthy volunteers [PV: p < 0.0001; AV: p = 0.03, p < 0.001]. PF and SV did not differ significantly between healthy volunteers and patients; however, a trend towards lower PF and SV could be detected in patients with mid-grade stenoses. Comparison of 4D flow MRI with CE-CT revealed a strong positive correlation in estimated degree of stenosis (CA: r = 0.86, SMA: r = 0.98). Patients with mid-grade stenoses had a significantly higher average WSS magnitude (AWM) than healthy volunteers (p = 0.02). CONCLUSION This feasibility study suggests that 4D flow MRI is a viable technique for the evaluation of complex flow characteristics in small vessels such as the CA and SMA. 4D flow MRI approves comparable to the morphologic assessment of complex vascular territories using CE-CT but, in addition, offers the functional evaluation of flow parameters that goes beyond the morphology.
Collapse
Affiliation(s)
- Florian Siedek
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Daniel Giese
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kilian Weiss
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Philips Healthcare Germany, Hamburg, Germany
| | - Sandra Ekdawi
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sebastian Brinkmann
- Department of General, Visceral and Tumor Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Wolfgang Schroeder
- Department of General, Visceral and Tumor Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Christiane Bruns
- Department of General, Visceral and Tumor Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - De-Hua Chang
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Thorsten Persigehl
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stefan Haneder
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| |
Collapse
|
|
14
|
Vitz S, Göbel H, Leibl B, Aigner T, Grabenbauer GG. Adenocarcinoma of the oesophagus: neoadjuvant chemoradiation and radical surgery : Long-term results. Strahlenther Onkol 2018; 194:1007-1016. [PMID: 29872880 DOI: 10.1007/s00066-018-1320-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/15/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE To retrospectively evaluate long-term treatment results following neoadjuvant chemoradiation (CRT) and radical surgery in patients with advanced adenocarcinoma (AC) of the oesophagus. PATIENTS AND METHODS Between 2005 and 2015, a total of 102 consecutive patients with a median age of 64 years (range, 44-86 years) and AC of the oesophagus were evaluated of whom 84 received a full CRT. A group of 51 patients was treated with neoadjuvant intent followed by radical surgery. A total dose of 50.4 Gy with mostly weekly paclitaxel/fluorouracil chemotherapy was administered. Six to eight weeks following CRT, a transthoracic subtotal oesophageal and proximal gastric resection was performed. Survival curves for overall survival and no evidence of disease (NED) survival (primary endpoints) were calculated according to Kaplan-Meier, and possible prognostic factors were evaluated by the log-rank test as well as by a Cox regression analysis. RESULTS Median follow-up time of the surviving patients was 48 months (range, 14-134 months). Overall and NED survival rates for patients of the study group (n = 51) were 40 and 32%, respectively, at 5 years. Age (p = 0.04), ypT category (p = 0.1) and the development of distant metastases (p = 0.05) were identified as (marginally) independent prognostic variables with impact on survival. Median survival time for patients of the study group (n = 51) was 45 ± 18 months (95%CI 9-81 months). Clear resection margins were achieved in 46/51 patients (92%). Regression rates with complete regression rare residual cancer and increased number of residual cells, but predominantly fibrosis were 33, 41, and 10%, respectively. Patterns of failure revealed local with distant recurrence in 2/51 (4%), regional recurrence alone in 2/51 (4%), and distant metastases in 27/51 (53%) patients. CONCLUSION Neoadjuvant CRT in patients with AC of the oesophagus followed by thoracoabdominal surgery is a locally very effective concept. A significant tumour regression in almost 75% of the patients may stimulate prospective trials on the omission of radical surgery for some elderly patients. Due to a high rate of distant metastases further investigations in terms of effective systemic therapy may be warranted.
Collapse
Affiliation(s)
- Stephanie Vitz
- Department of Radiation Oncology, Coburg Hospital, Ketschendorfer Str. 33, 96450, Coburg, Germany.,Coburg Cancer Centre, Coburg Hospital, Coburg, Germany
| | - Holger Göbel
- Department of Gastroenterology, Helmut G. Walter Hospital Lichtenfels, Lichtenfels, Germany.,Coburg Cancer Centre, Coburg Hospital, Coburg, Germany
| | - Bernhard Leibl
- Visceral and Abdominal Surgery, Coburg Hospital, Coburg, Germany.,Coburg Cancer Centre, Coburg Hospital, Coburg, Germany
| | - Thomas Aigner
- Department of Pathology, Coburg Hospital, Coburg, Germany.,Coburg Cancer Centre, Coburg Hospital, Coburg, Germany
| | - Gerhard G Grabenbauer
- Department of Radiation Oncology, Coburg Hospital, Ketschendorfer Str. 33, 96450, Coburg, Germany. .,Coburg Cancer Centre, Coburg Hospital, Coburg, Germany.
| |
Collapse
|
|
15
|
Visser E, Edholm D, Smithers BM, Thomson IG, Burmeister BH, Walpole ET, Gotley DC, Joubert WL, Atkinson V, Mai T, Thomas JM, Barbour AP. Neoadjuvant chemotherapy or chemoradiotherapy for adenocarcinoma of the esophagus. J Surg Oncol 2018; 117:1687-1696. [PMID: 29806960 DOI: 10.1002/jso.25089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The optimal treatment strategy for patients with esophageal adenocarcinoma (EAC) remains undetermined. This study compared outcomes in patients undergoing neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) for EAC. METHODS Patients who underwent nCT or nCRT followed by surgery for EAC were identified from a prospective database (2000-2017) and included. After propensity score matching, the impact of the treatments on postoperative complications, in-hospital mortality, pathological outcomes, and survival rates were compared. RESULTS Of the 396 eligible patients, 262 patients were analysed following matching with 131 patients in both groups. There were no significant differences between the nCT and nCRT groups for overall complications (59% vs 57%, P = 0.802) or in-hospital mortality (2% vs 0%, P = 0.156). Patients who had nCRT had more R0 resections (93% vs 83%, P = 0.013), and higher pathological complete response rates (15% vs 5%, P < 0.001). No differences in 5-year overall survival rates (nCT vs nCRT; 44% vs 33%, P = 0.645) were found. CONCLUSION In this study no differences between nCT and nCRT were seen in postoperative complications and in-hospital mortality in patients treated for EAC. Inspite of improved complete resection and pathological response there was no difference in the overall survival between the treatment modalities.
Collapse
Affiliation(s)
- Els Visser
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David Edholm
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Institution of Surgical Sciences, Uppsala University, Sweden
| | - B Mark Smithers
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,Mater Medical Research Institute, Mater Health Services, Raymond Terrace, South Brisbane, Australia
| | - Iain G Thomson
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Bryan H Burmeister
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Euan T Walpole
- The University of Queensland, Brisbane, Queensland, Australia.,Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - David C Gotley
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Warren L Joubert
- Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Victoria Atkinson
- The University of Queensland, Brisbane, Queensland, Australia.,Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tao Mai
- Radiation Oncology, Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Janine M Thomas
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Mater Medical Research Institute, Mater Health Services, Raymond Terrace, South Brisbane, Australia
| | - Andrew P Barbour
- Upper Gastrointestinal/Soft Tissue Unit, Discipline of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| |
Collapse
|
|
16
|
Chang DH, Brinkmann S, Smith L, Becker I, Schroeder W, Hoelscher AH, Haneder S, Maintz D, Spiro JE. Calcification score versus arterial stenosis grading: comparison of two CT-based methods for risk assessment of anastomotic leakage after esophagectomy and gastric pull-up. Ther Clin Risk Manag 2018; 14:721-727. [PMID: 29713180 PMCID: PMC5909785 DOI: 10.2147/tcrm.s157352] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Anastomotic leakage is a major surgical complication following esophagectomy and gastric pull-up. Specific risk factors such as celiac trunk (TC) stenosis and high calcification score of the aorta have been identified, but no data are available on their relative prognostic values. This retrospective study aimed to compare and evaluate calcification score versus stenosis quantification with regards to prognostic impact on anastomotic leakage. Patients and methods Preoperative contrast-enhanced computed tomography scans of 164 consecutive patients with primary esophageal cancer were evaluated by two radiologists to apply a calcification score (0–3 scale) assessing the aorta, the celiac axis and the right and left postceliac arteries. Concurrently, the presence and degree of stenosis of TC and superior mesenteric artery were recorded for stenosis quantification. Results Anastomotic leakage was noted in 14/164 patients and 12/14 showed stenosis of TC (n=11). The presence of TC stenosis was found to have a significant impact on anastomotic healing (p=0.004). The odds ratio for the prediction of anastomotic leakage by the degree of stenosis was 1.04 (95% CI, 1.02–1.07). Ten of 14 patients had aortic calcification scores of 1 or 2, but calcification scores of the aorta, the celiac axis and the right and left postceliac arteries did not correlate with the corresponding TC stenosis values and showed no influence on patient outcome as defined by the occurrence of anastomotic insufficiency (p=0.565, 0.855, 0.518 and 1.000, respectively). Inter-reader reliability of computed tomography analysis and absolute agreement on calcium scoring was mostly over 90%. No significant differences in preoperative comorbidities and patient characteristics were found between those with and without anastomotic leakage. Conclusion Measurement of TC stenosis in preoperative contrast-enhanced computed tomography scans proved to be more reliable than calcification scores in predicting anastomotic leakage and should, therefore, be used in the risk assessment of patients undergoing esophagectomy and gastric pull-up.
Collapse
Affiliation(s)
- De-Hua Chang
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Brinkmann
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Lucy Smith
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Wolfgang Schroeder
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | | | - Stefan Haneder
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Judith Eva Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
|
17
|
Krug S, Michl P. Esophageal Cancer: New Insights into a Heterogenous Disease. Digestion 2018; 95:253-261. [PMID: 28384630 DOI: 10.1159/000464130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/16/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Esophageal cancer represents a heterogeneous malignancy mostly diagnosed in advanced stages. Worldwide, squamous cell carcinomas (SCCs) continue to be the most prevalent subtype; however, in the Western countries, the incidence of adenocarcinomas is increasing and will exceed that of SCC in the near future. During the last decade, several landmark trials contributed to a better understanding of the disease and emphasized the importance of multimodal treatment protocols. SUMMARY With the introduction of perioperative or neoadjuvant approaches, the survival of both subtypes of esophageal cancer has significantly improved. Several trials confirmed a survival benefit for perioperative chemotherapy or neoadjuvant chemoradiation, respectively, for patients with resectable locally advanced adenocarcinomas. However, the question of whether perioperative chemotherapy or neoadjuvant chemoradiation is more effective for the long-term survival in this population has yet to be fully elucidated. In SCCs, neoadjuvant chemoradiation followed by surgery or definitive chemoradiation in case of functional inoperability represent the preferred treatment options. Compared to neoadjuvant protocols, adjuvant chemotherapy or chemoradiation have only minor effects and are associated with enhanced toxicities. Current preclinical and clinical trials investigate efficacy and tolerability of novel drugs aiming to modulate immune check-points and dual inhibition of HER2. In this "to-the-point" article, we review the current standard and summarize the most recent and encouraging therapeutic advances in esophageal cancer. Multimodal treatment approaches for esophageal cancer should be discussed in a multidisciplinary team based on histology, tumor localization, and patient performance status. Neoadjuvant chemoradiation is beneficial for patients with locally advanced SCC and adenocarcinomas of the esophagus and the gastroesophageal junction (GEJ), with perioperative chemotherapy representing a valid alternative for GEJ adenocarcinomas. Combination therapies are indicated for metastatic adenocarcinomas, while the benefit of palliative chemotherapy in SCC remains controversial. Trastuzumab is indicated in HER2+ metastatic adenocarcinomas.
Collapse
Affiliation(s)
- Sebastian Krug
- Department of Internal Medicine I, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | | |
Collapse
|
|
18
|
Gong W, Zhao H, Liu S, Guan J, Liu X, Hou Q, Zhu Z, Guo H. Outcomes of radiation therapy for resectable M0 gastric cancer. Oncotarget 2018; 9:1726-1734. [PMID: 29416726 PMCID: PMC5788594 DOI: 10.18632/oncotarget.22574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022] Open
Abstract
Background The role of radiaotion therapy in resectable gastric cancer patients without distant metastases remains controversial. This retrospective analysis was performed to identify whether resectable gastric cancer patients without distant metastases might benefit from radiation. Results The results of the Kaplan-Meier analysis and log-rank test showed that a total of 3309 patients had a MST of 29.0 months, a 1-year survival rate of 74.7%, and a 3-year survival rate of 45.5%. Among them, the MST of the "RPS" group and the "RAS" group were significantly longer compared with that of the "No Radiation" group (32.7vs 32.9 vs 25.3 months, P < 0.05). The 1-year survival rates were 83.7%, 83.5% and 65.6% for the "RPS", "RAS" and "No radiation" groups, respectively (P < 0.05) and the 3-year survival rates were 52.6%, 63.6% and 44.9%, respectively (P < 0.05). The multivariate Cox proportional hazard regression analysis showed that radiation was an independent prognostic factor. Materials and Methods A total of 5744 patients from the SEER database who were initially diagnosed with histologically confirmed gastric cancer without distant metastases from 2010 to 2013 were included. Patients were divided into three groups as follows: patients who underwent radiation after surgery ("RAS" group), patients who underwent radiation prior to surgery ("RPS" group) and patients who did not undergo radiation ,only surgery performed ("No radiation'"group). Conclusions This retrospective analysis demonstrated that "RPS" or "RAS"alone were independent prognostic factors for survival improvement in selected gastric cancer patients without distant metastases.
Collapse
Affiliation(s)
- Weipeng Gong
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Hongwei Zhao
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Shanshan Liu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Jie Guan
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Xin Liu
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Qingsheng Hou
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Zhenyu Zhu
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| | - Hongliang Guo
- Department of Surgical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, 250117, China
| |
Collapse
|
|
19
|
Bringeland EA, Wasmuth HH, Grønbech JE. Perioperative chemotherapy for resectable gastric cancer - what is the evidence? Scand J Gastroenterol 2017; 52:647-653. [PMID: 28276825 DOI: 10.1080/00365521.2017.1293727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The UK MAGIC trial published in 2006 was the first RCT to identify improved long-term survival rates using preoperative chemotherapy for resectable gastric or gastroesophageal cancer. Overnight, the treatment regimen impacted European guidelines. However, the majority of patients underwent limited lymph node dissection, and analyses of the rates of curative resection, downsizing and downstaging were not by intention to treat, rightfully raising concerns about their validity. For the subset of true gastric cancers, meta-analyses may even question the claims of improved long-term survival rates by present-day regimens. A rhetorical question can be posed as to whether downstaging and improved survival rates by preoperative (radio)-chemotherapy for cancers of the distal esophagus or gastric cardia, has confounded our conclusions on the (lack of) effect of present-day regimens of perioperative chemotherapy for true gastric cancers, let alone in a situation with proper lymph node dissection. At present, a plea can be made to move one step back and revert to an RCT with a surgery alone arm. Inclusion criteria and analyses of future RCTs must stratify on tumor location and the Lauren type and embrace the newly developed scheme of sub-classification of gastric cancers based on extensive molecular profiling as reported in the seminal Cancer Genome Atlas Study.
Collapse
Affiliation(s)
- Erling A Bringeland
- a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Hans H Wasmuth
- a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Jon E Grønbech
- a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.,b Department of Cancer Research and Molecular Medicine , Norwegian University of Science and Technology , Trondheim , Norway
| |
Collapse
|
|
20
|
Stahl M, Walz MK, Riera-Knorrenschild J, Stuschke M, Sandermann A, Bitzer M, Wilke H, Budach W. Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction (POET): Long-term results of a controlled randomised trial. Eur J Cancer 2017. [PMID: 28628843 DOI: 10.1016/j.ejca.2017.04.027] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Results of the PreOperative therapy in Esophagogastric adenocarcinoma Trial (POET) showed some benefits when including radiotherapy into the preoperative treatment. This article is reporting long-term results of this phase III study. PATIENTS AND METHODS Patients with locally advanced adenocarcinomas of the oesophagogastric junction (Siewert types I-III) were eligible. Randomisation was done to chemotherapy (group A) or induction chemotherapy and chemoradiotherapy (CRT; group B) followed by surgery. RESULTS The primary end-point of the study was overall survival at 3 years. The study was closed early after 119 patients having been randomised and were eligible. Local progression-free survival after tumour resection was significantly improved by CRT (hazard ratio [HR] 0.37; 0.16-0.85, p = value 0.01) and 20 versus 12 patients were free of local tumour progression at 5 years (p = 0.03). Although the rate of postoperative in-hospital mortality was somewhat higher with CRT (10.2% versus 3.8%, p = 0.26), more patients were alive at 3 and 5 years after CRT (46.7% and 39.5%) compared with chemotherapy (26.1% and 24.4%). Thus, overall survival showed a trend in favour of preoperative CRT (HR 0.65, 95% confidence interval [CI] 0.42-1.01, p = 0.055). CONCLUSION Although the primary end-point overall survival of the study was not met, our long-term follow-up data suggest a benefit in local progression-free survival when radiotherapy was added to preoperative chemotherapy in patients with locally advanced adenocarcinoma of the oesophagogastric junction.
Collapse
Affiliation(s)
- Michael Stahl
- Department of Medical Oncology, Kliniken Essen-Mitte, Essen, Germany.
| | - Martin K Walz
- Department of Surgery, Kliniken Essen-Mitte, Essen, Germany
| | | | - Martin Stuschke
- Department of Radiation Oncology, University of Duisburg-Essen, Essen, Germany
| | | | - Michael Bitzer
- Department of Gastroenterology, University of Tübingen, Tübingen, Germany
| | - Hansjochen Wilke
- Department of Medical Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
|
21
|
Martín Sánchez M, Pérez Escutia MÁ, Lora Pablos D, Guardado Gonzales S, Cabezas Mendoza AM, Campos Bonel A, Pérez Montero H, D’Ambrosi R, Pérez-Regadera Gómez JF. Adjuvant radiochemotherapy in locally advanced gastric cancer. Strahlenther Onkol 2017; 193:1005-1013. [DOI: 10.1007/s00066-017-1173-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/13/2017] [Indexed: 02/07/2023]
|
|
22
|
Xu S, Feng L, Chen Y, Sun Y, Lu Y, Huang S, Fu Y, Zheng R, Zhang Y, Zhang R. Consistency mapping of 16 lymph node stations in gastric cancer by CT-based vessel-guided delineation of 255 patients. Oncotarget 2017; 8:41465-41473. [PMID: 28611300 PMCID: PMC5522214 DOI: 10.18632/oncotarget.18407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/21/2017] [Indexed: 01/29/2023] Open
Abstract
In order to refine the location and metastasis-risk density of 16 lymph node stations of gastric cancer for neoadjuvant radiotherapy, we retrospectively reviewed the initial images and pathological reports of 255 gastric cancer patients with lymphatic metastasis. Metastatic lymph nodes identified in the initial computed tomography images were investigated by two radiologists with gastrointestinal specialty. A circle with a diameter of 5 mm was used to identify the central position of each metastatic lymph node, defined as the LNc (the central position of the lymph node). The LNc was drawn at the equivalent location on the reference images of a standard patient based on the relative distances to the same reference vessels and the gastric wall using a Monaco® version 5.0 workstation. The image manipulation software Medi-capture was programmed for image analysis to produce a contour and density atlas of 16 lymph node stations. Based on a total of 2846 LNcs contoured (31-599 per lymph node station), we created a density distribution map of 16 lymph node drainage stations of the stomach on computed tomography images, showing the detailed radiographic delineation of each lymph node station as well as high-risk areas for lymph node metastasis. Our mapping can serve as a template for the delineation of gastric lymph node stations when defining clinical target volume in pre-operative radiotherapy for gastric cancer.
Collapse
Affiliation(s)
- Shuhang Xu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Lingling Feng
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yongming Chen
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China.,Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Ying Sun
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yao Lu
- Guangdong Province Key Laboratory of Computational Science, School of Data and Computer Science, Sun Yat-Sen University, Guangzhou 510006, China
| | - Shaomin Huang
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yang Fu
- Department of Statistical Science, Sun Yat-Sen University School of Mathematics, Guangzhou 510275, China
| | - Rongqin Zheng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yujing Zhang
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Rong Zhang
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China.,Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| |
Collapse
|
|
23
|
Goense L, van der Sluis PC, van Rossum PSN, van der Horst S, Meijer GJ, Haj Mohammad N, van Vulpen M, Mook S, Ruurda JP, van Hillegersberg R. Perioperative chemotherapy versus neoadjuvant chemoradiotherapy for esophageal or GEJ adenocarcinoma: A propensity score-matched analysis comparing toxicity, pathologic outcome, and survival. J Surg Oncol 2017; 115:812-820. [PMID: 28267212 DOI: 10.1002/jso.24596] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/19/2017] [Accepted: 02/08/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To evaluate toxicity, pathologic outcome, and survival after perioperative chemotherapy (pCT) compared to neoadjuvant chemoradiotherapy (nCRT) followed by surgery for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma. METHODS Consecutive patients with resectable esophageal or GEJ adenocarcinoma who underwent pCT (epirubicin, cisplatin, and capecitabine) or nCRT (paclitaxel, carboplatin, and 41.4 Gy) followed by surgery in a tertiary referral center in the Netherlands were compared. Propensity score matching was applied to create comparable groups. RESULTS Of 193 eligible patients, 21 were discarded after propensity score matching; 86 and 86 patients who underwent pCT and nCRT, respectively, remained. Grade ≥3 thromboembolic events occurred only in the pCT group (19% vs. 0%, P < 0.001), whereas grade ≥3 leukopenia occurred more frequently in the nCRT group (14% vs. 4%, P = 0.015). No significant differences regarding postoperative morbidity and mortality were found. Pathologic complete response was more frequently observed with nCRT (18% vs. 11%, P < 0.001), without significantly improving radicality rates (95% vs. 89%, P = 0.149). Both strategies resulted in comparable 3-year progression-free survival (pCT vs. nCRT: 46% vs. 55%, P = 0.344) and overall survival rates (49% vs. 50%, P = 0.934). At 3-year follow-up, fewer locoregional disease progression occurred in the nCRT group (19% vs. 37%, P = 0.024). CONCLUSIONS Compared to perioperative chemotherapy, neoadjuvant chemoradiotherapy achieves higher pathologic response rates and a lower risk of locoregional disease progression, without improving survival.
Collapse
Affiliation(s)
- Lucas Goense
- Department of Surgery, University Medical Center, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | | | - Peter S N van Rossum
- Department of Surgery, University Medical Center, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | | | - Gert J Meijer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center, Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center, Utrecht, The Netherlands
| | | |
Collapse
|
|
24
|
Xing XZ, Wang HJ, Qu SN, Huang CL, Zhang H, Wang H, Yang QH, Gao Y. The value of esophagectomy surgical apgar score (eSAS) in predicting the risk of major morbidity after open esophagectomy. J Thorac Dis 2016; 8:1780-7. [PMID: 27499969 DOI: 10.21037/jtd.2016.06.28] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recently, surgical apgar score (SAS) has been reported to be strongly associated with major morbidity after major abdominal surgery. The aim of this study was to assess the value of esophagectomy SAS (eSAS) in predicting the risk of major morbidity after open esophagectomy in a high volume cancer center. METHODS The data of all patients who admitted to intensive care unit (ICU) after open esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College from September 2008 through August 2010 was retrospectively collected and reviewed. Preoperative and perioperative variables were recorded and compared. The eSAS was calculated as the sum of the points of EBL, lowest MAP and lowest HR for each patient. Patients were divided into high-risk (below the cutoff) and low-risk (above the cutoff) eSAS groups according to the cutoff score with optimal accuracy of eSAS for major morbidity. Univariable and multivariable regression analysis were used to define risk factors of the occurrence of major morbidity. RESULTS Of 189 patients, 110 patients developed major morbidities (58.2%) and 30-day operative mortality was 5.8% (11/189). There were 156 high risk patients (eSAS ≤7) and 33 low risk (eSAS >7) patients. Univariable analysis demonstrated that forced expiratory volume in one second of predicted (FEV1%) ≤78% (44% vs. 61%, P=0.024), McKeown approach (22.7% vs. 7.6%, P=0.011), duration of operation longer than 230 minutes, intraoperative estimated blood loss (347±263 vs. 500±510 mL, P=0.015) and eSAS ≤7 (62.2% vs. 90.0%, P=0.001) were predictive of major morbidity. Multivariable analysis demonstrated that FEV1% ≤78% (OR, 2.493; 95% CI, 1.279-4.858, P=0.007) and eSAS ≤7 (OR, 2.810; 95% CI, 1.105-7.144; P=0.030) were independent predictors of major morbidity after esophagectomy. Compared with patients who had eSAS >7, patients who had eSAS ≤7 had longer hospital length of stay (25.39±14.36 vs. 32.22±22.66 days, P=0.030). However, there were no significant differences in ICU length of stay, duration of mechanical ventilation, ICU death, 30-day death rate and in-hospital death rate between high risk and low risk patients. CONCLUSIONS The eSAS score is predictive of major morbidity, and lower eSAS is associated with longer hospital length of stay in esophageal cancer patients after open esophagectomy.
Collapse
Affiliation(s)
- Xue-Zhong Xing
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hai-Jun Wang
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shi-Ning Qu
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chu-Lin Huang
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hao Wang
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Quan-Hui Yang
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Gao
- Department of Intensive Care Unit, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
|
25
|
Wang J, Zhang YJ. Combination of concept and clinical practice - putting a high premium on neoadjuvant therapy for adenocarcinoma of the esophagogastric junction. Shijie Huaren Xiaohua Zazhi 2016; 24:3223-3231. [DOI: 10.11569/wcjd.v24.i21.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising rapidly in recent years. The opinion that AEG is an independent disease different from squamous cell carcinoma of the esophagus and gastric adenocarcinoma has been accepted by more and more scholars. R0 resection with D2 lymph node dissection is the cornerstone of treatment, but surgical techniques remain controversial with particular uncertainty about the operation ways, appropriate resection extent about the esophagus and stomach, and lymphadenectomy sites. Neoadjuvant therapy has attracted increasing attention due to a high rate of relapse after resection and poor survival rate for most patients with advanced disease at diagnosis. Although clinical literature and meta-analyses show that neoadjuvant chemotherapy results in a significant survival benefit at 5 years for resectable locally advanced AEG, and preoperative chemoradiotherapy also should be as a standard treatment for AEG versus surgery alone, the optimal regimens of neoadjuvant therapy and comparisons between preoperative chemotherapy and chemoradiotherapy still need to be studied further.
Collapse
|
|
26
|
Martínek J, Akiyama JI, Vacková Z, Furnari M, Savarino E, Weijs TJ, Valitova E, van der Horst S, Ruurda JP, Goense L, Triadafilopoulos G. Current treatment options for esophageal diseases. Ann N Y Acad Sci 2016; 1381:139-151. [PMID: 27391867 DOI: 10.1111/nyas.13146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 02/06/2023]
Abstract
Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot-assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.
Collapse
Affiliation(s)
- Jan Martínek
- Department of Hepatogastroenterology, IKEM, Prague, Czech Republic.
| | - Jun-Ichi Akiyama
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Zuzana Vacková
- Department of Hepatogastroenterology, IKEM, Prague, Czech Republic
| | - Manuele Furnari
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Teus J Weijs
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Elen Valitova
- Department of Upper Gastrointestinal Tract Disorders, Clinical Scientific Centre, Moscow, Russia
| | - Sylvia van der Horst
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | |
Collapse
|
|
27
|
Badgwell B, Blum M, Elimova E, Estrella J, Chiang YJ, Das P, Mansfield P, Ajani J. Frequency of Resection After Preoperative Chemotherapy or Chemoradiotherapy for Gastric Adenocarcinoma. Ann Surg Oncol 2016; 23:1948-1955. [DOI: 10.1245/s10434-016-5112-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
|
28
|
Biondi A, Lirosi MC, D’Ugo D, Fico V, Ricci R, Santullo F, Rizzuto A, Cananzi FCM, Persiani R. Neo-adjuvant chemo(radio)therapy in gastric cancer: Current status and future perspectives. World J Gastrointest Oncol 2015; 7:389-400. [PMID: 26690252 PMCID: PMC4678386 DOI: 10.4251/wjgo.v7.i12.389] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/03/2015] [Accepted: 10/15/2015] [Indexed: 02/05/2023] Open
Abstract
In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.
Collapse
|
|
29
|
Mu JW, Gao SG, Xue Q, Mao YS, Wang DL, Zhao J, Gao YS, Huang JF, He J. Updated experiences with minimally invasive McKeown esophagectomy for esophageal cancer. World J Gastroenterol 2015; 21:12873-12881. [PMID: 26668512 PMCID: PMC4671043 DOI: 10.3748/wjg.v21.i45.12873] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.
METHODS: We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).
RESULTS: Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.
CONCLUSION: Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.
Collapse
|