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To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection.
We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions. The clinicopathological factors that co...
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... patients (4.2%) died of post-operative complica- tions: 2 were due to multi-organ failure associated with pancreatic fistula, and 1 was due to acute gangrenous cho- lecystitis combined with peritonitis. These complications are listed in Table 2. Thirty-one patients (43.7%) died during the follow-up period. ...
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Citations
... All these studies recorded VI as positive or negative, which was evaluated by hematoxylin and eosin (HE) staining [20] or staining not specified [17][18][19]21]. Fukuda et al. also did not find a significant prognostic impact of VI in 71 patients with T4 GC after curative resection [22]. In their study, VI was classified in either v0/v1 or v2/v3 by the JCGC (3rd English ed.), and the staining method was not specified. ...
... The VI grade as well as pTNM stage was an independent recurrence predictor with a statistical significance, consistent with the previous studies [17][18][19]23]. Although VI was not associated with postoperative recurrence in some studies which analyzed stage I and T4 GC [20][21][22], we speculate that it may be due to the intrinsic excellent and dismal prognoses of stage I and T4 GCs, respectively. In fact, many studies concluded that the lymphatic/ vascular invasions are not directly related to patients' prognosis with stage I GC [24]. ...
Background
Venous invasion (VI) in pathological examination of surgically resected gastric cancer (GC) may predict postoperative recurrence, but there are no objective criteria for VI grading.
Methods
157 GC patients (pathological stages I 82, II 34, and III 41) who underwent surgery with curative intent were analyzed. VI was graded in pathological examination by elastica van Gieson staining based on the number of VIs per glass slide as follows: v0, 0; v1, 1−3; v2, 4−6; and v3, ≥ 7. Filling-type invasion in veins with a minor axis of ≥ 1 mm increased the grade by 1. The association of VI grade with prognosis was statistically analyzed.
Results
Recurrence increased with VI grade (v0 1.5%, v1 29.6%, v2 41.7%, v3 78.6%). VI grade as well as pathological (p) tumor, node, metastasis (TNM) stage was a significant recurrence predictor by the multivariate Cox analysis. VI grade was implicated in hematogenous and peritoneal recurrences independent of pTNM stage but not in nodal recurrence. GC was then divided into two tiers, without indication of adjuvant chemotherapy (AC) (pStage I, pT1 and pT3N0) and with AC indication (pStages remaining II/III), based on the ACTS-GC trial, which is common in Japan and East Asia. VI grade was a significant recurrence predictor in both tiers. v2/v3 revealed a significantly worse recurrence-free survival (RFS) than v0/v1 in GC without AC indication. v0/v1 exhibited RFS rate exceeding 95% even after 5 years but that of v2/v3 fell around 70% within one year postoperatively, suggesting that AC may be considered for this tier with v2/v3. GC with AC indication exhibited dismal RFS according to the VI grade. RFS rate fell below 80% within one year postoperatively when VI was positive, while recurrence was not observed in v0, which was, however, rare in this tier (10.9%). Differentiation grade did not significantly affect postoperative prognosis in both tiers.
Conclusions
VI grade was a significant predictor of postoperative GC recurrence irrespective of the AC indication based on the ACTS-GC study and this VI grading system could be applied in future studies of adjuvant therapy in GC presently deemed without AC indication in Japan.
... According to the 8th version of the TNM staging system of the American Joint Committee on Cancer (AJCC), T4a GC was defined as the tumor perforating serosa (6). Owing to the presence of incurable factors including distant lymph node involvement, peritoneal metastasis, and hematogenous metastasis, the outcomes of traditional treatments varied distinctly in this group of patients (7,8). Further, with the complexity of the prognosis and its influencing factors, there are still challenges in assessing the prognosis precisely and individually. ...
... The proposed nomograms also showed favorable ability to categorize patients with T4a GC into high-and low-risk groups with significant differences in OS and CSS. As described before, owing to the presence of incurable factors such as distant lymph node involvement, peritoneal metastasis, and hematogenous metastasis, patients with T4a GC always suffered from distinctly different outcomes of traditional treatments (7,8). In this study, we compared the clinicopathological factors and also other factors between patients with T4a and other GC and found T4a GC always accompanied with larger tumor size, more severe tumor grade, more lymph node invasion, and distant metastasis, which may lead to a worse clinical outcome. ...
Background: T4a gastric cancer (GC) is a subtype of advanced GC (AGC), which urgently needs a comprehensive grade method for better treatment strategy choosing. The purpose of this study was to develop two nomograms for predicting the prognosis of patients with T4a GC.
Methods: A total of 1,129 patients diagnosed as T4a GC between 2010 and 2015 were extracted from the Surveillance, Epidemiology, and End Result (SEER) program database. Univariate and multivariate Cox analyses were performed to explore the independent predictors and to establish nomogram for overall survival (OS) of the patients, whereas competing risk analyses were performed to find the independent predictors and to establish nomogram for cancer-specific survival (CSS) of the patients. The area under the curve (AUC), calibration curve, decision curve analysis (DCA), and Kaplan–Meier analysis were performed to evaluate the nomograms.
Results: Older age, larger tumor size, black race, signet ring cell carcinoma (SRCC), more lymph node involvement, the absence of surgery, the absence of radiotherapy, and the absence of chemotherapy were identified as independent prognostic factors for both OS and CSS. In the training cohort, the AUCs of the OS nomogram were 0.760, 0.743, and 0.723 for 1-, 3-, and 5-year OS, whereas the AUCs of the CSS nomogram were 0.724, 0.703, and 0.713 for 1-, 3-, and 5-year CSS, respectively. The calibration curve and DCA indicated that both nomograms can effectively predict OS and CSS, respectively. The abovementioned results were also confirmed in the validation cohort. Stratification of the patients into high- and low-risk groups highlighted the differences in prognosis between the two groups both in training and in validation cohorts.
Conclusions: Age, tumor size, race, histologic type, N stage, surgery status, radiotherapy, and chemotherapy were confirmed as independent prognostic factors for both OS and CSS in patients with T4a GC. Two nomograms based on the abovementioned variables were constructed to provide more accurate individual survival predictions for them.
... At present, surgical resection is the main treatment for patients with early gastric cancer, while chemotherapy is the preferred treatment for patients with advanced gastric cancer [15,16]. However, given that the symptoms are nonspecific, most patients with gastric cancer are diagnosed at advanced stages [17]. Therefore, enhancing the effects of chemotherapy by seeking new specific therapeutic targets is important for improving the prognosis of gastric cancer. ...
Chondroitin polymerizing factor (CHPF) is an important glycosyltransferase involved in the biosynthesis of chondroitin sulfate. However, the relationship between CHPF and gastric cancer has not been fully investigated. CHPF expression in gastric cancer tissues was detected by immunohistochemistry and correlated with gastric cancer patient prognosis. Cultured gastric cancer cells and human gastric epithelial cell line GES1 were used to investigate the effects of shCHPF and shE2F1 on the development and progression of gastric cancer by MTT, western blotting, flow cytometry analysis of cell apoptosis, colony formation, transwell and gastric cancer xenograft mouse models, in vitro and in vivo. In gastric cancer tissues, CHPF was found to be significantly upregulated, and its expression correlated with tumor infiltration and advanced tumor stage and shorter patient survival in gastric cancer. CHPF may promote gastric cancer development by regulating cell proliferation, colony formation, cell apoptosis and cell migration, while knockdown induced the opposite effects. Moreover, the results from in vivo experiments demonstrated that tumor growth was suppressed by CHPF knockdown. Additionally, E2F1 was identified as a potential downstream target of CHPF in the regulation of gastric cancer, and its knockdown decreased the CHPF-induced promotion of gastric cancer. Mechanistic study revealed that CHPF may regulate E2F1 through affecting UBE2T-mediated E2F1 ubiquitination. This study showed, for the first time, that CHPF is a potential prognostic indicator and tumor promoter in gastric cancer whose function is likely carried out through the regulation of E2F1.
... Locally advanced GC is defined as stage T4 disease in which the tumour perforates the serosa (T4a) or invades adjacent structures (T4b), and often has a poor prognosis because of the presence of peritoneal seeding, liver metastasis, and/or distant lymph node involvement (14). CT-TA has recently been considered a promising tool; CT-TA evaluates gray level Then, using the program, three-fold dilatation was performed sequentially (c) and a standard perigastric area to be analyzed within the ROI boundaries was provided distributions and spatial intratumoural heterogeneities (15). ...
Introduction:To explore the role of computed tomography (CT) texture analysis in predicting T-stage of gastric cancers (GC).Methods:Preoperative enhanced CT images of 110 patients (men: 84, women: 26) with GC were reviewed retrospectively. Regions of interest were manually drawn along the margin of the lesion on the section where it appeared largest on the portal venous CT images, which yielded texture parameters (1, 10, 50, 90, and 99% percentiles; minimum, mean, and maximum norm; variance; skewness, and kurtosis). Correlations between texture parameters and pathological stage were analysed with Spearman’s correlation test. The distributions of all variables were checked with the aid of the Kolmogorov-Smirnov test. The Independent-Samples t-test and the Mann-Whitney U test were used (as appropriate) to compare quantitative data. The chi-squared test was employed to compare qualitative data. The diagnostic performance of CT texture parameters in differentiating different stages was evaluated using receiver operating characteristic analysis.Results:The T4 variance was significantly greater than that of the T1-to-T3 group (p˂0.05). The T4 skewness was significantly lower than that of the T1-to-T3 group (p˂0.05) but the T4 kurtosis significantly higher (p˂0.05).Conclusion:The histogram parameters of CT-TA, especially skewness and kurtosis derived from portal, venous phase CT images, may serve as biomarkers stratifying the risk of serosal invasion (stage-T4) by locally advanced GC. Thus, histogram analysis can be used preoperatively to evaluate serosal invasion.
... Several prognostic indicators of gastric cancer have been identified, with the most indicative being lymph involvement and wall invasion depth, determined from postoperative pathological specimens [4,5]. Other postoperative histopathological prognostic factors include venous invasion, perineural invasion, surgical margins, peritoneal cytology and tumor size [6,7]. Tumor size is the main prognostic indication of certain solid organ tumors, such as those of the breast and liver, but is absent from the tumor, node and metastasis (TNM) staging system for gastric cancer [8]. ...
Purpose. This study investigates the prognostic significance of tumor size and its effect on survival among patients undergoing gastrectomy and D2 lymph node dissection due to gastric cancer. Materials and Methods. The clinicopathological characteristics of 320 patients who were operated due to gastric cancer between November 2006 and September 2019 were assessed retrospectively, of which 271 were included in the present study. A receiver-operating characteristic curve (ROC) analysis was carried out to identify the tumor size cut-off value. Patients were divided into small-size and large-size tumor groups. Clinicopathological characteristics were assessed using Chi-square and Mann-Whitney U tests, while survival was assessed with a Kaplan-Meier log-rank test. Results. The cut-off gastric cancer tumor size value was calculated as 4.75 cm. A statistical difference was noted in the tumor depth of wall invasion (p<0.001), the number of positive lymph nodes removed (p<0.001), vascular invasion (p=0.001) and perineural invasion (p=0.001) of the two groups. Survival was poorer in patients with large-size tumors than in those with small-size tumors (62 months vs. 88 months, respectively; p<0.001), and tumor size was associated with wall invasion depth (p<0.001) and Borrmann’s classification (p=0.002). A univariate analysis revealed tumor size to be a prognostic factor for survival (p=0.001), while no such finding could be established in a multivariate analysis (p=0.637). Conclusion. Tumor size is a prognostic marker for gastric cancer, and a preoperative assessment in this regard may suggest neoadjuvant therapy.
... In this study, the morbidity rate was 51%. In other studies, the morbidity rates vary from 11.8 to 90.5% [22][23][24][25]. The most frequent complications in this study were wound infection (17%), followed by intra-abdominal abscess (15%) and anastomotic leak (10%) ( Table 1). ...
... The most frequent complications in this study were wound infection (17%), followed by intra-abdominal abscess (15%) and anastomotic leak (10%) ( Table 1). Similar results have been found in other studies [18][19][20][21][22][23][24][25]. In the present study, 17 patients (19%) developed significant complications (6 cases anastomotic leak, 7 cases for intra-abdominal sepsis, and 4 cases for wound dehiscence) that required surgical intervention. ...
... The 30-day postoperative mortality rate was 8% (seven patients). In similar studies, mortality rates vary from 0 to 15% [22][23][24][25]. Moreover, in multivariate analysis, the 30-day postoperative mortality was associated with old age and leakage (duodenal, pancreatic, and esophageal) (p = 0.05). ...
Background
Adhesions and infiltration into adjacent tissues are present in about 12% of gastrointestinal (GIT) cancers. These adhesions have high potential risk of malignancy. Free resection margin is a predictor of good survival in such patients. This study aims at evaluating the post-operative outcomes after multi-visceral resection of locally advanced gastrointestinal cancers.
Patients and Methods
Ninety patients who underwent extended and multi-visceral resection for GIT cancers invading or adhering to adjacent organs have been included.
Results
For gastric cancer, distal gastrectomy was performed for 12% of the cases and total gastrectomy in 20%. For recto-sigmoid cancer, anterior resection was performed in 18% and abdomino-perineal resection in 7%. Partial colectomy was performed for colonic cancer in 43% of the cases. One organ was excised with GIT tumor in 60 cases (67%). The other 30 cases (33%) required excision of more than one organ. Pathological invasion of adjacent organs was confirmed in 42% of cases. Free margins were obtained in 87% of patients. Morbidity rate was 51%. The most frequent complications were wound infection (17%), anastomotic leak (10%), and chest infection (10%). In this study, 19% required surgical re-intervention. Positive margin and positive lymph nodes (LNs) as well as mucoid adenocarcinoma were associated with a higher recurrence rate.
Conclusion
Achieving free resection margins could be a safe and feasible procedure and may offer good prognosis when followed by adjuvant therapy for patients with locally advanced GIT cancer if patients were precisely selected to have procedure done in a high volume center.
... Gastric cancer is one of the most common cancers worldwide. Approximately 10% of patients have tumors that perforate the serosa and extend to adjacent organs [3,4]. The transverse colon is the most common organ involved with gastric cancer; however, whether or not the patients with tumors invading the colon have improved survival than those with tumors invading other organs is still unknown. ...
... revealed that lymph node metastasis (greater than pN3) is an independent poor prognostic factor for patients with T4 gastric carcinoma who underwent curative surgery [18]. Further, it was observed that patients with extensive lymph node metastasis (N2 or N3) had a significantly poorer prognosis compared to patients with limited lymph node metastasis (N0 or N1) [4,7]. Cheng et al. regarded T4 gastric cancer with N2 or N3 nodal disease as incurable and a contraindication for extensive surgery [17]. ...
Purpose
Extended multi-organ resection for locally advanced (T4) gastric cancer remains controversial. Herein we aimed to evaluate the surgical outcomes and survival of patients with T4 gastric cancer extending to the transverse colon.
Materials and Methods
Between 2011 and 2015, forty patients had undergone curative resection for T4 gastric cancer extending to the transverse colon. Patient characteristics, related complications, long-term survival, and prognostic factors for T4 gastric cancer were analyzed.
Results
ost-operative morbidity occurred in 5 (12.5%) patients. The 1-, 3-, and 5-year overall survival rates were 75.0%, 49.2%, and 36.9%, respectively. Univariate analysis revealed that tumor size ( P =0.049), advanced T stage ( P =0.013), and lymph node metastasis ( P =0.006) are poor prognostic factors of overall survival. Based on multivariate analysis, advanced T stage and lymph node metastasis were identified as independent prognosis factors.
Conclusions
Patients with T4 gastric cancer extending to the transverse colon might benefit from curative resection with acceptable morbidity and mortality.
... Ivyspring International Publisher invasion of the adjacent structure (T4b), patients often suffered from recurrence and had dismal overall survival, even after R0 resection. Several studies have reported potential prognostic factors affecting the survival of T4 gastric cancer patients after curative resection, including lymph node metastasis, venous invasion, peritoneal washing cytology and tumor diameter [6][7][8]. However, the sample sizes of previous studies were small. ...
... Several studies [6-8, 12, 13] had reported the prognostic factors for T4 gastric cancer. Fukuda et al [6] reported that number of metastatic lymph nodes, venous invasion and peritoneal washing cytology influenced the prognosis of T4 gastric cancer after potentially curative resection. Li et al [7] found that lymph node involvement was the only prognostic factor of OS. ...
Background: To investigate prognostic factors and recurrence patterns in T4 gastric cancer (GC) patients after curative resection.
Methods: Between January 2004 and December 2014, 249 patients with T4 gastric cancer undergoing curative resection were recruited. Patient characteristics, survival, prognostic factors and recurrence patterns were analyzed.
Results: Our results showed that the median survival time (MST) for T4 gastric cancer after curative resection was 55.47 months, with 59.47 months for T4a (tumor perforating serosa) and 25.90 months for T4b (tumor invasion of the adjacent structure). Multivariate analysis indicated that age (hazard ratio [HR], 1.86; P = 0.006), location of tumor (HR, 1.25, 0.90 - 5.64; P < 0.001) and intraoperative blood loss (HR, 1.85; P = 0.010) were independent prognostic factors for overall survival (OS). After a median follow-up of 25.87 months, a total of 109 (43.8%) patients suffered from recurrence, and 90 patients had been observed specific recurrence sites, among which peritoneal metastasis was the most common recurrence pattern, 59.0% for T4a and 88.3% for T4b, respectively.
Conclusions: For T4 gastric cancer patients after curative resection, older age, gastric cancer of the entire stomach and more intraoperative blood loss were associated with poor OS. The recurrence rate after curative resection for T4 was high, and the most common recurrence pattern was peritoneal metastasis.
... The morbidity and mortality rates following such procedures is reported to vary considerably between studies and stands at 11.8% to 90.5% and from 0 to 15%, respectively. 4,5,6,7 In our study, the morbidity and mortality rates were 65 % and 8.6%, respectively, which were comparable to previous reports. Hence, aggressive surgical approach including multiorgan resection was still recommended for T4 gastric tumors. ...
... Fukuda et al showed that Positive peritoneal washing cytology is the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection. 6 In our study routine peritoneal washing cytological examination was not performed. ...
... Clinical impact of underutilization of adjuvant therapy in node positive gastric adenocarcinoma presence of N2 or N3 disease substantially decreases this range to 20-35% (8)(9)(10)(11). ...
Background:
Adjuvant therapy for gastric adenocarcinoma has shown a survival advantage, though it may be underutilized. The purpose of this study is to examine how infrequently adjuvant therapy is administered with curative intent gastrectomy for node positive gastric cancer and the long-term effects to patients.
Methods:
The National Cancer Database was queried from 2006-2013 for patients with node positive gastric adenocarcinoma undergoing a potentially curative gastrectomy. Overall survival was compared between patients who received adjuvant chemotherapy or chemoradiation and those who did not.
Results:
Of 2,565 patients, 793 (30.9%) patients did not receive any adjuvant chemotherapy or radiation therapy, while 147 (5.7%) received peri-operative chemotherapy and 723 (28.2%) received post-operative chemoradiation. From 2006-2013, the percentage of patients receiving peri-operative chemotherapy rose from 1.1% to 9.9%, while those receiving post-operative chemoradiation decreased from 39.7% to 21.6%. The adjusted restricted mean survival time over 5 years for no adjuvant therapy was 27.7 months, peri-operative chemotherapy was 39.6 months, and post-operative chemoradiation was 37.7 months (P<0.0001).
Conclusions:
Approximately one third of patients treated for node positive gastric cancer undergo surgical resection without adjuvant therapy. This is associated with poorer survival, highlighting the need for improvement in multimodality care and cancer outcomes.
