Treatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren’s Classification in Pan–Cancer Analysis Era?

Zurlo, Ina Valeria; Basso, Michele A.; Strippoli, Antonia; Calegari, Maria Alessandra; Orlandi, Armando; Cassano, Alessandra; Salvatore, Mariantonietta Di; Garufi, Giovanna; Bria, Emilio; Barone, Carlo; Pozzo, Carmelo

doi:10.3390/cancers12071749

Cited by 13 publications

(9 citation statements)

References 28 publications

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“…In China, gastric cancer (GC) has the second-highest cancer burden and the third most common cause of cancer-related deaths (with an age-standardized rate of incidence of 20.6 per 100,000 people, an age-standardized rate of mortality 15.9 per 100,000 population), and most patients are diagnosed at advanced disease stages (1). Patients presenting with locally advanced gastric cancer (LAGC) encounter problems associated with precise diagnoses and personalized treatment plans (2,3) since tumor differentiation, Lauren classifications, and the presence of signet-ring cells can influence prognoses and treatment determinations (4)(5)(6). Lauren classifications are convenient and easy to implement and have good interobserver agreement (7).…”

Section: Introductionmentioning

confidence: 99%

“…Lauren classifications are convenient and easy to implement and have good interobserver agreement ( 7 ). A recent study showed that the LAGC Lauren types correlated with perioperative chemotherapy responses ( 6 ). Endoscopic biopsies are invasive procedures prone to sampling errors due to the high heterogeneity of GCs; thus, the histopathology of tumor biopsies might not be consistent with those of whole-tumor resections ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

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The Value of Whole-Tumor Histogram and Texture Analysis Using Intravoxel Incoherent Motion in Differentiating Pathologic Subtypes of Locally Advanced Gastric Cancer

Sun

Tan

et al. 2022

Front. Oncol.

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PurposeTo determine if whole-tumor histogram and texture analyses using intravoxel incoherent motion (IVIM) parameters values could differentiate the pathologic characteristics of locally advanced gastric cancer.MethodsEighty patients with histologically confirmed locally advanced gastric cancer who received surgery in our institution were retrospectively enrolled into our study between April 2017 and December 2018. Patients were excluded if they had lesions with the smallest diameter < 5 mm and severe image artifacts. MR scanning included IVIM sequences (9 b values, 0, 20, 40, 60, 100, 150,200, 500, and 800 s/mm2) used in all patients before treatment. Whole tumors were segmented by manually drawing the lesion contours on each slice of the diffusion-weighted imaging (DWI) images (with b=800). Histogram and texture metrics for IVIM parameters values and apparent diffusion coefficient (ADC) values were measured based on whole-tumor volume analyses. Then, all 24 extracted metrics were compared between well, moderately, and poorly differentiated tumors, and between different Lauren classifications, signet-ring cell carcinomas, and other poorly cohesive carcinomas using univariate analyses. Multivariate logistic analyses and multicollinear tests were used to identify independent influencing factors from the significant variables of the univariate analyses to distinguish tumor differentiation and Lauren classifications. ROC curve analyses were performed to evaluate the diagnostic performance of these independent influencing factors for determining tumor differentiation and Lauren classifications and identifying signet-ring cell carcinomas. The interobserver agreement was also conducted between the two observers for image quality evaluations and parameter metric measurements.ResultsFor diagnosing tumor differentiation, the ADCmedian, pure diffusion coefficient median (Dslowmedian), and pure diffusion coefficient entropy (Dslowentropy) showed the greatest AUCs: 0.937, 0.948, and 0.850, respectively, and no differences were found between the three metrics, P>0.05). The 95th percentile perfusion factor (FP P95th) was the best metric to distinguish diffuse-type GCs vs. intestinal/mixed (AUC=0.896). The ROC curve to distinguish signet-ring cell carcinomas from other poorly cohesive carcinomas showed that the Dslowmedian had AUC of 0.738. For interobserver reliability, image quality evaluations showed excellent agreement (interclass correlation coefficient [ICC]=0.85); metrics measurements of all parameters indicated good to excellent agreement (ICC=0.65-0.89), except for the Dfast metric, which showed moderate agreement (ICC=0.41-0.60).ConclusionsThe whole-tumor histogram and texture analyses of the IVIM parameters based on the biexponential model provided a non-invasive method to discriminate pathologic tumor subtypes preoperatively in patients with locally advanced gastric cancer. The metric FP P95th derived from IVIM performed better in determining Lauren classifications than the mono-exponential model.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Value of Whole-Tumor Histogram and Texture Analysis Using Intravoxel Incoherent Motion in Differentiating Pathologic Subtypes of Locally Advanced Gastric Cancer

Sun

Tan

et al. 2022

Front. Oncol.

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“…The highest prevalence is observed in Eastern Asia whereas the lowest in Africa and the highest mortality rate in Eastern Asia while the lowest in Northern America, Australia and Europe. GC is subcategorized according to Lauren’s classification into intestinal and diffuse subtypes which demonstrate different epidemiology, clinical behavior, chemoresistance, progression and prognosis but there have been no trials or analyses to evaluate whether these two subtypes would potentially benefit more from different treatment modalities[ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison between upfront surgery and neoadjuvant chemotherapy in patients with locally advanced gastric cancer: A systematic review

Fiflis,

Papakonstantinou,

Giakoustidis

et al. 2023

World J Gastrointest Surg

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Tumour rupture of gastrointestinal stromal tumours (GISTs) has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome. Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor, it may change the natural history of a low-risk GIST to a high-risk GIST. Originally, tumour rupture was defined as the spillage or fracture of a tumour into a body cavity, but recently, new definitions have been proposed. These definitions distinguished from the prognostic point of view between the major defects of tumour integrity, which are considered tumour rupture, and the minor defects of tumour integrity, which are not considered tumour rupture. Moreover, it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture. Therefore, after excluding tumour rupture, R1 may not be an unfavourable prognostic factor for GISTs. Additionally, after the standard adjuvant treatment of imatinib for GIST with rupture, a high recurrence rate persists. This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

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“…Therefore, signet cells gastric adenocarcinoma patients seem to benefit less from perioperative chemotherapy, raising the need to consider and evaluate drugs with better response in intraperitoneal disease or drugs with higher peritoneal cavity penetration. Zurlo et al suggest that the intestinal histotype might have a better response to a perioperative regime when compared to diffuse type to whom an adjuvant chemotherapy approach might ensure better survival 20 .…”

Section: Introductionmentioning

confidence: 99%

Gastric cancer: histological response of tumor and metastatic lymph nodes for perioperative chemotherapy

Fonseca¹,

Coimbra²,

Barbosa³

et al. 2022

CIRU

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Background: Gastric cancer is the fourth cancer most common in the world and the second cause of cancer-related deaths. Perioperative chemotherapy may reduce tumor burden and decrease lymph node invasion, improving R0 resections rates. On the other hand, administered before surgery, chemotherapy may cause fibrosis and tissue edema, with potential increase of surgical difficulty and in the number of post-operative complications. Therefore, we aim to investigate the effect of perioperative chemotherapy for tumor burden and metastatic lymph nodes of gastric cancer. Methods: Retrospective analysis of all patients submitted to perioperative chemotherapy and surgery, between January 2010 and June 2020, which showed lymph node regression and tumor regression (Becker's classification). Results: A total of 112 patients with an average age of 61.9 years were analyzed. About 90.2% completed three cycles of perioperative chemotherapy. Good tumor response to chemotherapy (<10% residual tumor) was achieved in 21.3% of patients. Only three patients obtained a complete pathological response. A median lymph node response of 33.3% was achieved in our series. Conclusion: Despite no evident outstanding regression rate was observed, perioperative chemotherapy seems to be useful in obtaining a R0 resection in gastric cancer, even in advanced gastric cancer.

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Treatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren’s Classification in Pan–Cancer Analysis Era?

Cited by 13 publications

References 28 publications

The Value of Whole-Tumor Histogram and Texture Analysis Using Intravoxel Incoherent Motion in Differentiating Pathologic Subtypes of Locally Advanced Gastric Cancer

The Value of Whole-Tumor Histogram and Texture Analysis Using Intravoxel Incoherent Motion in Differentiating Pathologic Subtypes of Locally Advanced Gastric Cancer

Comparison between upfront surgery and neoadjuvant chemotherapy in patients with locally advanced gastric cancer: A systematic review

Gastric cancer: histological response of tumor and metastatic lymph nodes for perioperative chemotherapy

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