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Clinical impact of molecular classifications in gastric cancer

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Abstract

Treatment options to gastric cancer (GC) have been changing in recent years from a standard to a tailored approach. Different individualized procedures can range from endoscopic resection, D2 with open or minimally invasive approach, to neo-adjuvant therapy followed by extended surgery. In more advanced stages, a combined approach with the inclusion of intraperitoneal chemo-hyperthermia (HIPEC) may represent a new advanced option. The inclusion of histological type according to Laurén classification in the flowchart of treatment could increase both accuracy and effectiveness of such tailored approach. New molecular classifications of GC have been introduced recently and translational clinical studies are ongoing. These classifications are expected to be included in multidisciplinary treatment of GC. In particular, in the group with microsatellite instability a less extended lymphadenectomy may be proposed. Also tailored neo-adjuvant treatment may be proposed according to molecular classifications. The group of patients with epithelial-to-mesenchymal transition shows very high propensity to peritoneal dissemination, as well as N-metastases, and may benefit from prophylactic HIPEC and extended lymphadenectomy when confirmed in prospective trials.

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  1. Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy

    Daniele Marrelli, Karol Polom, Alessandro Neri & Franco Roviello

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  1. Daniele Marrelli
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All procedures followed were in accordance with the Ethical Standards of the Responsible Committee on Human Experimentation (independent Scientific Committe of Siena University) and with the Helsinki declaration of 1975 and revised in 2008.

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Informed consent was obtained from all patients for being included in the study. Additional written informed consent for the treatment of personal and sensible data was obtained from all patients prior to the data collection and evaluation.

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The article is part of topical collection on Gastric Cancer Surgery.

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Marrelli, D., Polom, K., Neri, A. et al. Clinical impact of molecular classifications in gastric cancer. Updates Surg 70, 225–232 (2018). https://doi.org/10.1007/s13304-018-0546-0

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