The 8th edition American Joint Committee on gastric cancer pathological staging classification performs well in a population with high proportion of locally advanced disease

Huang, Shih-Hao; Chien, Ti-Hsuan; Fang, Wen-Liang; Wang, Frank; Tsai, Cheng-Chung; Yeh, Chun‐Nan; Chen, Tse–Ching; Wu, Ren‐Chin; Chiu, Cheng‐Tang; Yeh, Ta‐Sen

doi:10.1016/j.ejso.2018.05.036

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…The clinicopathological data on demographics, tumor location, pathological findings, and pathological stage were obtained from the prospectively collected electronic medical records. Pathological stages had been systematically converted to the AJCC Staging Manual, edition 8 . The prescribed regimens of adjuvant chemotherapy were fluorouracil‐based, including intravenous 5‐fluorouracil (5‐FU), titanium silicate‐1, uracil‐tegafur, or oxaliplatin plus capecitabine .…”

Section: Methodsmentioning

confidence: 99%

Is Adjuvant Chemotherapy Necessary for Patients with Deficient Mismatch Repair Gastric Cancer?—Autophagy Inhibition Matches the Mismatched

et al. 2020

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Purpose The use of microsatellite instability (MSI) and mismatch repair (MMR) as predictive biomarkers for fluorouracil‐based adjuvant chemotherapy in colorectal cancer has been a paradigm shift. However, whether this applies to gastric cancer is questionable. Furthermore, we herein investigated whether and how autophagy plays a role in MSI‐relevant chemoresistance. Materials and Methods A total of 929 patients with deficient MMR (dMMR) and proficient MMR (pMMR) gastric cancers who underwent curative‐intent gastrectomy were enrolled. We compared clinicopathological variables and survival among dMMR and pMMR cohorts and tested the responses of MSI‐high and microsatellite stable (MSS) gastric cancer cell lines to 5‐fluorouracil (5‐FU) with or without chloroquine, an autophagy inhibitor. Results We identified an 8.9% prevalence of dMMR cases (83 out of 929) in our cohort. This was associated with old age, tumor site at the distal stomach, an intestinal phenotype, fewer nodal metastasis, and early pathological stages. MMR was an independent prognostic factor after multivariate adjustment. Overall survival (OS) of dMMR patients was better than that of the pMMR patients but was only applicable to stage III patients. There was no difference in OS between dMMR patients treated with or without adjuvant chemotherapy, although the latter showed more medical morbidities. The MSI‐high gastric cancer cell lines, versus the MSS counterparts, displayed increased resistance to 5‐FU and increased autophagy. Interestingly, autophagy inhibition abrogated the chemoresistance. Conclusion Our data show that fluorouracil‐based adjuvant chemotherapy does not work for dMMR cases, if not worse. Autophagy inhibition and/or immune checkpoint inhibition might be promising alternative strategies for gastric cancer treatment. Implications for Practice The use of microsatellite instability (MSI) and mismatch repair (MMR) as predictive biomarkers for adjuvant chemotherapy in colorectal cancer has caused a paradigm shift in cancer therapy, although its implications in gastric cancer are still questionable. The data obtained in the current study indicate that MSI‐MMR is an independent prognostic factor for gastric cancer. Standard fluorouracil‐based adjuvant chemotherapy did not work for deficient MMR cases, and was likely worse. Instead, strategies like autophagy inhibition and/or immune checkpoint inhibition should be taken into consideration in the future.

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Section: Methodsmentioning

confidence: 99%

Is Adjuvant Chemotherapy Necessary for Patients with Deficient Mismatch Repair Gastric Cancer?—Autophagy Inhibition Matches the Mismatched

et al. 2020

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“…Because of the geographic differences in incidence and mortality gastric cancer[13,14] and variations in surgical techniques, the 7 th AJCC staging system based on data mainly from the US may be valid for a particular population[15,16] but not equally applicable to other ethnic groups. [7, 17] The extent of LN metastasis was proven to be an important independent prognostic factor in gastric cancer[18–20] with the evolution of the N subset of the AJCC staging system. Compared with the previous editions, the 7 th edition strengthened the role of the number of positive LNs by subdividing the LN classes into 0, 2, 6 or more rather than the anatomical LN distribution.…”

Section: Discussionmentioning

confidence: 99%

“…[5] Before its 5 th edition, nodal (N) staging within the TNM classification was based on the anatomical extent of LN metastasis. [6] Starting with the 5 th AJCC edition, N staging has been based on the number of involved LNs[7, 8] and the anatomic extent of LN metastasis is no longer included. Unlike tumor (T) staging within the TNM classification, which relies on pathological assessment, harvesting LNs for N staging relies on surgical techniques.…”

Section: Introductionmentioning

confidence: 99%

Anatomical location-based nodal staging system is superior to the 7th edition of the American Joint Committee on Cancer staging system among patients with surgically resected, histologically low-grade gastric cancer: A single institutional experience

et al. 2019

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BackgroundA hybrid topographic and numeric lymph node (LN) staging system for gastric cancer, which was recently proposed by Japanese experts as a simple method with a prognostic predictive power comparable to the N staging of the American Joint Committee on Cancer (AJCC) Tumor-node-metastasis classification, has not yet been validated in other Asian countries. This study aimed to examine the prognostic predictability of the hybrid staging system with the current AJCC staging system in gastric cancer.MethodsOverall, 400 patients with gastric cancer who underwent surgery at Changhua Christian Hospital from January 2007 to December 2017 were included in the study. Univariate and multivariate analyses were performed to identify prognostic factors for gastric cancer-related death. Homogeneity and discrimination abilities of the two staging systems were compared using likelihood ratio chi-square test, linear trend chi-square test, Harrell’s c-index, and bootstrap analysis.ResultsOne-third of the LN-positive patients were reclassified into the new N and Stage system. The concordance rates of the two staging systems and the N staging between the two staging systems were 0.810 and 0.729, respectively. Harrell’s c-indices for the stage and N staging were higher in the 7th AJCC staging system than the hybrid staging system (c-index for stage, 0.771 vs 0.764; c-index for nodal stage, 0.713 vs 0.705). Stratification of the patients according to the histological grade revealed that Harrell’s c-indices for the stage and N stage of the hybrid staging system were comparable with those of the 7th AJCC staging system (c-index for AJCC stage vs hybrid stage, 0.800 vs 0.791; c-index for AJCC N stage vs hybrid N stage, 0.746 vs 0.734) among patients with histologically lower grade gastric cancer. The performance of the new nodal staging system was better than that of the 7th AJCC staging system by likelihood ratio and linear trend tests and bootstrap analysis in the low-grade group.ConclusionsThe hybrid anatomical location-based classification may have better prognostic predictive ability than the 7th AJCC staging system for LN metastasis of low-grade gastric cancer. Further studies involving different ethnic populations are necessary for the validation of the new staging system.

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“…Diese Frage soll in der derzeit rekrutierenden multinationalen DIPLOMA-Studie geklärt werden. Es gibt zwar systematische Reviews, die vergleichbare onkologische Langzeitergebnisse zeigen, jedoch leiden all diese Studien unter einem Selektionsbias, da kleinere und weniger fortgeschrittene Tumoren minimalinvasiv operiert wurden und größere Tumoren eher offen chirurgisch [13,14]. Trotz der stetigen Weiterentwicklung der minimalinvasiven Chirurgie bzw.…”

Section: Aufbau Der Robotisch Assistierten Pankreaschirurgieunclassified

Robotergestützte Bauchspeicheldrüsenchirurgie

et al. 2020

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Zusammenfassung Einführung Der Einsatz von Robotern in der minimalinvasiven Chirurgie hat in den letzten Jahren immer weiter zugenommen. Die roboterunterstützte Pankreaschirurgie hat gegenüber der laparoskopischen Pankreaschirurgie den Vorteil einer besseren Handhabung und verbesserten Angulation durch die größere Flexibilität der Instrumente. Darüber hinaus besteht durch die 3-D-Technik eine verbesserte Sicht und durch eine softwarebasierte Tremorkontrolle eine exakte Instrumentenführung. Die körperliche Belastung des Chirurgen durch die sitzende Position ist bei langen Eingriffen geringer. Methoden und Ergebnisse Dieser Artikel liefert einen Ansatz für die Einrichtung eines Roboter-Pankreas-Programms und eine detaillierte Anleitung im Sinne von SOPs für die robotergestützte Pankreaslinksresektion und robotergestützte Pankreatoduodenektomie. Ergebnisse In unserem standardisierten SOP-Ansatz verwenden wir sowohl bei der Pankreaslinksresektion als auch bei der Pankreatduodenektomie jeweils 5 Trokare – 4 Da-Vinci-Trokare und einen laparoskopischen Hilfstrokar. Wir bevorzugen die Position der Robotertrokare auf einer geraden horizontalen Linie mit einem Abstand von etwa 20 cm vom Operationsfeld. Die Operation wird in standardisierten Arbeitsschritten durchgeführt. Bei der Pankreaslinksresektion sind dies: Zugang und Visualisierung des Pankreas, Mobilisierung der linken Dickdarmflexur und des Pankreasunterrandes, Präparation der V. lienalis und der mesenterikoportalen Achse, Präparation des Pankreasoberrandes mit Lymphadenektomie und Darstellung der A. lienalis, Durchtrennung des Pankreas, retrograde Präparation des Pankreas und der Milz (bei onkologischen Eingriffen). Bergung, Einlage von Drainagen und Wundverschluss. Bei der Pankreatoduodenektomie sind es folgende Schritte: Zugang und Visualisierung des Pankreas, erweitertes Kocher-Manöver, Darstellung der Unterkante und der mesenterikoportalen Achse, Darstellung des Pankreasoberrandes und des Lig. hepatoduodenale, Präparation des Pankreashalses, Darstellung der Mesenterialwurzel und Pars IV duodeni, Präparation des Mesopankreas, Durchführung der Pankreasanastomose und der biliodigestiven Anastomose, Naht der dudenojejunalen Anastomose, Einlage von Drainagen und schichtweiser Wundverschluss. Der graduelle Aufbau unseres Roboter-Pankreas-Programms und der strukturierte Ansatz für komplexe Pankreasresektionen werden erläutert. Zusammenfassung Zusammenfassend beschreiben wir den Ansatz der robotischen Bauchspeicheldrüsenchirurgie in einem minimalinvasiven Exzellenzzentrum und Bauchspeicheldrüsenzentrum auf struktureller und verfahrenstechnischer Ebene, um die Einrichtung derartiger Programme an anderen Standorten zu unterstützen.

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The 8th edition American Joint Committee on gastric cancer pathological staging classification performs well in a population with high proportion of locally advanced disease

Cited by 15 publications

References 25 publications

Is Adjuvant Chemotherapy Necessary for Patients with Deficient Mismatch Repair Gastric Cancer?—Autophagy Inhibition Matches the Mismatched

Is Adjuvant Chemotherapy Necessary for Patients with Deficient Mismatch Repair Gastric Cancer?—Autophagy Inhibition Matches the Mismatched

Anatomical location-based nodal staging system is superior to the 7th edition of the American Joint Committee on Cancer staging system among patients with surgically resected, histologically low-grade gastric cancer: A single institutional experience

Robotergestützte Bauchspeicheldrüsenchirurgie

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