Patterns of relapse in patients with localized gastric adenocarcinoma who had surgery with or without adjunctive therapy: costs and effectiveness of surveillance

Elimova, Elena; Slack, Rebecca; Chen, Hsiang Chun; Planjery, Venkatram; Shiozaki, Hironori; Shimodaira, Yusuke; Charalampakis, Nikolaos; Lin, Qinlu; Harada, Kazuto; Wadhwa, Roopma; Estrella, Jeannelyn S.; Kaya, Dılşa Mızrak; Sagebiel, Tara; Lee, Jeffrey H.; Weston, Brian; Bhutani, Manoop S.; Murphy, Mariela Blum; Matamoros, Aurelio; Minsky, Bruce D.; Das, Prajnan; Mansfield, Paul F.; Badgwell, Brian D.; Ajani, Jaffer A.

doi:10.18632/oncotarget.19226

Cited by 15 publications

(18 citation statements)

References 27 publications

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“…Four large series attempted to characterize the benefit of surveillance testing in Western patients with gastroesophageal adenocarcinoma, using older cohorts from the periods of 2001‐2010, 1998‐2009, and 1995‐2014 . Perioperative treatment for many gastric cancer patients were likely suboptimal prior to the publication of the pivotal MAGIC trial in 2006 .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, prior to the CROSS trial published in 2012, use of neoadjuvant chemoradiation was likely limited for patients with esophageal cancer. In two cohorts, most patients with gastric or GEJ tumors received neoadjuvant chemoradiation, which is not the standard of care . Our study adds updated and comprehensive data following modern standard of care multimodality perioperative therapy.…”

Section: Discussionmentioning

confidence: 99%

“…While there is no clear association between cumulative diagnostic radiation exposure and secondary malignancies in adults, the average radiation dose for a CT chest/abdomen/pelvis with intravenous contrast is comparable to 9 years of background radiation, which may be concerning for many patients. Almost half of the patients underwent additional follow‐up testing including further imaging and invasive biopsies, with the majority proving false positivity of initial surveillance tests, which likely added unnecessary risks, patient anxiety, and cost . Substantial financial implications also exist, and Choosing Wisely campaign recommends avoiding surveillance testing if it is not expected to improve survival or quality of life…”

Section: Discussionmentioning

confidence: 99%

“…Successful salvage therapy resulted in post‐recurrence disease‐free survival (DFS) of ≥2 years. This interval was chosen arbitrarily, taking into consideration the median survival of patients with relapsed metastatic gastric cancer is often less than 12 months at experienced centers, and the same definition has been used in the literature …”

Section: Methodsmentioning

confidence: 99%

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Surveillance and outcomes after curative resection for gastroesophageal adenocarcinoma

et al. 2020

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Background:The goal of surveillance testing is to enable curative salvage therapy through early disease detection, however supporting evidence in gastroesophageal adenocarcinoma is limited. We evaluated frequency of successful salvage therapy and outcomes in patients who underwent surveillance. Methods: A single-site, retrospective cohort study was conducted to identify all patients who received curative resection for gastroesophageal adenocarcinoma. Surveillance testing were those investigations not triggered by abnormal symptoms, physical examination, or blood tests. Successful salvage therapy was any potentially curative therapy for disease recurrence which resulted in postrecurrence disease-free survival ≥2 years. Time-to-event data were analyzed using the Kaplan-Meier method and log rank tests. Results: Between 2011 and 2016, 210 consecutive patients were reviewed. Esophageal (14%), gastroesophageal junction (40%), and gastric adenocarcinomas (45%) were treated with surgery alone (29%) or multimodality therapy (71%). Adjuvant therapy was administered in 35%. At median follow-up of 38.3 months, 5-year overall survival (OS) rate was 56%. Among 97 recurrences, 53% were surveillance-detected, and 46% were symptomatic. None was detected by surveillance endoscopy. Median time-to-recurrence (TTR) was 14.8 months. Recurrences included locoregional only (4%), distant (86%), and both (10%). Salvage therapy was attempted in 15 patients, 4 were successful. Compared to symptomatic recurrences, patients with surveillancedetected recurrences had longer median OS (36.2 vs 23.7 months, P = .004) and postrecurrence survival (PRS, 16.5 vs 4.6 months, P < .001), but similar TTR (16.2 vs 13.3 months, P = .40) and duration of palliative chemotherapy (3.9 vs 3.3 months, P = .64). Conclusions: Among patients surveyed, 96% of recurrences were distant, and salvage therapy was successful in only 1.9% of patients. Longer OS in patients with 3024 | JIANG et Al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Surveillance and outcomes after curative resection for gastroesophageal adenocarcinoma

et al. 2020

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“…iako rano otkrivanje povrata bolesti ne rezultira boljim preživljenjem, redovito praćenje često pruža psihološku potporu bolesnicima i omogućava korekciju nutritivnih deficita poput deficita vitamina B12 i željeza. 14,17,55 u svih se liječenih bolesnika preporučuju: anamneza i klinički pregled svaka 3 -6 mjeseci prve 2 godine, zatim svakih 6 mjeseci od 3 do 5 godina te nakon toga jedanput na godinu. 14 kod bolesnika s tis i t1a liječenih endoskopskom resekcijom preporučuje se ezofagogastroskopija svakih 6 mjeseci prve godine te zatim jedanput na godinu tijekom 3 godine kod tis i tijekom 5 godina kod t1a.…”

Section: Preporuke Za Kontrolu I Praćenje Liječenih Bolesnikaunclassified

Clinical recommendations for diagnosis, treatment and monitoring of patients with gastric cancer

Bišof

António

Omrčen

et al. 2018

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melihA solAk mekić 11 , slaVko GašparoV 12 , nAdAn rustemović 4 , ivicA sJekAvicA 13 , eduArd vrdolJAk 3 deskriptori: Adenokarcinom-dijagnoza, farmakoterapija, kirurgija, patologija; Želučani tumori-dijagnoza, farmakoterapija, kirurgija, patologija; tumorki stadij; gastrektomija-metode; disekcija limfnih čvorova; kombinirani protutumorski kemoterapijski protokoli-terapijska primjena; Adjuvantna kemoterapija; Adjuvantna kemoradioterapija; tumorske metastaze; Palijativna skrb-metode; ishod liječenja; smjernice; hrvatska sažetak. iako se učestalost najčešćega malignog tumora želuca, adenokarcinoma, posljednjih desetljeća smanjuje, raste učestalost proksimalnih lokalizacija raka želuca i ezofagogastričnog prijelaza. zbog uglavnom kasnog otkrivanja već uznapredovale bolesti rezultati liječenja oboljelih ne zadovoljavaju. dijagnoza se najčešće postavlja biopsijom učinjenom tijekom ezofagogastroskopije. liječenje lokoregionalne bolesti temelji se na kirurškom zahvatu u kombinaciji s perioperativnom kemoterapijom. Alternativno, ako nije primijenjena preoperativna kemoterapija, potrebno je provesti adjuvantnu kemoradioterapiju ili kemoterapiju. metastatska bolest liječi se palijativnom kemoterapijom i suportivnom terapijom. odluku o liječenju donosi multidisciplinarni tim individualiziranim pristupom svakom bolesniku. u tekstu koji slijedi sadržane su kliničke upute radi standardizacije dijagnostičkih postupaka, liječenja i praćenja bolesnika s rakom želuca u republici hrvatskoj.

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Concurrent lymphovascular and perineural invasion after preoperative therapy for gastric adenocarcinoma is associated with decreased survival

Blumenthaler

Newhook

Ikoma

et al. 2021

Journal of Surgical Oncology

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Background and Objectives We sought to evaluate the impact of lymphovascular invasion (LVI) and perineural invasion (PNI) on survival outcomes in gastric cancer patients treated with preoperative therapy. Methods Patients with gastric cancer treated with preoperative therapy and potentially curative resection were stratified according to the presence of LVI, PNI, or both. Kaplan–Meier and Cox regression analyses were used to evaluate the impact on overall survival (OS) and disease‐free survival (DFS). Results The study included 281 patients, of whom 93 (33%) had LVI, 69 (25%) had PNI, 51 (18%) had both LVI and PNI, and 170 (61%) had neither. LVI and PNI were each associated with higher ypT and ypN categories and more positive lymph nodes (all p < .001), associations that were emphasized with both factors present. On multivariable analyses, ypN (p < .001) and concurrent LVI/PNI (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.55–4.45; p = .001) were predictive of OS and DFS (ypN: p < .001; both LVI/PNI: HR: 2.27; 95% CI: 1.34–3.82; p = .002). Conclusions Gastric cancer patients with concurrent LVI and PNI after preoperative therapy have more advanced disease and worse survival outcomes than patients with neither or only one of these factors.

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Patterns of relapse in patients with localized gastric adenocarcinoma who had surgery with or without adjunctive therapy: costs and effectiveness of surveillance

Cited by 15 publications

References 27 publications

Surveillance and outcomes after curative resection for gastroesophageal adenocarcinoma

Surveillance and outcomes after curative resection for gastroesophageal adenocarcinoma

Clinical recommendations for diagnosis, treatment and monitoring of patients with gastric cancer

Concurrent lymphovascular and perineural invasion after preoperative therapy for gastric adenocarcinoma is associated with decreased survival

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