Current challenges in gastric cancer surgery: European perspective

Rawicz‐Pruszyński, Karol; Sandick, Johanna W. van; Mielko, Jerzy; Ciseł, Bogumiła; Polkowski, Wojciech

doi:10.1016/j.suronc.2018.08.004

Cited by 28 publications

(24 citation statements)

References 59 publications

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“…It is a pity that there is no Lauren subtype and no perioperative chemotherapy survival or HR data related to each Lauren subtype, not only in the FLOT4 study but also in other perioperative studies. 4 , 5 , 7 , 8 , 63 – 78 As a result, we could not extract the data and perform meta-analysis for perioperative studies. However, it is worth mentioning that some papers, which are related to perioperative chemotherapy in different Lauren subtype of GC, indicated that IGC patients may benefit more from perioperative chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

Wang

Busuttil

et al. 2020

Ther Adv Med Oncol

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Background: The association between the survival or efficacy of chemotherapy and the Lauren subtype of gastric cancer (GC) remains unclear. We aimed to clarify whether patients with different Lauren subtypes have different survival after treatment with systemic chemotherapy: intestinal gastric cancer (IGC) patients survived better than patients with mixed type gastric cancer (MGC) or diffuse gastric cancer (DGC) after treatment with systemic chemotherapy. Patients & methods: Relevant studies for the meta-analysis were identified through searching Pubmed, Embase, Cochrane and Ovid up to March 2020. We also included our own prospectively collected cohort of patients that were followed over a 10-year period. Sub-group and sensitivity analyses were also performed. Results: In our prospective cohort, the overall survival (OS) of IGC patients receiving systemic chemotherapy (chemoIGC) [median OS 5.01 years, interquartile range (IQR) 2.63–6.71] was significantly higher than that of DGC patients receiving the same chemotherapy (chemoDGC) (median OS 1.33 years, IQR 0.78–3.33, p = 0.0001). After adjusting for age, gender and cancer stage, there was a significant difference in OS in patients treated with chemotherapy based on the Lauren classification of GC {hazard ratio (HR) for OS of the IGC versus DGC 0.33, [95% confidence interval (CI), 0.17–0.65; p < 0.001]}. In the IGC patients, the adjusted HR associated with chemotherapy was 0.26 (95% CI, 0.12–0.56; p = 0.001), whereas the association was 0.64 (95% CI, 0.30–1.33; p = 0.23) in the DGC patient group. In our meta-analysis, 33 studies comprising 10,246 patients treated with systemic chemotherapy (chemoIGC n = 4888, chemoDGC n = 5358) met all the selection criteria. While we accounted for much of the heterogeneity in these studies, we found that chemoIGC patients showed significantly improved OS [HR, 0.76 (95% CI, 0.71–0.82); p < 0.00001] when compared with similarly treated chemoDGC patients. Conclusion: Our results support the consideration of Lauren subtype when prescribing systemic chemotherapy for GC, particularly for MGC or DGC, which may not benefit from chemotherapy. Lauren classification should be considered to stratify chemotherapy regimens to GC patients in future clinical trials, with particular relevance to MGC or DGC, which is more difficult to treat with current regimens.

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Section: Discussionmentioning

confidence: 99%

A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

Wang

Busuttil

et al. 2020

Ther Adv Med Oncol

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“…18 However, the main difference between the East and the West is the role of surgery in the multidisciplinary treatment of advanced GC. 19 An upfront standardized radical surgery with D2 lymphadenectomy is conventional in Asian countries, with a minimally-invasive approach for early GC. Whereas in the Western hemisphere, more limited surgery in terms of lymphadenectomy (D1 plus = modified D2), is usually preceded by preoperative neoadjuvant radio-(US) and/or chemotherapy (Europe), with nearly 50% of patients not receiving any adjuvant therapy after resection.…”

Section: East Vs Westmentioning

confidence: 99%

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Polkowski¹,

Sędłak²,

Rawicz‐Pruszyński³

2020

CMAR

Self Cite

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The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource reallocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio-and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.

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“…There appears to be a decreasing trend in occurrence, notably in Western countries; it is still commonly reported in China and Japan. Even though the prognosis of patients with advanced gastric cancer seems to have improved as a result of the standardization of surgical techniques and recent advances in chemotherapy, the 5-year postoperative survival rate remains low [ 2 ]. Peritoneal metastasis is the most common and significant cause of mortality after surgery for gastric cancer [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Transforming growth factor-β1 induces connective tissue growth factor expression and promotes peritoneal metastasis of gastric cancer

Liu

et al. 2020

Bioscience Reports

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Transforming Growth Factor-β1 (TGF-β1) is involved in human cancer development and progression. Nonetheless, the role of TGF-β1 as regards peritoneal metastasis of gastric cancer has not been completely characterized. In this study, we investigated the exact role of TGF-β1 on peritoneal metastasis of gastric cancer. The results indicated that human peritoneal mesothelial cells (HPMCs) exposed to TGF-β1 or serum free conditional medium (SF-CM) of SGC7901 which produced a large amount of TGF-β1 became exfoliated, apoptosis and exhibited signs of injury, and the tumor-mesothelial cell adhesion significantly increased. Connective tissue growth factor (CTGF) expression was also increased when HPMCs were exposed to TGF-β1 or SF-CM of SGC7901. However, these effects were significantly decreased when HPMCs were exposed to SF-CM of SGC7901- TGFβS, a TGF-β1 knockdown stable cell line. Animal studies revealed that nude mice injected with SGC7901- TGFβS cells featured a smaller number of peritoneal seeding nodules and lower expression of CTGF in ascites than the control cell lines. These findings suggest that TGF-β1 promotes peritoneal metastasis of gastric cancer and induces CTGF expression. Therefore, blockage of TGF-β1 or TGF-β1 signaling pathway might prevent and treat peritoneal metastasis of gastric cancer.

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Current challenges in gastric cancer surgery: European perspective

Cited by 28 publications

References 59 publications

A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Transforming growth factor-β1 induces connective tissue growth factor expression and promotes peritoneal metastasis of gastric cancer

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