Abstract only
155
Background: In the 7th edition of TNM classification, node positive gastric cancer is subclassified into three categories (N1, 1-2 positive nodes; N2, 3-6 positive nodes; N3, 7 or ...more positive nodes) according to the number of positive lymph node (LN). However, anatomical location of positive LN is not taken into account in the TNM classification, although Japanese classification for gastric cancer had adopted anatomical location oriented nodal staging system and had shown relevance between location of positive LN and survival outcome. The aim of the present study is, therefore, to clarify the impact of anatomical location of positive LN on numerical number oriented, latest TNM nodal staging system. Methods: The present study included 1047 node positive gastric cancer patients who underwent curative gastrectomy at the Shizuoka Cancer Center between September 2002 and December 2014. Survival outcomes were compared between patients with positive extra-perigastric lymph node (PEPLN) and those with positive perigastric lymph node (PPLN) in each nodal stage according to the 7th edition of TNM classification. Results: The present study included 471 N1 patients, 309 N2 patients, and 267 N3 according to the 7th edition of TNM classification, and 5-year survival rates (5ysr) were 81.8%, 70.5%, and 51.9%, respectively. In the N1 group, 5ysr was 75.4% in patients with PEPLN, while it was 83.2% in those with PPLN, and the difference was not statistically significant (P = 0.105). It was also similar between patients with PEPLN (64.2%) and those with PPLN (73.8%, P = 0.343) in the N2 group. However, in the N3 group, survival outcome was significantly worse in patients with PEPLN (47.9%) than in those with PPLN (63.9%, P = 0.036). Conclusions: In the N1 and N2 group, involvement of extraperigastric LN did not have impact on survival outcome. On the contrary, in the N3 group, patients with PEPLN showed worse survival outcome than those with PPLN, and they could be potential candidates for intense postoperative adjuvant treatment.
The recurrent laryngeal nerve lymph node is one of the most common metastatic sites in oesophageal cancer, and dissection of this lymph node is considered beneficial. Although the risk of ...complications from this procedure, such as recurrent laryngeal nerve palsy, is well known, few reports have detailed those risks in a large number of cases. Our study examined the risks of recurrent laryngeal nerve lymph node dissection, with a special focus on recurrent laryngeal nerve palsy.
Retrospectively collected data from 661 patients, who underwent transthoracic oesophagectomy for oesophageal cancer, were analysed.
Recurrent laryngeal nerve palsy occurred in 36% of the patients. Among these patients, except those in whom recurrent laryngeal nerve was intentionally excised due to metastatic lymph node, permanent palsy was detected in 12%. Bilateral recurrent laryngeal nerve lymph node dissection, cervical anastomosis and upper oesophageal cancer were independent risk factors for recurrent laryngeal nerve palsy. Although recurrent laryngeal nerve palsy was a risk factor for aspiration, tracheostomy and postoperative pneumonia, it did not directly correlate with death caused by pneumonia. Among postoperative complications, only recurrent laryngeal nerve palsy correlated with bilateral recurrent laryngeal nerve lymph node dissection.
Recurrent laryngeal nerve palsy is a complication that should be avoided but does not seem to be severe enough to affect patient survival after surgery. Although bilateral recurrent laryngeal nerve lymph node dissection can induce recurrent laryngeal nerve palsy in patients who undergo transthoracic oesophagectomy, this procedure did not correlate with aspiration and pneumonia.
Abstract only
e15536
Background: Postoperative adjuvant chemotherapy with administration of S-1 for one year is standard treatment in patients with pStageII/III in Japan. However, survival outcome of ...patients with pStageIII remains unsatisfactory, so several attempt have been made to improve the survival in these patients. However, actual survival according to sub-classification in pStage III has not been elucidated. The eighth edition of the American Joint Committee on Cancer (AJCC) TNM postoperative staging for gastric cancer was published in 2016 and included major revisions of pStageIII. The aim of the current study was to evaluate the validity of the eighth edition TNM classification, especially in pStageIII for gastric cancer based on patients treated in single Japanese high volume cancer center. Methods: A total of 646 gastric cancer patients with pStageIII who underwent R0 resection from 2002 to 2016 were included. Prognostic value was analyzed for validation and compared TNM seventh edition. Results: Some improvement was observed in the separation of pN. Patients with pN3b (5-year survival rates = ysr; 13.4%) had the significant poor survival than those with N3a (5-ysr; 39.1%) (P < 0.001). In pStage III disease, clear survival distribution was observed in eighth edition IIIA (N = 315); 5-ysr: 67.0%, risk ratio (RR) = 1 (reference), IIIB (N = 230); 5-ysr: 51.1%, RR = 1.694, P < 0.001, IIIC (N = 101); 5-ysr: 30.9%, RR = 2.771, P = 0.002, compared to seventh edition IIIA (N = 233); 5-ysr: 69.3%, RR = 1;, IIIB (N = 230); 5-ysr: 53.8%, RR = 1.682, P = 0.001, IIIC (N = 183); 5-ysr: 38.7%, RR = 2.571, P = 0.004. Conclusions: Survival outcome of pStageIIIC (T3-T4bN3b, T4bN3a) in eighth edition is very poor. So, more aggressive regimen should be planned for pStageIIIC gastric cancer in eighth TNM staging.
Abstract only
40
Background: The number of the oldest-old patients with gastric cancer has been increasing in Japan. Selecting optimal operation for these patients is difficult because coping with ...both radicality and tolerability of surgery is mandatory. The aim of this study is to clarify the feasibility and effectiveness of gastrectomy for these patients. Methods: A total of 721 old patients (aged 75 years old and older) with gastric cancer who underwent curative gastrectomy at Shizuoka Cancer Center between from Oct. 2002 to Aug. 2015 were included in this study. The patients were classified into oldest-old group (OOP; aged 85 years and older) and old group (OP; aged 75 to 84 years old). Characteristics of the patients and short and long-term outcomes were compared between the groups. Results: OOP group included 57 patients, and OP group 664 patients. Though median serum albumin level in OOP group (3.8 g/dl) was significantly lower than in OP group (4.1 g/dl) (p = 0.002), the other clinicopathological characteristics including gender, BMI, co-morbidity, ASA-PS, ECOG-PS and preoperative stage were not significantly different between the groups. In terms of operative results, gastrectomy with reduced extent of lymph node dissection was frequently performed in OOP group (33.3%) than in OP group (6.0%) with significant difference (p < 0.001). Median operation time was significantly shorter in OOP group (195 minutes) than in OP group (222 minutes) (p = 0.001), and median blood loss was significantly less in OOP group (154 ml) than in OP group (227 ml) (p = 0.041). There was no significant difference of the incidence of postoperative complications between the groups. There was no significant difference of overall survival (p = 0.973) and disease-specific-survival (p = 0.549) between the groups. In multivariate analysis, preoperative BMI < 20, serum albumin < 3.8 g/dl and 15 days or more postoperative hospital stay were revealed as significant independent prognostic factors. Conclusions: Gastrectomy is safe with acceptable oncologic outcomes for OOP with optimally reducing the extent of surgery in each patient. In order to improve the outcome in OOP, preoperative nutritional management and support for home health care system should be considered.
Abstract only
101
Background: Preoperative malnutrition worsens morbidity and survival, however the role of post-gastrectomy nutritional status in survival remains unclear. The nutrition risk index ...(NRI) described by Buzby is a scoring system for identifying patients with preoperative poor nutrition status. However, the significance of NRI in evaluating post-gastrectomy nutritional status has not yet been established. Therefore, we aimed to clarify whether malnutrition condition evaluated by NRI after surgery can be a predictive factor for long-term survival in patients with gastric cancer. Methods: Pathological stage I, II, and III gastric cancer patients who underwent curative gastrectomy between 2002 and 2013 were included in this study. NRI was calculated using the following formula; (1.489 × serum albumin, g/L) + (41.7 × current weight/usual weight), and we defined an NRI of above 97.5 as normal nutrition (N group) and 97.5 or below as malnutrition (M group). NRI was evaluated before gastrectomy and 1, 3 and 12 months after gastrectomy. The correlations of clinicopathological characteristics, surgical treatment and overall survival, with nutritional status were retrospectively evaluated. Results: A total of 2552 patients were enrolled. There were significant differences in age, sex, body mass index, performance status, co-morbidity, histology and malignant stage between the groups before gastrectomy. Overall survival in the M group was significantly poorer, both before gastrectomy (adjusted HR 1.31; p < 0.001) and at 1 month (adjusted HR 1.52; p < 0.001), 3 months (adjusted HR 1.35; p = 0.004) and 12 months (adjusted HR 1.37; p = 0.006) after gastrectomy. In multivariate analysis, low NRI at 12 months after gastrectomy, age, co-morbidity and malignant stage were independently associated with overall survival. Overall survival in patients who fulfilled preoperative normal nutrition status criteria was also significantly poorer at 12 months after gastrectomy in the M group. Conclusions: Malnutrition after surgery, as well as before surgery, had a significant impact on overall survival. Postoperative nutritional statue evaluated by NRI may be a good predictive marker for long-term survival.
Abstract only
114
Background: Recently, REGATTA trial showed that debulking surgeries followed by chemotherapy did not improve survival outcomes compared to chemotherapy alone for incurable advanced ...gastric cancer (AGC). Therefore, the standard treatment for incurable AGC without emergent symptom is not gastrectomy plus chemotherapy but chemotherapy alone. However, in patients who are unfit for chemotherapy due to poor performance status (PS), age, or comorbid chronic diseases, the role of palliative gastrectomy remains controversial. The aim of this study is to determine the role of palliative resection in patients with incurable AGC unfit for chemotherapy. Methods: Two hundred and twelve gastric cancer patients having any cause of incurable factors and underwent palliative gastrectomy or bypass operation between November 2002 and December 2014 were enrolled. Of these 212 patients, 64 patients who did not receive any chemotherapy were divided into two groups; Gastrectomy group with 45 patients who underwent palliative gastrectomy (distal gastrectomy in 18, total gastrectomy in 27) and Bypass group with 19 patients who underwent gastrojejunostomy. Survival outcomes and clinicopathologic features were compared between the two groups. Results: The reasons why unfit for chemotherapy were age (15), patients’ refusal (14), poor PS (11), postoperative complications (11), comorbidity (10), disease progression (3). There was no significant difference of clinicopathologic features between the two groups such as, age (MAN; 74.1 vs 77.1, p = 0.198), gender (male/female: 37/8 vs 13/6, p = 0.321), and number of incurable factors 2 or more (51.1% vs 63.2%, p = 0.422) except for postoperative complications of C-D grade 3 or more (24.4% vs 0%, p = 0.025). Median survival time of Gastrectomy group and Bypass group were 154 days (95%CI: 124-253) and 86 days (95%CI: 71-166), respectively, and significantly longer in Gastrectomy group (p = 0.002). Conclusions: These results suggest that palliative gastrectomy may improve survival in patients with incurable advanced gastric cancer unfit for chemotherapy.
Abstract only
57
Background: Neuroendocrine carcinoma (NEC) in the stomach is a rare disease with the incidence of about 0.6 % of all gastric cancer and is well known as a highly malignant tumor with ...poor survival. Despite the malignant phenotype of this disease, the global gene expression profiling of gastric NEC has not yet been elucidated. We have started a comprehensive molecular profiling project that analyzes genome and transcriptome of tumor obtained from cancer patients admitted to Shizuoka Cancer Center from January 2014, setting a goal to get 3,000 samples in 3 years. We had already evaluated more than 1,500 samples from various types of malignancies, including 111 samples from gastric cancer. Here, we performed deep sequencing of 409 cancer-related genes for gastric NEC patients, adding whole-exome sequencing and gene expression profiling, to identify a gene variant of gastric NEC. Methods: Surgically-resected fresh tumor samples and peripheral blood were analyzed by whole-exome sequencing (Ion Proton, Life Technologies) and gene expression profiling (DNA microarray, Agilent Technologies). A total of 111 patients with gastric cancer were evaluated until August 2015, including 6 gastric NEC (5.4 %). We compared single nucleotide variants (SNVs) and gene expression profiles between gastric NEC and gastric adenocarcinoma. Results: All the gastric NEC patients were male with median age of 69 years (59–79 years). According to classification of TNM 7th, there were two patients with stage IA, one with IIA, one with IIIB and two with IIIC. Three of them had adenocarcinoma components constituted > 30% of the respective tumors, fulfilling the criteria for mixed adenoneuroendocrine carcinoma (MANEC), as defined by the WHO classification. There was no specific SNV for NEC. However, gene expression profiling identified several specific genes expressing in NEC; most of the highly expressed genes were also known to be expressed in neuroendocrine cells. Furthermore, CPLX2 and SCG3, which had been reported to be expressed in various neuroendocrine tumors, were included. Conclusions: Gastric NEC could be characterized by specific gene expression including those expressed in neuroendocrine cells and neuroendocrine tumors.
Abstract only
72
Background: Gastric cancer is well known as having heterogeneous features. Recently, the Asian Cancer Research Group (AGRG) had proposed a new classification scheme based on the gene ...expression profile of the tumor. However, the genomi/expression profiling of gastric cancer in Japanese patients is still unknown. We started a comprehensive molecular profiling study that analyzes genome and transcriptome of tumor obtained from cancer patients admitted to Shizuoka Cancer Center from 2014. We already had evaluated more than 1,500 samples from various type of cancer. Among them, 104 gastric cancer patients were analyzed. Methods: Fresh surgically resected tumor/normal samples and peripheral blood were obtained and whole-exome sequencing (Ion Proton, Life Technologies) and gene expression profiling (DNA microarray, Agilent Technologies) were performed. Patients were grouped based on the gene expression profile according to AGRG classification, and clinicopathological features were compared among the group. Results: Patients were classified into MSI in 14, MSS/EMT in 15, MSS/TP53
+
in 38 and MSS/TP53
-
in 37, respectively. There was no significant difference of sex among the group. Age was significantly younger in MSS/EMT and MSS/TP53
-
. In MSI, tumor tended to be located at antrum, and differentiated type tumor was predominant. In MSS/EMT, advanced T stage (T4) and undifferentiated type of tumor was predominant. In MSS/TP53
+
, relatively less advanced stage and localized macroscopic type tumor was predominant. In MSS/TP53
-
, relatively advanced stage and invasive macroscopic type tumor was predominant. Although the follow-up period is insufficient, relapse-free survival was the worst in MSS/EMT and no patient recurred in MSI. Conclusions: Classification of gene expression profiling based on ACRG was possible in Japanese gastric cancer. Distribution and tumor characteristics were almost identical to ACRG cohort. Gene -expression profiling may be comprehensively used for tumor classification and further clinical trials of molecular targeting agents.
PDF