Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials.

Hermans, J.; Bonenkamp, Johannes J.; Boon, M. E.; Bunt, A. M. G.; Ohyama, Shigekazu; Sasako, Mitsuru; Velde, Cornelis J.H. van de

doi:10.1200/jco.1993.11.8.1441

Cited by 500 publications

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“…Although most clinical trials investigating adjuvant chemotherapy generated inconclusive results (Hermans et al, 1993;Earle and Maroun, 1999;Cascinu et al, 2005), the trial by Cunningham et al (2005) (the MAGIC trial) has re-opened the debate about chemotherapy for operable gastric cancer patients. In this study, 503 patients affected by adenocarcinoma of the stomach, oesophagogastric junction or lower oesophagus were randomised to perioperative chemotherapy or surgery alone.…”

Section: Discussionmentioning

confidence: 99%

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Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

et al. 2006

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The availability of different treatment options for radically resectable gastric cancer reopened the question of treatment selection and correct definition of high-risk categories. Lymphatic, blood vessel and perineural invasion (LBVI/PNI) seem to possess the necessary potential to provide useful information for the clinical management of this disease. Seven hundred and thirty-four patients with advanced gastric cancer who underwent curative gastrectomy were analysed according to the presence of LBVI/PNI. Patients were divided into two groups: group A for patients with LBVI/PNI (189 patients 26%) and group B for patients without LBVI/PNI (545 patients, 74%). The disease-free survival (DFS) for patients in group A was 32.1 months, whereas it was not reached for patients in group B (P ¼ 0.0001); the median overall survival was 45.5 months for patients in group A, whereas it was not reached for patients in group B (P ¼ 0.0001). At multivariate analysis, the presence of LBVI/PNI appeared an independent prognostic factor for DFS and OS. Our results were confirmed in subgroup analysis, separately considering stage I and early gastric cancer patients with and without LBVI/PNI. Taken together, our findings suggest the importance of LBVI/PNI in gastric cancer as it may provide additional information for identifying patients at high risk, who may be candidates for further medical treatment after or before surgery.

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Section: Discussionmentioning

confidence: 99%

“…Although most clinical trials investigating adjuvant chemotherapy generated inconclusive results (Hermans et al, 1993;Earle andMaroun, 1999, Cascinu et al, 2005), it has been reported that a chemoradiotherapy adjuvant approach may improve the outcome of radically resected gastric cancer by lowering the incidence of local relapse (Macdonald et al, 2001).…”

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Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

et al. 2006

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“…Studies over the past few years seeking to define the role of post-surgical adjuvant chemotherapy in gastric cancer have yielded contradictory results (de Braud et al, 1992;Atiq et al, 1993;Hermans et al, 1993), leaving the issue still unresolved. However, the modulation of 5-FU by folinic acid has led to the testing of promising new combinations in advanced gastric cancer (Murad et al, 1993;Neri et al, 1993).…”

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confidence: 99%

Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study

Neri

Leonardis²,

Romano³

et al. 1996

Br J Cancer

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“…However, the prognosis of patients with locally advanced gastric cancer is generally poor even with curative resection (Noguchi et al, 1989;Shiu et al, 1989;Fuchs and Mayer, 1995). Adjuvant chemotherapy has failed to demonstrate a significant survival benefit for such patients in most randomized trials and meta-analyses, except in a few studies with positive results (Shiu et al, 1989;Krook et al, 1991;Kim et al, 1992;Hermans et al, 1993;Nakazato et al, 1994;Fuchs and Mayer, 1995;Lise et al, 1995;Macdonald et al, 1995;Kelsen, 1996;Kim et al, 1998;Cirera et al, 1999;Earle and Maroun, 1999).…”

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Expression of thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

Lim

Nam

et al. 2001

Br J Cancer

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SummaryWe evaluated the expression of thymidylate synthase (TS) in locally advanced gastric cancer patients treated with adjuvant chemotherapy after curative resection and investigated the association between TS expression and clinicopathologic characteristics including prognosis of the patients. TS expression was evaluated by immunohistochemical staining using TS106 monoclonal antibody in 103 locally advanced gastric cancer patients (stage IB-IV) who underwent 5-fluorouracil (5-FU) and doxorubicin-based adjuvant chemotherapy after curative resection. 65 patients (63%) had primary tumours with high TS expression (≥ 25% of tumour cells positive), and 38 patients (37%) demonstrated low TS expression (< 25% of tumour cells positive or no staining). High TS expression was associated with male gender (P = 0.002), poorly differentiated histology (P = 0.015), and mixed type in Lauren's classification (P = 0.027). There were no statistically significant differences in 4-year disease-free survival (60.0% vs 57.2%, P = 0.548) and overall survival (59.6% vs 59.3%, P = 0.792) between high-TS group and low-TS group. In conclusion, although high TS expression was associated with poorly differentiated histology and mixed type in Lauren's classification, it did not predict poor disease-free and overall survival in gastric cancer patients treated with 5-FU and doxorubicin-based adjuvant chemotherapy after curative resection. Further prospective studies including the evaluation of other biological markers associated with the resistance to 5-FU and doxorubicin are necessary. 186-192 © 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2000.1553, available online at http://www.idealibrary.com on http://www.bjcancer.com based adjuvant chemotherapy after curative surgical resection at Ajou University Medical Center in Suwon, Korea, between July 1994 and October 1996. All patients had a postsurgical pathologic stage ranging from IB to IV without evidence of distant metastasis according to the American Joint Committee on Cancer TNM classification (American Joint Committee on Cancer, 1997). Curative resection was defined by the General Rules for the Gastric Cancer Study in Surgery and Pathology of the Japanese Research Society for Gastric Cancer as: no involvement of surgical stumps; sufficient lymphatic dissection (R number ≥ N number); no distant metastasis; removal of involved adjacent organs and structures by combined en-bloc resection; and no gross residual disease (Japanese Research Society for Gastric Cancer, 1981). None of these patients received chemotherapy prior to surgery.Although all patients received 5-FU and doxorubicin-based adjuvant chemotherapy, the regimens were not uniform. The most commonly administered regimen was FA (5-FU, doxorubicin) with OK-432 (51 patients), followed by FAM (5-FU, doxorubicin, mitomycin-C) (33 patients), FA (11 patients), and FA with lentinan (eight patients). Chemotherapy was usually started 2-3 weeks after surgery. In the FA regimen with or without immunotherapy (OK-432 or lentinan), 5-FU (...

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Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials.

Abstract: In conclusion, at present, postoperative chemotherapy cannot be considered as standard adjuvant treatment. New trials of adjuvant therapy for gastric cancer must include a no-treatment control arm.

Cited by 500 publications

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Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study

Expression of thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

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