A primary tumor of mixed histological type is a novel poor prognostic factor for patients undergoing resection of liver metastasis from gastric cancer

Ikari, Naoki; Taniguchi, Kiyoaki; Serizawa, Akiko; Yamada, Takuji; Yamamoto, Masakazu; Furukawa, Toru

doi:10.1002/jhbp.445

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…For liver metastases from gastric cancer, no reports of RCTs were found. A meta‐analysis of the 5‐year survival rate was performed using data from five of the reported retrospective cohort studies 22–26 and incorporated into this set of guidelines; our meta‐analysis showed that giving chemotherapy after hepatectomy for liver metastases from gastric cancer increased the 5‐year survival rate more than hepatectomy alone.…”

Section: Resultsmentioning

confidence: 99%

“…For liver metastases from gastric cancer, no reports of RCTs were found. A meta-analysis of the 5-year survival rate was performed using data from five of the reported retrospective cohort studies [22][23][24][25][26] and incorporated into this set of guidelines; our meta-analysis showed that giving chemotherapy after hepatectomy for liver metastases from gastric cancer increased the 5-year survival rate more than hepatectomy alone. Overall 3-year and 5-year survival rates of conversion hepatectomy, i.e., hepatectomy in patients where the cancer was converted from an unresectable to resectable state by chemotherapy, would be better compared with those of chemotherapy alone for unresectable colorectal cancer (clinical question 14).…”

Section: Liver Metastasesmentioning

confidence: 99%

“…Using data from five of the reports, we performed a meta-analysis of the 5-year survival rate ( Figure 9B). [22][23][24][25][26] The results suggested that administering chemotherapy after hepatectomy did not significantly increase the 5-year survival rate compared with hepatectomy alone (improvement of 6%; 95% CI: 8%-19%, P = .42). The relative risk was 0.98 (95% CI: 0.84-1.14, P = .82).…”

Section: F I G U R Ementioning

confidence: 99%

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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Background Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. Methods Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. Results The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. Conclusions These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher‐quality evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Liver Metastasesmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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“…Recent studies from the Far East have shown more aggressive clinical behavior and worse survival in the mixed type, but mainly for early GC [ 28 , 29 ]. Even though it seems that the mixed type does not influence the OS when compared to the diffuse type in both early and advanced GC [ 28 , 30 ], mixed type histology has been indicated as a poor prognostic factor [ 31 ]. Aggressive biological features of mixed type GC include high Ki-67 proliferation index, and abnormal expression of E-cadherin and vascular endothelial growth factor (VEGF) [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Mixed Type Histology as a Predictive Factor for Esophagojejunostomy Leak in Advanced Gastric Cancer

Rawicz‐Pruszyński

Sędłak

Mlak

et al. 2020

Cancers

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Since esophagojejunostomy leak (EJL) after gastrectomy is a potentially fatal complication and may impact the survival of patients with advanced gastric cancer (GC), it is important to establish risk factors for the EJL and to prevent this surgical complication. The aim of this study was analysis of predictors for the postoperative clinically apparent EJL. All patients operated for advanced GC between October 2016 and December 2019 were analyzed from a prospectively maintained database. The evaluation of the EJL and postoperative complications according to the demographic and clinical (categorized) variables was performed with odds ratio test (multivariate analysis was performed with the use of logistic regression method). Among the 114 patients included in the study, 71.1% received neoadjuvant chemotherapy and 19.3% underwent gastrectomy followed by the hyperthermic intraperitoneal chemotherapy (HIPEC). Postoperative EJL was found in 4.6% patients. The risk of EJL was significantly higher for mixed-type GC (OR = 12.45, 95% CI: 1.03–150.10; p = 0.0472). The risk of other postoperative complications was significantly higher in patients undergoing HIPEC (OR = 3.88, 95% CI: 1.40–10.80, p = 0.0094). The number of lymph nodes removed (>38) was characterized by 80% sensitivity and 79.6% specificity in predicting EJL (AUC = 0.80, 95% CI: 0.72–0.87; p < 0.0001). Mixed histological type of GC is a tumor-related risk factor for the EJL. HIPEC was confirmed to be a risk factor for postoperative complications after gastrectomy.

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“…In this retrospective study, we investigated whether a UDT component within MT early gastric cancers could be recognized preoperatively, since the presence of a UDT component profoundly affects the clinical course and treatment decision of early gastric cancers. Some retrospective studies of surgical cases reported a higher probability of lymph node metastasis[ 16 - 20 ] and even poorer prognosis[ 21 - 24 ] in MT gastric cancers, while other studies have reported that these relationships may not apply to MT gastric cancers that meet the criteria for endoscopic curative resection[ 25 , 26 ]. However, retrospective studies of surgical cases tend to ignore the uncertainty of a preoperative diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Histopathological validation of magnifying endoscopy for diagnosis of mixed-histological-type early gastric cancer

Ozeki¹,

Hirasawa²,

Kobayashi³

et al. 2020

WJG

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BACKGROUND The undifferentiated-type (UDT) component profoundly affects the clinical course of early gastric cancers (EGCs). However, an accurate preoperative diagnosis of the histological types is unsatisfactory. To date, few studies have investigated whether the UDT component within mixed-histological-type (MT) EGCs can be recognized preoperatively. AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively. METHODS This was a single-center retrospective study. First, we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component. Histopathological examination investigated each lesion’s UDT component: (1) Whole mucosal layer occupation of the UDT component; (2) UDT component exposure to the surface of the mucosa; and (3) existence of a clear border between the differentiated-type and UDT components. Then, preoperative endoscopic images with magnifying endoscopy with narrow-band imaging (ME-NBI) were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination. The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined. RESULTS In the histopathological examination, the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3% (33/49) and 79.6% (39/49) of samples, respectively. A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3% (32/49) of MT lesions. In the endoscopic examination, the preoperative endoscopic images showed that only 24.5% (12/49) of MT EGCs revealed the UDT component within the area where it was present histopathologically. Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component finding (61.5% vs 11.1%, P = 0.0009). Only 26.5% (13/49) of the lesions were diagnosed from the pretreatment biopsy as having a UDT component. Combined results of the pretreatment biopsy and ME-NBI showed the preoperative presence of the UDT component in 40.8% (20/49) of MT EGCs. CONCLUSION Recognition of a UDT component within MT EGCs is difficult even when pretreatment biopsy and ME-NBI are combined. Endoscopic resection plays a significant role in both treatment and diagnosis.

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A primary tumor of mixed histological type is a novel poor prognostic factor for patients undergoing resection of liver metastasis from gastric cancer

Abstract: Histological evaluation of primary tumors may aid to identify patients suitable for undergoing surgical resection of liver metastasis from gastric cancer.

Cited by 7 publications

References 31 publications

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Mixed Type Histology as a Predictive Factor for Esophagojejunostomy Leak in Advanced Gastric Cancer

Histopathological validation of magnifying endoscopy for diagnosis of mixed-histological-type early gastric cancer

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