Purpose: The aim of this study was to examine the usefulness of the Controlling Nutritional Status (CONUT) score as an indicator of the therapeutic effect and as a prognostic marker in patients ...treated with nivolumab for unresectable advanced gastric cancer. Materials and Methods: A retrospective analysis was performed for 31 patients with the CONUT scores before treatment with nivolumab for unresectable advanced gastric cancer from October 2017 to December 2019. The patients were divided into two groups based on a normal (group A) or poor (group B) nutritional status assessed by the CONUT score. Result: Patients with a normal nutritional status had a significantly better therapeutic response based on disease control rates of 90% in group A and 33% in group B (P=0.0032). Multivariate analysis showed that the CONUT score was a predictor of disease control (odds ratio: 14.7, P=0.022). Patients with a normal nutrition status also had a significantly better prognosis, with median survival times of 337 days in group A and 123 days in group B (hazard ratio HR: 0.36, P=0.033). Multivariate analysis showed that the CONUT score was a prognostic indicator of overall survival (HR: 0.32, P=0.022). Conclusion: The CONUT score was correlated with the therapeutic effect of nivolumab and with disease prognosis. Thus, the CONUT score may be a clinically useful index to predict the effect of nivolumab in patients with unresectable advanced gastric cancer.
Background
Postoperative adjuvant chemotherapy is not indicated for T1N1M0/T2N0M0/T3N0M0 gastric cancer. However, approximately 10% to 30% of these patients experience recurrence and metastasis.
...Methods
Among 658 patients with gastric cancer who received gastrectomy with curative intent, 130 T1N1M0/T2N0M0 and 73 T3N0M0 patients were enrolled. Overall survival (OS) and relapse‐free survival (RFS) were analyzed based on TP53 codon 72 polymorphisms Arg/Arg, Arg/Pro, and Pro/Pro. The hazard ratio (HR) for each subgroup was compared by TP53 codon 72 polymorphisms.
Results
Of the 189 patients for whom polymorphism analysis results were available, the 5‐ and 10‐year OS was 84.9% and 65.1%, respectively. The 5‐ and 10‐year RFS was 81.8% and 65.4%, respectively. When the study cohort was divided into two groups according to polymorphism status (ie, “Arg/Arg and Arg/Pro” vs Pro/Pro), both the OS (HR, 2.799; 95% confidence interval CI, 1.071‐7.315; P = .036) and RFS (HR, 2.639; 95% CI, 1.025‐6.794; P = .044) of the Pro/Pro group were significantly lower than those for the Arg/Arg and Arg/Pro groups across the entire observation period.
Conclusions
The TP53 codon 72 Pro/Pro polymorphism may isolate a relatively high‐risk patient group in T1N1M0/T2N0M0/T3N0M0 gastric cancer.
We conducted a feasibility study using S-1, a novel oral derivative of 5-fluorouracil, as postoperative adjuvant chemotherapy for curatively resected gastric cancer patients.
Adjuvant chemotherapy ...consisted of eight courses (4-week administration and 2-week withdrawal) of S-1, at 80-120 mg/body per day. Forty-one patients from 11 institutions were enrolled in this pilot study, from November 1999 to October 2000.
Thirty-five patients were eligible. In 7 patients, S-1 administration was discontinued due to recurrence. Among the 28 patients without recurrence, the planned eight courses of S-1 were administered to 17 patients (60.7%). In 4 patients, S-1 administration was discontinued due to subjective symptoms, such as anorexia, in the first course. Adverse reactions such as neutropenia, leukopenia, elevated total bilirubin, anorexia, general fatigue, diarrhea, nausea, and stomatitis were seen in more than half of the patients. Although grade 3 neutropenia (29.3%), leukopenia (9.8%), and diarrhea (9.8%) were observed, no grade 4 adverse effects appeared. Compared with the treatment of unresectable or recurrent gastric cancer with S-1, the incidence of adverse reactions in the adjuvant setting was slightly higher, probably due to the influence of gastrectomy.
Except for the early development of anorexia, most likely due to adverse effects of surgery, postoperative administration of S-1 for 1 year seems feasible as adjuvant chemotherapy for gastric cancer.
Background and Objectives
Limited information exists regarding beneficial effects of Helicobacter pylori. To examine the effect in advanced gastric cancer, we compared survival for patients treated ...with surgery‐only or adjuvant chemotherapy on the basis of H. pylori infection status.
Methods
A cohort of 491 patients who underwent R0 resection for locally advanced gastric cancer between 2000 and 2009 at 12 institutions in northern Japan was included. H. pylori infection status, was assessed from paraffin‐embedded formalin‐fixed samples. Overall survival (OS) and disease‐free survival (DFS) in surgery‐only (Surgery) and adjuvant chemotherapy (S‐1) groups were analyzed. A propensity score matching was employed to correct for confounding factors by indication.
Results
H. pylori infection was positive in 175 patients and negative in 316 patients. H. pylori‐positive patients showed significantly better survival than H. pylori‐negative patients in both OS (hazard ratio HR 0.593, 95% confidence interval CI 0.417‐0.843; P = 0.003) and DFS (HR 0.679, 95%CI 0.492‐0.937; P = 0.018). Propensity score matching further confirmed that S‐1 was virtually only effective when tumors were H. pylori‐positive.
Conclusions
The favorable outcome of H. pylori‐positive patients implies that the host immune system is modulated by H. pylori enhancing the chemotherapeutic efficacy.
Pulmonary metastasis of gastric cancer usually occurs as a result of carcinomatous lymphangiosis or carcinomatous pleurisy, and solitary pulmonary metastasis after gastric cancer surgery is rare. ...Although resection of solitary pulmonary metastases is reportedly effective, the role of surgical treatment is unclear.The study subjects were five patients who underwent surgical resection of a solitary pulmonary metastasis after gastric cancer surgery.Median time to pulmonary metastasis recurrence was 22 months, and the time was ≥12 months in all cases. Median survival after pneumonectomy was 45 (8-96) months, and the 5-year survival rate was 40%. The two patients for whom the time to pulmonary metastasis recurrence after gastric cancer surgery was ≥30 months both survived recurrence-free for ≥5 years after pneumonectomy.Some patients achieved a good outcome following pneumonectomy for a solitary pulmonary metastasis after gastric cancer surgery. The prognosis for patients in whom the time to recurrence after gastric cancer resection is ≥30 months may be particularly good, suggesting that surgery should therefore be considered if at all possible.
Brain metastasis of gastric cancer is comparatively rare and has been reported to carry poor prognosis. Recently we have experienced three cases of brain metastasis after surgery for gastric cancer ...in which aggressive treatments were performed. The patients included one man and two women, with the median age at the surgery for gastric cancer of 61. As for the progression of gastric cancer, two patients had pStage IIIC gastric cancer and one had pStage IV with liver metastasis. The time from the surgery for gastric cancer to brain metastasis was more than 12 months in all three cases. The number of brain lesions was solitary in one case, or multiple in two cases. The treatments for the brain metastases included stereotactic radiation therapy in two cases and surgery in one case. All three patients died of cancer, including two of cerebral hernia associated with progression of the brain lesion and one of progression of a lung lesion. The surviving time after brain metastasis was 27 days, eight months, or nine months, respectively.Contrary to our understanding that the prognosis after brain metastasis of gastric cancer is poor, comparatively long-term survival was gained in our three patients. Control of the brain lesion might be important, and hence we should aggressively consider and employ available treatments if it is treatable.
Aim : Chylorrhea occurs occasionally in gastric cancer surgery with only standard lymph node dissection. The aim of this study was to verify whether the use of polymer ligation clips (PLCs) prevents ...chylorrhea in gastric cancer surgery with standard lymph node dissection.Methods : In the present study, 262 gastric cancer patients who underwent D1+ or D2 lymph node dissection were included. PLCs were used in suprapancreatic lymph node dissection. The incidence of chylorrhea was compared between the clip and no-clip groups. The treatment details and outcomes of patients with chylorrhea were also examined.Results : There were 96 patients in the clip group and 166 in the no-clip group. Chylorrhea did not occur in the clip group (0/96), but did occur in 7 of 166 patients (4.2%) in the no-clip group (p<0.05). Although all 7 patients with chylorrhea were cured, their postoperative hospital stay ranged between 8 and 43 days, with a median of 25 days.Conclusions : The usefulness of PLCs to prevent chylorrhea following gastric cancer surgery with standard lymph node dissection was demonstrated. Since chylorrhea takes a long time to treat, its prevention by routine clip use is very useful.
Isolated dissection of the abdominal visceral arteries is relatively rare, and there are no prior reports of such complications in gastrectomy performed for gastric cancer. We safely performed ...laparoscopic distal gastrectomy with D1 dissection for early-stage gastric cancer in a 58-year-old man with asymptomatic celiac and splenic artery dissection discovered on preoperative CT. The patient was discharged without postoperative complications, and progress is currently being monitored, at 7 months postoperatively. When dissecting lymph nodes peripheral to the celiac artery, common hepatic artery, or splenic artery in gastric cancer surgery where complications from the abdominal visceral artery dissection were located, it is important to be aware of the risk of vascular injury, aneurysm formation, caused by heat dissipation from energy devices such as electrical or ultrasonically activated scalpels, before proceeding with surgery.
The patient was a 59-year-old man who had been followed up after surgical treatment for a thoracic aortic aneurysm at the Department of Cardiovascular Surgery in our hospital. A contrast-enhanced CT ...scan conducted one year and 6 months after the surgery disclosed a tumorous lesion at the cardiac part of the stomach. Close exploration led to a diagnosis of a submucosal tumor 50 mm in diameter being present just under the gastric cardia. We decided to perform surgery. Considering the location and the diameter of the tumor, we selected laparoscopic proximal gastrectomy. He was discharged from our hospital on the 6th postoperative day and his postoperative QOL was satisfactory. Histopathology revealed the tumor to be a submucosal tumor with the maximum diameter of 42 mm, consisting of large fusiform and polygonal cells, where an abundant of eosinophil granules was seen in the cytoplasm. Immunohistochemical staining for PAS, S-100 protein, or NSE was positive. Consequently, granular cell tumor of the stomach was diagnosed.Granular cell tumor of the stomach is a rare entity and there have been only four cases, including ours, performed laparoscopic resection in Japan. We present our case with some bibliographical comments including selection of the treatments.
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