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Revista Espanola de Enfermedades... Mar 2012Gastric cancer is a disease with high incidence and mortality in our population. The prognosis of patients with this disease is closely related to the neoplasm stage at... (Review)
Review
Gastric cancer is a disease with high incidence and mortality in our population. The prognosis of patients with this disease is closely related to the neoplasm stage at diagnosis, including the following characteristics of the tumor: extension into the gastric wall thickness, spread to locoregional lymph nodes and the ability to generate distant metastases, as described by the TNM classification. For localized tumors characterized only by invasion of mucosa or submucosa at diagnosis, survival at 5 years is between 70 and 95% with exclusive surgical management; however, when extension into the gastric wall is higher and/or there is locoregional nodal involvement, survival decreases to 20-30% at 5 years. Currently, at high-volume centers, the extent of gastrectomy is individualized based on several parameters, which in an increasing number of cases allows a total gastrectomy with D2 lymphadenectomy and preservation of the spleen and pancreas. This improved procedure increases the chance of R0 surgery and improves the relationship between resected and affected lymph nodes, resulting in a decreased risk of the long-term locoregional recurrence. To improve these results, different therapeutic strategies combining chemotherapy or chemoradiotherapy with surgery have been tested. Previously, the Intergroup 0116 clinical trial, published in 2001, which changed clinical practice in the United States, showed that adjuvant chemoradiotherapy improved survival (from 26 to 37 months overall survival) of these patients. In Europe, perioperative chemotherapy has been considered the standard treatment, since the publication of two randomized phase III trials showed an increase at 5 years survival in the group treated with chemotherapy.
Topics: Chemoradiotherapy, Adjuvant; Chemotherapy, Adjuvant; Combined Modality Therapy; Digestive System Surgical Procedures; Gastrectomy; Humans; Perioperative Care; Randomized Controlled Trials as Topic; Stomach; Stomach Neoplasms
PubMed: 22449155
DOI: 10.4321/s1130-01082012000300006 -
World Journal of Gastroenterology May 2016Gastric cancer is one of the most lethal cancers worldwide despite many advances and options in therapy. As it is often diagnosed at an advanced stage, prognosis is poor... (Review)
Review
Gastric cancer is one of the most lethal cancers worldwide despite many advances and options in therapy. As it is often diagnosed at an advanced stage, prognosis is poor with a median overall survival of less than twelve months. Chemotherapy remains the mainstay of treatment for these patients but it confers only a moderate survival advantage. There remains a need for new targeted treatment options and a way to better define patient populations who will benefit from these agents. In the past few years, there has been a better understanding of the biology, molecular profiling, and heterogeneity of gastric cancer. Our increased knowledge has led to the identification of gastric cancer subtypes and to the development of new targeted therapeutic agents. There are now two new targeted agents, trastuzumab and ramucirumab, that have recently been approved for the treatment of advanced and metastatic gastric cancer. There are also many other actively investigated targets, including epidermal growth factor receptor, the phosphatadylinositol 3-kinase/protein kinase B/mammalian target of rapamycin pathway, c-Met, poly ADP-ribose polymerase, and immune checkpoint inhibition. In this review, we discuss the current management of advanced gastric cancer as well as emerging targeted therapies and immunotherapy.
Topics: Animals; Antineoplastic Agents; Biomarkers, Tumor; Drug Design; Genetic Predisposition to Disease; Humans; Immunotherapy; Molecular Targeted Therapy; Neoplasm Recurrence, Local; Phenotype; Signal Transduction; Stomach Neoplasms; Treatment Outcome
PubMed: 27239108
DOI: 10.3748/wjg.v22.i20.4812 -
Revista Do Colegio Brasileiro de... 2017
Topics: Humans; Neoplasm Invasiveness; Neoplasm Staging; Stomach Neoplasms; Surgical Procedures, Operative
PubMed: 29267550
DOI: 10.1590/0100-69912017006012 -
BMC Surgery Jun 2022Our aim of was to compare importance of the tumor markers (TMs) serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in prediction of recurrence after... (Review)
Review
BACKGROUND
Our aim of was to compare importance of the tumor markers (TMs) serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in prediction of recurrence after curative gastrectomy for gastric cancer.
METHODS
We reviewed retrospectively the clinical records of 149 patients who underwent curative gastrectomy for stage I-III gastric cancer and whose CEA and CA19-9 levels were determined once preoperatively and for more than 3 years postoperatively. We investigated whether the clinicopathological characteristics of patients including age, sex, pathological disease stage, operative approach, type of gastrectomy, and degree of lymph node dissection as well as preoperative positivity of CEA and CA19-9 were risk factors for recurrence in univariate and multivariate analyses. Rate of recurrence was compared between patients positive and negative for postoperative CEA or CA19-9. We also calculated sensitivity, specificity, positive and negative predictable values of postoperative positivity of CEA and CA19-9 for recurrence. The lead time was compared between CEA and CA19-9 that was defined as the time of the first detection of increases in tumor markers and confirmation of recurrence on imaging modalities.
RESULTS
The number of patients positive for preoperative CEA was 25 (17%) and for CA19-9 was 11 (7%). Recurrence was confirmed in 29 (19%) patients. Stage III disease, preoperative positivity for CA19-9 but not CEA, and total gastrectomy were risk factors for recurrence in univariate analysis, but stage III disease was the only risk factor for recurrence in multivariate analysis. Forty and 15 patients were positive for postoperative CEA and CA19-9, respectively. The recurrence rate of 47% (7/15) in patients positive for postoperative CA19-9 was greater than that in negative patients (22/134 = 16%), but it did not differ between patients who were positive or negative for postoperative CEA. Specificity for CA19-9 was greater than that for CEA (P < 0.05). The lead time of CEA (3.9 ± 4.7 months) was not different from that of CA19-9 (6.1 ± 7.1 months).
CONCLUSIONS
These results indicate that CA19-9 rather than CEA is likely to be more useful for the detection of recurrence after curative gastrectomy for gastric cancer.
Topics: Biomarkers, Tumor; CA-19-9 Antigen; Carcinoembryonic Antigen; Gastrectomy; Humans; Neoplasm Recurrence, Local; Retrospective Studies; Stomach Neoplasms
PubMed: 35655198
DOI: 10.1186/s12893-022-01667-z -
Annals of Oncology : Official Journal... 2003Gastric cancer incidence and mortality has fallen dramatically over the last 50 years in many regions, but remains the second most common cancer worldwide. Despite a... (Review)
Review
Gastric cancer incidence and mortality has fallen dramatically over the last 50 years in many regions, but remains the second most common cancer worldwide. Despite a marked decline in fundic and distal tumors, there is a rising incidence of adenocarcinomas of the gastroesophageal junction and gastric cardia, particularly in Western nations. This may imply that there are in fact two diseases differing from each other in epidemiology, etiology, pathology and clinical expression. While surgical resection remains the cornerstone of gastric cancer treatment, the optimum extent of nodal resection remains controversial, with randomized studies failing to show that the D2 procedure improves survival when compared with D1 dissection. The high rate of recurrence and poor survival following surgery provides a rationale for the early use of adjuvant treatment. Adjuvant chemotherapy or adjuvant radiotherapy, when used alone, do not improve survival following resection. However, the results of the recent Intergroup 0116 study are promising in showing that the combination of 5-fluorouracil (5-FU)-based chemotherapy with radiotherapy significantly prolongs disease-free and overall survival when compared with no adjuvant treatment. In advanced gastric cancer, chemotherapy enhances quality of life and prolongs survival when compared with best supportive care. There is no agreed standard of treatment in this setting. Of the commonly used regimens, epirubicin plus cisplatin and 5-FU (ECF) probably has the strongest claim to this role. However, there is a pressing need for new agents, both cytotoxic and molecularly targeted, to be assessed in both the advanced and adjuvant settings.
Topics: Chemotherapy, Adjuvant; Humans; Neoplasm Staging; Radiotherapy, Adjuvant; Risk Factors; Stomach Neoplasms
PubMed: 12810455
DOI: 10.1093/annonc/mdg726 -
World Journal of Gastroenterology Jan 2017Multiple primary malignancy is defined as two or more malignancies detected in an individual person. In particular, synchronous quintuple primary malignancy is extremely... (Review)
Review
Multiple primary malignancy is defined as two or more malignancies detected in an individual person. In particular, synchronous quintuple primary malignancy is extremely rare. A 52-year-old male with anal pain and intermittent blood-tinged stool was diagnosed with malignancies in the stomach, jejunum, ascending colon, transverse colon and rectum. He underwent a subtotal gastrectomy, segmental resection of the jejunum and total protocolectomy with end ileostomy. The postoperative pathologic findings were moderate differentiated gastric adenocarcinoma (pT1bN0M0, pStageIA), combined adenocarcinoma and neuroendocrine carcinoma of the jejunum (pT3N0M0, pStageIIA), three mucinous adenocarcinoma of the ascending colon (pT3N0M0, pStageIIA), transverse colon (pT1N0M0, pStageI) and rectum (pT3N1aM0, pStageIIIB). The tumors did not lack MLH-1 and MSH-2 expression, as the markers (bat26, D5S346, bat25, D2S123) suggest MSI-H presence. Adjuvant chemoradiotherapy was started according to regimen, FOLFOX 4 for advanced rectal cancer. Six years post-operation, the patient is currently attending regular follow-ups without recurrence or metastasis.
Topics: Adenocarcinoma, Mucinous; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Cancer Pain; Chemoradiotherapy, Adjuvant; Colectomy; Colonic Neoplasms; Endoscopy, Gastrointestinal; Fluorouracil; Gastrectomy; Gastrointestinal Hemorrhage; Humans; Ileostomy; Jejunal Neoplasms; Leucovorin; Male; Microsatellite Instability; Middle Aged; Neoplasm Staging; Neoplasms, Multiple Primary; Organoplatinum Compounds; Positron Emission Tomography Computed Tomography; Rectal Neoplasms; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 28104993
DOI: 10.3748/wjg.v23.i1.173 -
Digestive Surgery 2013There is currently no consensus on the best strategy for the follow-up of patients who have undergone surgical treatment with curative intent for gastric cancer. The... (Review)
Review
There is currently no consensus on the best strategy for the follow-up of patients who have undergone surgical treatment with curative intent for gastric cancer. The wide variation in recommendations for surveillance among international experts and hospital schedules clearly reflects a lack of an established body of evidence on this subject. Consequently, most of the international guidelines aimed at early detection of disease recurrence gloss over details concerning the mode, duration, and intensity of surveillance since they cannot be based on an acceptable grade of recommendation. Very few report anything other than the detection of recurrences or death as the primary endpoints, and, given the poor survival of patients with recurrent gastric cancer, the prognostic effect of early detection seems doubtful. In recent years, an increasing focus on evidence-based medicine, which has coincided with a growing concern about costs and efficiency in medicine, has caused a reevaluation of most surveillance practices. In this paper, we review and discuss the current body of evidence and follow-up practices after curative resection of gastric cancer.
Topics: Early Detection of Cancer; Evidence-Based Medicine; Follow-Up Studies; Global Health; Guidelines as Topic; Humans; Neoplasm Recurrence, Local; Practice Guidelines as Topic; Prognosis; Quality of Life; Stomach Neoplasms; Survival Rate
PubMed: 23867593
DOI: 10.1159/000350878 -
Gut Oct 1970This paper describes two cases of gastric leiomyoblastoma (bizarre smooth muscle tumour), one of them having evidence of metastases. Both patients remain well after...
This paper describes two cases of gastric leiomyoblastoma (bizarre smooth muscle tumour), one of them having evidence of metastases. Both patients remain well after seven years and three and a half years respectively. The literature is reviewed, and the clinical features, diagnosis, and treatment are discussed. The histological appearances are described in detail and an attempt is made to assess the criteria for the diagnosis of malignancy.
Topics: Aged; Barium Sulfate; Humans; Leiomyoma; Liver; Male; Middle Aged; Neoplasm Metastasis; Pylorus; Stomach Neoplasms
PubMed: 5485837
DOI: 10.1136/gut.11.10.875 -
Molecules (Basel, Switzerland) May 2021Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) is a specific transcription factor with potent effects on the regulation of antioxidant gene expression that modulates... (Review)
Review
Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) is a specific transcription factor with potent effects on the regulation of antioxidant gene expression that modulates cell hemostasis under various conditions in tissues. However, the effects of Nrf2 on gastric cancer (GC) are not fully elucidated and understood. Evidence suggests that uncontrolled Nrf2 expression and activation has been observed more frequently in malignant tumors, including GC cells, which is then associated with increased antioxidant capacity, chemoresistance, and poor clinical prognosis. Moreover, Nrf2 inhibitors and the associated modulation of tumor cell redox balance have shown that Nrf2 also has beneficial effects on the therapy of various cancers, including GC. Based on previous findings on the important role of Nrf2 in GC therapy, it is of great interest to scientists in basic and clinical tumor research that Nrf2 can be active as both an oncogene and a tumor suppressor depending on different background situations.
Topics: Biomarkers, Tumor; Drug Resistance, Neoplasm; Humans; NF-E2-Related Factor 2; Stomach Neoplasms
PubMed: 34070502
DOI: 10.3390/molecules26113157 -
Epigenomics Jun 2012
Topics: Biomarkers, Tumor; Carcinogens; Cell Transformation, Neoplastic; DNA Methylation; DNA, Neoplasm; Epigenesis, Genetic; Helicobacter Infections; Helicobacter pylori; Humans; Stomach Neoplasms; Tumor Microenvironment
PubMed: 22690658
DOI: 10.2217/epi.12.12