Survival Benefit of Neoadjuvant Chemotherapy for Resectable Cancer of the Gastric and Gastroesophageal Junction

Jiang, Lei; Yang, Kehu; Guan, Qingyu; Chen, Yan; Zhao, Peng; Tian, Jianmin

doi:10.1097/mcg.0000000000000212

Cited by 41 publications

(28 citation statements)

References 54 publications

(81 reference statements)

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“…Gastric cancer is an aggressive malignancy in which most patients treated with surgical resection develop disease recurrence, with a recent meta-analysis showing that 5-year survival for patients undergoing surgery is 42% if given neoadjuvant therapy and only 30% if not. 13 The present study indicates that presence of LI, VI and/or PNI is associated with poorer survival in patients with gastric adenocarcinoma who are treated with neoadjuvant therapy followed by gastrectomy with D2 lymphadenectomy, with PNI having prognostic significance independent of lymph node status. The reported prevalence of LI, VI and PNI is widely distributed, with PNI being reported between 2% and 48%, VI 7-44% and LI 10-91%.…”

Section: Discussionsupporting

confidence: 49%

Prognostic Significance of Lymphatic, Venous and Perineural Invasion After Neoadjuvant Chemotherapy in Patients with Gastric Adenocarcinoma

et al. 2020

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Background. The significance of perineural (PNI), lymphatic (LI) and venous invasion (VI) in gastric cancer patients who have received neoadjuvant chemotherapy is unclear. The aim of this study is to determine the incidence and prognostic significance of LI, VI and PNI in these patients. Patients and Methods. Consecutive patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy were reviewed. Presence of LI, VI and PNI was recorded and correlated with clinical outcomes. Results. A total of 243 patients underwent gastrectomy after neoadjuvant therapy for gastric adenocarcinoma. LI was identified in 129 (53%), VI in 107 (44%) and PNI in 116 (48%) of patients.

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Section: Discussionsupporting

confidence: 49%

Prognostic Significance of Lymphatic, Venous and Perineural Invasion After Neoadjuvant Chemotherapy in Patients with Gastric Adenocarcinoma

et al. 2020

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“…There were 14 early stage cancers in the no NACT group, but patients in this group were older and had more comorbidity as well. A recent meta-analysis has suggested that neoadjuvant chemotherapy improves survival in patients with gastric and gastro-oesophageal junctional cancers [ 19 ]. Given that all patients are not eligible for NACT, these results are not applicable to all patients.…”

Section: Discussionmentioning

confidence: 99%

Radical Gastrectomy: Still the Cornerstone of Curative Treatment for Gastric Cancer in the Perioperative Chemotherapy Era—A Single Institute Experience over a Decade

Kanhere

Goel

Finlay

et al. 2018

International Journal of Surgical Oncology

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Background and Objectives Most gastric cancer patients now undergo perioperative chemotherapy (POCT) based on the MAGIC trial results. POCT consists of neoadjuvant chemotherapy (NACT) as well as postoperative adjuvant chemotherapy. This study assessed the applicability of perioperative chemotherapy and the impact of radical gastrectomy encompassing a detailed lymph-node resection on outcomes of gastric cancer. Methods Medical and pathology records of all gastric carcinoma resections were reviewed from 2006 onwards. Pathological details, number of lymph-nodes resected, and proportion of involved nodes, reasons for nonadministration of NACT, complications, recurrence, and survival data were analysed. Results Only twenty-eight (37.8%) out of 74 patients underwent NACT and only nine completed POCT. NACT was declined due to comorbidities/patient refusal n = 24, early stage n = 14, and emergency presentation n = 8. Patients receiving NACT were much younger. Anastomotic leaks, hospital-mortality, lymph-node yield, and proportion of involved lymph-nodes were similar in both groups. Thirty-two patients died due to recurrence with lymph-node involvement heralding higher recurrence risk and much poorer survival (HR 2.66; p = 0.013). Conclusion More than 60% patients with resectable gastric carcinoma did not undergo NACT. Radical gastrectomy with lymphadenectomy remained the cornerstone of treatment in this period.

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“…The duration of treatment ranged from one day to three months and the mean age of trial participants was 60.2 years and range from 34 to 75 years. For the primary outcome of interest, six unique comparisons were available for 178,17,18,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] different trials (one trial included two different comparisons). In terms of adverse effects, there were 158, 17-19, 32, 33, 35, 38-42, 46 trials providing data for seven unique comparisons.…”

mentioning

confidence: 99%

Systematic review with network meta‐analysis: the comparative effectiveness and safety of interventions in patients with overt hepatic encephalopathy

Zhu

Shi

Huang

et al. 2015

Aliment Pharmacol Ther

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Summary Background Interventional treatment for overt hepatic encephalopathy (OHE), includes non‐absorbable disaccharides, neomycin, rifaximin, L‐ornithine‐L‐aspartate and branched chain amino acids (BCAA). However, the optimum regimen remains inconclusive. Aim To compare interventions in terms of patients’ adverse events and major clinical outcomes. Methods Literature search of PubMed, Embase, Scopus, and Cochrane Library studies published up to July 31 2014. RCTs of above interventions in OHE patients were included. Network meta‐analysis combined direct and indirect evidence to estimate odds ratios (ORs) and mean difference (MD) between treatments and the probabilities of ranking for treatment based on clinical outcomes. Results Twenty eligible RCTs were included. When compared with observation, only L‐ornithine‐L‐aspartate (OR 3.71, P < 0.001) and BCAA (OR 3.37, P < 0.001) improved clinical efficacy significantly. However, when L‐ornithine‐L‐aspartate was compared with BCAA, non‐absorbable disaccharides and neomycin, there was a trend suggesting that L‐ornithine‐L‐aspartate may be the most effective intervention with respect to clinical improvement (OR 1.10), rifaximin (OR 1.31), non‐absorbable disaccharides (OR 2.75), neomycin (OR 2.22). In addition, L‐ornithine‐L‐aspartate (MD −20.18, 95% CI −40.12 to −0.27) provided a significant reduction in blood ammonia concentration compared with observation. Neomycin appeared to be associated with more adverse events in comparison with non‐absorbable disaccharides (OR 10.15), rifaximin (OR 17.31), L‐ornithine‐L‐aspartate (OR 3.16) or BCAA (OR 7.69). Conclusions L‐ornithine‐L‐aspartate treatment may show a trend in superiority for clinical efficacy among standard interventions for OHE. Rifaximin shows the greatest reduction in blood ammonia concentration, and treatment with neomycin demonstrates a higher probability in causing adverse effects among the five compared interventions.

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Survival Benefit of Neoadjuvant Chemotherapy for Resectable Cancer of the Gastric and Gastroesophageal Junction

Abstract: There is convincing evidence for a survival benefit of NAT over surgery alone in patient with cancer of the gastric and gastroesophageal junction.

Cited by 41 publications

References 54 publications

Prognostic Significance of Lymphatic, Venous and Perineural Invasion After Neoadjuvant Chemotherapy in Patients with Gastric Adenocarcinoma

Prognostic Significance of Lymphatic, Venous and Perineural Invasion After Neoadjuvant Chemotherapy in Patients with Gastric Adenocarcinoma

Radical Gastrectomy: Still the Cornerstone of Curative Treatment for Gastric Cancer in the Perioperative Chemotherapy Era—A Single Institute Experience over a Decade

Systematic review with network meta‐analysis: the comparative effectiveness and safety of interventions in patients with overt hepatic encephalopathy

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