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Is curative gastrectomy justified for gastric cancer with cytology positive as the only stage IV factor?

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Abstract

Aims

The prognosis of patients with gastric cancer and stage IV factors is poor. However, several recent studies have identified that curative surgery followed by S-1 chemotherapy for cytology positive (CY1) only patients contributed to a better prognosis. This study was designed to compare the prognosis between curative and palliative gastrectomy followed by chemotherapy in CY1 only stage IV gastric cancer.

Methods

Between 2001 and 2016, 1507 patients underwent gastrectomy for gastric cancer. Of these, 51 consecutive patients with only CY1 factor who underwent gastrectomy followed by chemotherapy were enrolled in this study.

Results

(1) Twenty three (45%) patients underwent curative D2 or D2+ gastrectomy, and the remaining 28 (55%) patients underwent palliative gastrectomy, followed by S-1 based or another historical recommended chemotherapy postoperatively. (2) Compared with patients undergoing palliative gastrectomy, patients undergoing curative gastrectomy had a significantly better prognosis (P = 0.042; median survival time: curative vs. palliative, 22.6 months vs. 11.8 months) and a lower incidence of recurrences (P = 0.091). Two- and five-year overall survival rates of patients following curative gastrectomy were 48.2% and 18.2%, respectively. A multivariate analysis showed that venous invasion [P = 0.006; hazard ratio (HR), 3.70 (95% CI: 1.27–9.43)] and curative gastrectomy [P < 0.005; HR, 0.28 (95% CI: 0.12–0.87)] were independent prognostic factors.

Conclusion

Curative gastrectomy followed by chemotherapy might be justified to improve the prognosis of patients with only CY1 Stage IV gastric cancer.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

    Article  CAS  Google Scholar 

  2. Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ (2009) Gastric cancer. Lancet 374:477–490

    Article  PubMed  PubMed Central  Google Scholar 

  3. Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, Pignon JP et al (2010) Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 303:1729–1737

    Article  CAS  PubMed  Google Scholar 

  4. Saidi RF, ReMine SG, Dudrick PS, Hanna NN (2006) Is there a role for palliative gastrectomy in patients with stage IV gastric cancer? World J Surg 30:21–27

    Article  PubMed  Google Scholar 

  5. Mahar AL, Coburn NG, Singh S, Law C, Helyer LK (2012) A systematic review of surgery for non-curative gastric cancer. Gastric Cancer 15(Suppl 1):S125–S137

    Article  PubMed  Google Scholar 

  6. Fujitani K, Yang HK, Mizusawa J, Kim YW, Terashima M, Han SU, Iwasaki Y, Hyung WJ, Takagane A, Park DJ, Yoshikawa T, Hahn S, Nakamura K, Park CH, Kurokawa Y, Bang YJ, Park BJ, Sasako M, Tsujinaka T, REGATTA study investigators (2016) Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol 17:309–318

    Article  CAS  PubMed  Google Scholar 

  7. Degiuli M, Sasako M, Ponti A (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97:643–649

    Article  CAS  PubMed  Google Scholar 

  8. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, van Elk P, Obertop H, Gouma DJ, van Lanschot J, Taat CW, de Graaf PW, von Meyenfeldt M, Tilanus H, Dutch Gastric Cancer Group (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 340:908–914

    Article  CAS  PubMed  Google Scholar 

  9. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449

    Article  PubMed  Google Scholar 

  10. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20

    Article  CAS  PubMed  Google Scholar 

  11. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, Toh Y, Nagaie T, Takagi S, Yamamura Y, Yanaoka K, Orita H, Takeuchi M (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221

    Article  CAS  PubMed  Google Scholar 

  12. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A et al (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376:687–697

    Article  CAS  Google Scholar 

  13. Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M (2014) Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg 101:653–660

    Article  CAS  PubMed  Google Scholar 

  14. Kodera Y, Ito S, Mochizuki Y, Ohashi N, Tanaka C, Kobayashi D, Kojima H, Matsui T, Kondo K, Fujiwara M (2012) Long-term follow up of patients who were positive for peritoneal lavage cytology: final report from the CCOG0301 study. Gastric Cancer 15:335–337

    Article  PubMed  Google Scholar 

  15. Oh CA, Bae JM, Oh SJ, Choi MG, Noh JH, Sohn TS, Kim S (2012) Long-term results and prognostic factors of gastric cancer patients with only positive peritoneal lavage cytology. J Surg Oncol 105:393–399

    Article  PubMed  Google Scholar 

  16. Bando E, Makuuchi R, Miki Y, et al. Clinical significance of intraoperative peritoneal cytology in gastric carcinoma-analysis of 3124 patients. 10th International Gastric Cancer Congress 2013 2013:abstract P27–abstract P25

  17. Kano K, Aoyama T, Maezawa Y, Nakajima T, Ikeda K, Yamada T, Sato T, Oshima T, Rino Y, Masuda M, Ogata T, Cho H, Yoshikawa T (2017) The survival and prognosticators of peritoneal cytology-positive gastric cancer patients who received upfront gastrectomy and subsequent S-1 chemotherapy. Int J Clin Oncol 22:887–896

    Article  CAS  PubMed  Google Scholar 

  18. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19

    Article  Google Scholar 

  19. Japanese Gastric Cancer Association (2018) Japanese gastric cancer treatment guidelines 2018 (ver. 5). Kanehara & Co

  20. Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5

    Article  PubMed  Google Scholar 

  21. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  22. Sobin L, Gospodarowicz M (2010) Wittekind C, editors: International Union Against Cancer. In: TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, New York

    Google Scholar 

  23. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K, ACTS-GC Group (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  CAS  PubMed  Google Scholar 

  24. Ueda Y, Yamagishi H, Ichikawa D, Morii J, Koizumi K, Kakihara N, Shimotsuma M, Takenaka A, Yamashita T, Kurioka H, Nishiyama M, Morita S, Nakamura K, Sakamoto J (2005) Phase I study of a combination of s-1 and weekly paclitaxel in patients with advanced or recurrent gastric cancer. Oncology 69:261–268

    Article  CAS  PubMed  Google Scholar 

  25. Noda S, Yashiro M, Toyokawa T, Morimoto J, Shinto O, Muguruma K, Sawada T, Hirakawa K (2011) Borrmann’s macroscopic criteria and p-Smad2 expression are useful predictive prognostic markers for cytology-positive gastric cancer patients without overt peritoneal metastasis. Ann Surg Oncol 18:3718–3725

    Article  PubMed  Google Scholar 

  26. Iwasaki Y, Sasako M, Yamamoto S, Nakamura K, Sano T, Katai H, Tsujinaka T, Nashimoto A, Fukushima N, Tsuburaya A, on behalf of the Gastric Cancer Surgical Study Group of the Japan Clinical Oncology Group (2013) Phase II study of preoperative chemotherapy with S-1 and cisplatin followed by gastrectomy for clinically resectable type 4 and large type 3 gastric cancers (JCOG0210). J Surg Oncol 107:741–745

    Article  CAS  PubMed  Google Scholar 

  27. Maehara Y, Kabashima A, Koga T, Tokunaga E, Takeuchi H, Kakeji Y, Sugimachi K (2000) Vascular invasion and potential for tumor angiogenesis and metastasis in gastric carcinoma. Surgery 128:408–416

    Article  CAS  PubMed  Google Scholar 

  28. Nakanishi Y, Ohara M, Domen H, Shichinohe T, Hirano S, Ishizaka M (2013) Differences in risk factors between patterns of recurrence in patients after curative resection for advanced gastric carcinoma. World J Surg Oncol 11:98

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nishibeppu K, Komatsu S, Ichikawa D, Imamura T, Kosuga T, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2018) Venous invasion as a risk factor for recurrence after gastrectomy followed by chemotherapy for stage III gastric cancer. BMC Cancer 18:108

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Komatsu S, Ichikawa D, Miyamae M, Kosuga T, Okamoto K, Arita T, Konishi H, Morimura R, Murayama Y, Shiozaki A, Kuriu Y, Ikoma H, Nakanishi M, Fujiwara H, Otsuji E (2016) Positive lymph node ratio as an indicator of prognosis and local tumor clearance in N3 gastric cancer. J Gastrointest Surg 20:1565–1571

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Gastric Surgery Division, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Shuhei Komatsu, Yasuhiro Shioaki, Hirotaka Furuke, Atsuki Ohta, Ryota Tsuji, Sachie Tanaka, Tatsuya Kumano, Ken-ichiro Imura, Katsumi Shimomura, Jun Ikeda, Fumihiro Taniguchi, Yasuo Ueshima, Chol Joo Lee, Eiichi Deguchi & Eito Ikeda

  2. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Shuhei Komatsu & Eigo Otsuji

Authors
  1. Shuhei Komatsu
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  2. Yasuhiro Shioaki
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  16. Eigo Otsuji
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Contributions

Shuhei Komatsu, Yasuhiro Shioaki, Hirotaka Furuke, Atsuki Ohta, Ryota Tsuji, Sachie Tanaka, Tatsuya Kumano, Ken-ichiro Imura, Katsumi Shimomura, Jun Ikeda, Fumihiro Taniguchi, Yasuo Ueshima, Chol Joo Lee, Eiichi Deguchi, Eito Ikeda, Eigo Otsuji performed the research and analyzed the data, and Shuhei Komatsu wrote the paper.

Corresponding author

Correspondence to Shuhei Komatsu.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study did not include any experiments on animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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This study was institutionally approved by Kyoto First Red Cross Hospital.

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Komatsu, S., Shioaki, Y., Furuke, H. et al. Is curative gastrectomy justified for gastric cancer with cytology positive as the only stage IV factor?. Langenbecks Arch Surg 404, 599–604 (2019). https://doi.org/10.1007/s00423-019-01791-0

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  • DOI: https://doi.org/10.1007/s00423-019-01791-0

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