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Ueda Y, Nishimura S, Inomata M, Akagi T, Shiroshita H, Etoh T, Takiguchi S, Sakai Y, Kumamaru H, Ueno H, Kitagawa Y. Risk factors for serious postoperative complications following gastrectomy in super-elderly patients ≥85-years-old with gastric cancer: A National Clinical Database study in Japan. Ann Gastroenterol Surg 2025; 9:79-88. [PMID: 39759983 PMCID: PMC11693583 DOI: 10.1002/ags3.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/21/2024] [Accepted: 06/27/2024] [Indexed: 01/07/2025] Open
Abstract
Aim This study aimed to evaluate the technical safety and feasibility of gastrectomy for super-elderly patients ≥85-y-old with gastric cancer and to clarify the risk factors for serious postoperative complications in these patients. Methods Between 2017 and 2020, 10,203 patients who underwent distal gastrectomy (DG) and 2580 patients who underwent total gastrectomy (TG) were reviewed from the Japanese National Clinical Database. All possible preoperative factors were used to explore the risk factors for serious postoperative complications in the super-elderly patients with gastric cancer. Results For DG, the operative mortality rate was 1.6% (162 patients), and the rate of serious postoperative complications was 7.8% (796 patients). Similarly, the mortality rate was 2.6% (67 patients), and the rate of serious complications was 11.3% (292 patients) for TG. Based on multivariate analysis, body mass index (≥25 kg/m2), activities of daily living (ADL) (partially dependent), ASA-PS (Grade ≥3), dyspnea, ascites, history of cerebrovascular disease, serum albumin (<4 g/dL), and creatinine (>1.2 mg/dL) in DG, and ADL (partially dependent), ASA-PS (Grade ≥3), previous percutaneous coronary intervention, dialysis, WBC (>9000 μL), and AST (>35 IU/L) in TG were strong risk factors for serious postoperative complications. Conclusions The study findings suggest that gastrectomy for super-elderly gastric cancer patients is relatively safe and feasible. Surgeons need to pay special attention to physical status and past medical history than tumor factors for preventing serious postoperative complications in super-elderly gastric cancer patients.
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Affiliation(s)
- Yoshitake Ueda
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Comprehensive Surgery for Community MedicineOita University Faculty of MedicineOitaJapan
| | - Shiori Nishimura
- Department of Healthcare Quality AssessmentThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Masafumi Inomata
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Tomonori Akagi
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Hidefumi Shiroshita
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Tsuyoshi Etoh
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Shuji Takiguchi
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesAichiJapan
| | - Yoshiharu Sakai
- Academic Committee of Japan Society for Endoscopic SurgeryTokyoJapan
- Japanese Red Cross Osaka HospitalOsakaJapan
| | - Hiraku Kumamaru
- Department of Healthcare Quality AssessmentThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Hideki Ueno
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of SurgeryKeio University School of MedicineTokyoJapan
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Aparicio T, Carteaux-Taieb A, Arégui A, Estrada J, Beraud-Chaulet G, Fossey-Diaz V, Hammel P, Cattan P. Management of esogastric cancer in older patients. Ther Adv Med Oncol 2024; 16:17588359241272941. [PMID: 39224532 PMCID: PMC11367604 DOI: 10.1177/17588359241272941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Although esogastric cancers often affect patients over 75, there are no specific age-related guidelines for the care of these patients. Esogastric cancers have a poor prognosis and require multimodal treatment to obtain a cure. The morbidity and mortality of these multimodal treatments can be limited if care is optimized by selecting patients for neoadjuvant treatment and surgery. This can include a geriatric assessment, prehabilitation, renutrition, and more extensive use of minimally invasive surgery. Denutrition is frequent in these patients and is particularly harmful in older patients. While older patients may be provided with neoadjuvant chemotherapy or radiotherapy, it must be adapted to the patient's status. A reduction in the initial dose of palliative chemotherapy should be considered in patients with metastases. These patients tolerate immunotherapy better than systemic chemotherapy, and a strategy to replace chemotherapy with immunotherapy whenever possible should be evaluated. Finally, better supportive care is needed in patients with a poor performance status. Prospective studies are needed to improve the care and prognosis of elderly patients.
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Affiliation(s)
- Thomas Aparicio
- Gastroenterology Department, Saint Louis Hospital, APHP, Université Paris Cité, 1 Avenue Claude Vellefaux, Paris 75475, France
| | - Anna Carteaux-Taieb
- Department of Digestive Surgery, Saint Louis Hospital, APHP, Université Paris Cité, Paris, France
| | - Amélie Arégui
- Paris Nord Oncogeriatrics Coordination Unit, Bretonneau Hospital, APHP, Paris, France
| | - Janina Estrada
- Geriatric Out-Patient Unit, Bretonneau Hospital, APHP, Paris, France
| | - Geoffroy Beraud-Chaulet
- Digestive and Medical Oncology Department, Paul Brousse Hospital, APHP, Paris-Saclay University, Villejuif, France
| | - Virginie Fossey-Diaz
- Paris Nord Oncogeriatrics Coordination Unit, Bretonneau Hospital, APHP, Paris, France
| | - Pascal Hammel
- Digestive and Medical Oncology Department, Paul Brousse Hospital, APHP, Paris-Saclay University, Villejuif, France
| | - Pierre Cattan
- Department of Digestive Surgery, Saint Louis Hospital, APHP, Université Paris Cité, Paris, France
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Yim THJYZ, Tan KY. Functional Outcomes after Abdominal Surgery in Older Adults - How concerned are we about this? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108347. [PMID: 38657374 DOI: 10.1016/j.ejso.2024.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Amidst trends of a rapidly ageing population with better surgical outcomes for geriatric patients, it is imperative to consider outcome measures beyond mortality and morbidity rates. In fact, the preservation of one's postoperative function has been cited as a key priority for older adults and is a crucial determinant of postoperative independence and survival. This review aims to examine the prevalence of perioperative function reporting amongst older surgical patients undergoing elective major abdominal surgery for cancer. We systematically reviewed studies from inception to December 2023 for studies which focused on the outcomes of older surgical patients undergoing elective major abdominal surgery for cancer. Relevant citations were screened (title, abstract and full article review) based on the inclusion and exclusion criteria. 103 studies were included, of which only 31 studies consisting of 20885 participants reported perioperative function. While the nominal number of studies which report perioperative function has been on a steady rise since 2018, the proportion of studies which do so remains low. Postoperative function is three times less likely to be reported than preoperative function, suggesting that functional recovery is not sufficiently assessed. This suggests that there is still a poor uptake of functional recovery as an outcome measure amongst surgeons, and any increase in perioperative function reporting is likely due to the increased administration of frailty assessments. These findings should urge greater efforts in quantifying and enabling functional recovery to improve the clinical outcomes and quality of care for older surgical patients.
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Affiliation(s)
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central Singapore 768828.
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Law C, Bhimani N, Mitchell D, Yu MY, Chan P, Leibman S, Smith G. The Impact of Age on the Post-operative Outcomes in Patients Undergoing Resection for Oesophageal and Gastric Cancer. World J Surg 2023; 47:3270-3280. [PMID: 37851066 PMCID: PMC10694104 DOI: 10.1007/s00268-023-07223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Within our ageing population, there is an increasing number of elderly patients presenting with oesophagogastric cancer. Resection remains the mainstay of curative treatment however it has substantial morbidity. The aim of this study was to assess whether age was an independent predictor of resection related complications in our unit. METHODS A retrospective cohort study of prospectively collated data from 2002 to 2020 of patients undergoing resection for oesophageal and gastric cancers was analysed. Patients aged over 75 and 75 and under were compared for peri-operative morbidity (via the Clavien-Dindo classification), length of stay (LOS), unplanned readmission, 30- and 90-day mortality, and use of neoadjuvant therapy. RESULTS Data for 466 consecutive patients undergoing oesophagogastric resection (277 oesophagectomy and 189 gastrectomy) were available for analysis. 22% of patients were aged over 75 (14% (39/277) of the oesophagectomy cohort, 34% (65/189) of the gastrectomy cohort). Oesophagectomy patients over 75 were more likely to develop post-operative complications, particularly cardiac or thromboembolic, (69.2%) than those in the younger cohort (50.4%, p = 0.029). There was no difference in complication rates between the younger and older patients undergoing gastrectomy (29.0% vs. 33.9% p = 0.495). The 30- and 90-day mortality rates were 1.4% (n = 4) and 2.5% (n = 7), respectively, for the oesophagectomy cohort and 1.1% (n = 2) and 1.6% (n = 3) for the gastrectomy cohort, with no difference between age groups. CONCLUSION In this series, we found that patients over the age of 75 were able to undergo oesophageal and gastric resection with curative intent with acceptable post-operative morbidity and mortality.
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Affiliation(s)
- Cameron Law
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Nazim Bhimani
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - David Mitchell
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Mia Yue Yu
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Priscilla Chan
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Steven Leibman
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Garett Smith
- Upper Gastrointestinal Surgical Unit, Clinical Administration 8A Office ASB, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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Yazici H, Esmer AC, Eren Kayaci A, Yegen SC. Gastrıc cancer surgery in elderly patients: promising results from a mid-western population. BMC Geriatr 2023; 23:529. [PMID: 37648960 PMCID: PMC10470131 DOI: 10.1186/s12877-023-04206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUNDS Extended resection for gastric cancer in elderly patients is still challenging for surgeons. This study aimed to evaluate the prognosis and the postoperative outcomes of elderly patients underwent gastric cancer surgery in a high-volume center. METHODS The medical records of patients with gastric cancer surgery at Marmara University Hospital's General Surgery Department were examined retrospectively. Patients were divided into two groups: Age ≤ 70 and Age > 70. The clinicopathological data of the patients were compared. The prognostic factors regarding gastric cancer surgery were analyzed with Cox proportional regression models. Kaplan Meier analysis and log-rank test were used to compare Overall Survival (OS) and Cancer-Specific Survival (CSS) among the groups. Competing risk regression analysis was used to examine cause-specific hazards among elderly patients. RESULTS The number of eligible patients was 250. Age > 70 group was 68 patients, and Age ≤ 70 group was 182 patients. There is no significant difference between the patient's demographics or pathological outcomes. Neoadjuvant therapies performed less in elderly patients [40 (22%) vs. 7 (10%), p: 0.03, respectively]. There was no significant difference in severe complication (≥ Grade III) rates in both groups. Multivariate analysis showed that advanced T stage and adjacent organ invasion were the independent risk factors for OS. No significant difference was observed between the groups regarding OS (Log Rank (Mantel-Cox): 0.102). Younger patients have worse CSS than those who are older. Cause-specific hazard model demonstrated a not increased hazard ratio [HR: 1.04(0.78-1.38)] for elderly patients for OS and CSS. CONCLUSION Gastric resections can be safely performed for elderly patients diagnosed with gastric cancer. This study showed that growing age is no longer a factor that will affect the clinician's decision in performing surgery in gastric cancer patients.
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Affiliation(s)
- Hilmi Yazici
- Pendik Research and Treatment Hospital, General Surgery Department, Marmara University, Istanbul, Turkey.
| | - Ahmet Cem Esmer
- Pendik Research and Treatment Hospital, General Surgery Department, Marmara University, Istanbul, Turkey
| | - Ayse Eren Kayaci
- Pendik Research and Treatment Hospital, General Surgery Department, Marmara University, Istanbul, Turkey
| | - Sevket Cumhur Yegen
- Pendik Research and Treatment Hospital, General Surgery Department, Marmara University, Istanbul, Turkey
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Klingbeil KD, Mederos M, Park JY, Seo YJ, Markovic D, Chui V, Girgis M, Kadera BE. Laparoscopic compared to open approach for distal gastrectomy may reduce pneumonia risk for patients with gastric cancer. Surg Open Sci 2023; 14:68-74. [PMID: 37533882 PMCID: PMC10392601 DOI: 10.1016/j.sopen.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Background Whether laparoscopic approach to gastrectomy for gastric cancer (GC) reduces the risk of pneumonia remains unknown. In this study, we compared pneumonia outcomes for patients with GC who underwent either laparoscopic gastrectomy (LG) or open gastrectomy (OG). Methods The ACS NSQIP database was queried to identify patients with GC who underwent LG or OG between Jan 2012 - Dec 2018. Outcomes were compared using regression models. A post-hoc analysis was performed for elderly patients. Results The study cohort included 2661 patients, 23.4 % undergoing LG. Laparoscopic approach lowered pneumonia risk (OR 0.47, p = .028) and reduced hospital length of stay, (5.3 vs 7.1 days, p < .001). Elderly patients undergoing LG demonstrated similar benefits. Risk factors for pneumonia included advanced age, dyspnea and weight-loss, whereas laparoscopic approach reduced this risk. Conclusions LG in patients with GC has both statistically and clinically significant advantages over OG with respect to pneumonia. Further studies are needed to validate the relationship between postoperative pneumonia and surgical approach for gastrectomy.
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Affiliation(s)
- Kyle D. Klingbeil
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Mederos
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Joon Y. Park
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Young-Ji Seo
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Daniela Markovic
- Department of Medicine, Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Victor Chui
- Department of Medicine, Division of Hematology and Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mark Girgis
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Brian E. Kadera
- Department of Surgery, Division of Surgical Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Eom BW. Surgical Outcomes of Patients Undergoing Gastrectomy for Gastric Cancer: Does the Age Matter? J Gastric Cancer 2022; 22:157-159. [PMID: 35938362 PMCID: PMC9359883 DOI: 10.5230/jgc.2022.22.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
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Lee DU, Fan GH, Chang K, Lee KJ, Han J, Jung D, Kwon J, Karagozian R. The Clinical Impact of Advanced Age on the Postoperative Outcomes of Patients Undergoing Gastrectomy for Gastric Cancer: Analysis Across US Hospitals Between 2011–2017. J Gastric Cancer 2022; 22:197-209. [PMID: 35938366 PMCID: PMC9359884 DOI: 10.5230/jgc.2022.22.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose This study systematically evaluated the implications of advanced age on post-surgical outcomes following gastrectomy for gastric cancer using a national database. Materials and Methods The 2011–2017 National Inpatient Sample was used to isolate patients who underwent gastrectomy for gastric cancer. From this, the population was stratified into those belonging to the younger age cohort (18–59 years), sexagenarians, septuagenarians, and octogenarians. The younger cohort and each advanced age category were compared in terms of the following endpoints: mortality following surgery, length of hospital stay, charges, and surgical complications. Results This study included a total of 5,213 patients: 1,366 sexagenarians, 1,490 septuagenarians, 743 octogenarians, and 1,614 under 60 years of age. Between the younger cohort and sexagenarians, there was no difference in mortality (2.27 vs. 1.67%; P=0.30; odds ratio [OR], 1.36; 95% confidence interval [CI], 0.81–2.30), length of stay (11.0 vs. 11.1 days; P=0.86), or charges ($123,557 vs. $124,425; P=0.79). Compared to the younger cohort, septuagenarians had higher rates of in-hospital mortality (4.30% vs. 1.67%; P<0.01; OR, 2.64; 95% CI, 1.67–4.16), length of stay (12.1 vs. 11.1 days; P<0.01), and charges ($139,200 vs. $124,425; P<0.01). In the multivariate analysis, septuagenarians had higher mortality (P=0.01; adjusted odds ratio [aOR], 2.01; 95% CI, 1.18–3.43). Similarly, compared to the younger cohort, octogenarians had a higher rate of mortality (7.67% vs. 1.67%; P<0.001; OR, 4.88; 95% CI, 3.06–7.79), length of stay (12.3 vs. 11.1 days; P<0.01), and charges ($131,330 vs. $124,425; P<0.01). In the multivariate analysis, octogenarians had higher mortality (P<0.001; aOR, 4.03; 95% CI, 2.28–7.11). Conclusions Advanced age (>70 years) is an independent risk factor for postoperative death in patients with gastric cancer undergoing gastrectomy.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Kevin Chang
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - John Han
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Daniel Jung
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Jean Kwon
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
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Jung JH, Lee SS, Chung HY. Quality of life changes in elderly patients after gastrectomy: perspective of an aged Asian society in the 2010s. Ann Surg Treat Res 2022; 102:214-222. [PMID: 35475230 PMCID: PMC9010969 DOI: 10.4174/astr.2022.102.4.214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The study aimed to investigate how elderly gastric cancer patients do postoperatively in terms of quality of life (QoL) compared to younger patients. We also investigated how the QoL of elderly gastric cancer patients has changed over the last decade in the aging population. Methods We included 113 elderly (≥70 years) and 202 younger patients, who underwent distal gastrectomy for stage I gastric cancer during the 2010s. The European Organisation for Research and Treatment of Cancer quality of life questionnaires were used to assess preoperative and postoperative (3-month/1-year) QoL. The baseline QoL and postoperative QoL changes were compared. The elderly patients were further grouped into the early- and late-2010s groups, based on the year of surgery, and their QoL and clinical data were compared. Results The baseline QoL was significantly different on some scales (physical/role functionings, and pain/dyspnea/dysphagia) in favor of younger patients. The postoperative QoL changes were not different with the exception of emotional functioning (1-year postoperatively) in favor of younger patients. Compared to the early-2010s group, comorbidities were more frequent, and the proportion of stage IA cancer was higher in the late-2010s group. There were no QoL differences with the exception of insomnia and financial difficulties (3-months postoperatively) in favor of the late-2010s group. Conclusion Despite baseline QoL differences, elderly gastric cancer patients did as well as younger patients in terms of postoperative QoL changes. More elderly gastric cancer patients with comorbidities are undergoing gastrectomies nowadays and it does not cause them a significant QoL disadvantage.
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Affiliation(s)
- Ji Hyun Jung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Eto K, Yoshida N, Iwatsuki M, Iwagami S, Yamashita K, Nakamura K, Harada K, Sawayama H, Ishimoto T, Baba Y, Miyamoto Y, Baba H. Impact of Type of Gastrectomy on Death from Pneumonia in Elderly Patients with Gastric Cancer Over the Long Term. World J Surg 2021; 46:425-432. [PMID: 34748057 DOI: 10.1007/s00268-021-06352-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gastrectomy may induce significant postoperative disabilities and worsen the quality of life in elderly patients. Without a functioning esophagogastric junction (EGJ), swallowing is impaired because of the anatomical and physiological changes after surgery, which increases the risk of postoperative pneumonia. The aim of this study was to identify the impact of the type of surgical procedure on death from pneumonia in elderly patients with gastric cancer (GC) over the long term. METHODS We analyzed the data of 343 patients with GC who underwent curative gastrectomy in our hospital. We divided the patients into elderly and non-elderly groups. Among them, 109 patients aged ≥ 75 years who underwent curative resection were analyzed, their clinicopathological factors and clinical outcomes were compared, and the impact of the type of surgical procedure on death from pneumonia over the long term was evaluated. The institutional scientific review board of Kumamoto University Hospital was approved for data collection and analysis (No. 1037). RESULTS There were significantly higher levels of American Society of Anesthesiologists (ASA) and poor nutrition in the elderly group; however, gender, BMI and factors related to pneumonia did not differ significantly between groups. The median duration of follow-up time 1588 days. On the multivariate analysis, age and surgical procedure were selected as independent predictive factors for pneumonia-related survival. CONCLUSION Preservation of the EGJ as much as possible while maintaining curability is useful for reducing postoperative death from pneumonia over the long term in elderly patients with gastric cancer.
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Affiliation(s)
- Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kohei Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenichi Nakamura
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kazuto Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Takatsugu Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Tsai MM, Lin HC, Yu MC, Lin WJ, Chu MY, Tsai CC, Cheng CY. Anticancer Effects of Helminthostachys zeylanica Ethyl acetate Extracts on Human Gastric Cancer Cells through Downregulation of the TNF-α-activated COX-2-cPLA2-PGE 2 Pathway. J Cancer 2021; 12:7052-7068. [PMID: 34729107 PMCID: PMC8558661 DOI: 10.7150/jca.64638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Gastric cancer (GC) is the second most prevalent cancer worldwide and the eighth most common cause of tumor-related death in Taiwan. Helminthostachys zeylanica, a flavonoid compound, has anti-inflammatory, immunomodulatory, and anticancer effects. We examined whether an extract of H. zeylanica (E1 and E2) has potential as a treatment for GC. Methods: We investigated the effects (pro-apoptosis, pro-autophagy, and antiproliferation ability) of H. zeylanica-E2 on cell viability in healthy gastric epithelial (GES-1) and GC cells (AGS and BGC823). H. zeylanica-E2 was toxic to GC cells but had little or no toxicity to normal cells. Results: In this study, H. zeylanica-E2 induced apoptosis through caspase 3/7, Bcl-2, Bax, cyclooxygenase-2 (COX-2), and cleaved poly (ADP-ribose) polymerase pathways in GC cells. In addition, it increased autophagy by stimulating autophagy-related protein (ATG)5, ATG7, LC3-I/LC3-II, and inhibiting COX-2 activity in GC cells. We also found that H. zeylanica-E2 exhibited antiproliferation ability through cell cycle arrest in G0/G1 and G2/M and suppressed the migration of GC cells. The anticancer effects of H. zeylanica-E2 in GC cells might be mediated partly through inhibition of tumor necrosis factor-α (TNF-α)-activated proinflammatory cytosolic phospholipase A2 (cPLA2)-COX-2-prostaglandin E2 (PGE2) pathway. Conclusions: Our results suggest that H. zeylanica-E2 has potential as a novel adjunctive agent for the treatment of GC.
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Affiliation(s)
- Ming-Ming Tsai
- Department of Nursing, Division of Basic Medical Sciences, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan and Department of General Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Jung Lin
- Graduate Institute of Health Industry Technology, Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Mei-Yi Chu
- Graduate Institute of Health Industry Technology, Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ching-Ching Tsai
- Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, and Department of Cardiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ching-Yi Cheng
- Graduate Institute of Health Industry Technology, Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Pulmonary Infection and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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12
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Nakamura N, Kaida D, Tomita Y, Miyata T, Miyashita T, Fujita H, Kinami S, Ueda N, Takamura H. Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients. In Vivo 2021; 35:2917-2921. [PMID: 34410987 DOI: 10.21873/invivo.12582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM A significant predictive factor for the occurrence of complications after gastrectomy in elderly gastric cancer patients is yet to be determined. We aimed to evaluate the clinical factors associated with overall complications including remote infection after gastrectomy in elderly gastric cancer patients. PATIENTS AND METHODS We retrospectively analyzed data of 101 patients aged over 80 years, who underwent curative gastrectomy. We analyzed the clinicopathological factors that were independently associated with the occurrence of overall complications or remote infection by a logistic regression model. RESULTS The overall complication rate was 24.8%. We identified pneumonia as a remote infection, and the occurrence rate of remote infections was 5.9%. On multivariate analysis, hemoglobin (<11 g/dl) and operation time (>240 min) were significantly correlated with the occurrence of overall complications. Regarding the occurrence of remote infection, performing total gastrectomy and a hemoglobin level <11 g/dl were identified as significant risk factors. CONCLUSION Preoperative anemia and intraoperative factors, including the surgical procedure, could affect the occurrence of postoperative complications in elderly patients.
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Affiliation(s)
- Naohiko Nakamura
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Daisuke Kaida
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Yasuto Tomita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Takashi Miyata
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Tomoharu Miyashita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Hideto Fujita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Nobuhiko Ueda
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
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13
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Kimura R, Moriyama T, Ohuchida K, Shindo K, Nagai S, Ohtsuka T, Nakamura M. Risk factors for postoperative pneumonia after laparoscopic gastrectomy in patients aged 75 years and over with gastric cancer. Asian J Endosc Surg 2021; 14:408-416. [PMID: 33145998 DOI: 10.1111/ases.12883] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The proportion of patients aged 75 years and over who undergo minimally invasive surgery for gastric cancer is increasing. However, the safety and feasibility of laparoscopic gastrectomy (LG) in this age group is controversial. This study aimed to evaluate whether LG is safe and effective in patients aged 75 years and over. METHODS The study included 728 patients with early and advanced gastric cancer who underwent curative LG between 2009 and 2017; 166 of these patients (22.8%) were aged 75 or over. All surgeries were performed laparoscopically. Selected clinical factors were compared between the 166 patients aged 75 years and over and the 562 patients aged under 75 years. RESULTS There were significant differences in presence of comorbidity, respiratory function and American Society of Anesthesiologists physical status scores between the older and younger groups. The older patients more frequently developed complications than the younger ones, particularly postoperative pneumonia. According to multivariate analyses of all participants, age, chronic obstructive pulmonary disease (COPD), and D2 lymphadenectomy were independent risk factors for postoperative pneumonia. Advanced stage and D2 lymphadenectomy were independent risk factors in the older group, whereas only COPD was an independent risk factor in the younger group. CONCLUSIONS LG for gastric cancer can be safely performed in patients aged over 75 years with an acceptable complication rate. However, the present data suggest that care should be taken in selecting LG with D2 lymphadenectomy to treat advanced cancer in these patients because the risk of postoperative complications, especially postoperative pneumonia, increases.
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Affiliation(s)
- Ryuichiro Kimura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taiki Moriyama
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuntaro Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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14
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Kakinuma D, Kanazawa Y, Matsuno K, Masuda Y, Ando F, Hagiwara N, Fujita I, Nomura T, Yoshiyuki T, Kato S, Yoshida H. Ligation and Fibrin Glue Spraying for Intractable Chylous Ascites after Radical Gastrectomy for Gastric Cancer: Case Report and Literature Review. J NIPPON MED SCH 2021; 88:242-247. [PMID: 32863341 DOI: 10.1272/jnms.jnms.2021_88-310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chylous ascites associated with radical resection of gastric cancer is a serious clinical condition. Lymph node dissection is indispensable during gastrectomy for gastric cancer. However, postoperative chylous ascites prolongs the hospital stay and re-operation. There are few reports on this subject. Most cases of chylous ascites resolve without treatment, but the condition can result in substantial morbidity. The definition of chylous ascites is ambiguous and varies in the English literature. In this report, we discuss a case of chylous ascites in a 68-year-old man who underwent distal gastrectomy for early gastric cancer at our hospital. He was admitted 8 months after surgery with a main complaint of abdominal swelling. Abdominal puncture helped to diagnose chylous ascites with marked elevation of triglyceride level. The patient received a hypercaloric infusion through a central line, and octreotide acetate, but did not improve. After assessment of lymph outflow by lymph scintigraphy, surgical ligation of the lymph vessels was performed through laparotomy. The volume of milky-white ascites in the abdominal cavity was 3,000 mL. Macroscopically, the fluid was confirmed as flowing from behind the common hepatic artery. Thus, ligation was performed. Chylous ascites has not recurred at 12 months after the re-operation. In summary, a case of chylous ascites after radical gastrectomy for gastric cancer was successfully treated by surgery. We review and discuss the relevant literature.
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Affiliation(s)
- Daisuke Kakinuma
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Kunihiko Matsuno
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Yuka Masuda
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Fumihiko Ando
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Itsuo Fujita
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Tsutomu Nomura
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Toshiro Yoshiyuki
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Shunji Kato
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School
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15
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Li Q, Huang LY, Xue HP. Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer. World J Gastrointest Oncol 2020; 12:1146-1166. [PMID: 33133383 PMCID: PMC7579735 DOI: 10.4251/wjgo.v12.i10.1146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/04/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is one of the most common malignant tumors in the world. Although in recent years tremendous progress has been made in its early detection, the postoperative overall survival (OS) of GC patients remains extremely low. A number of studies have shown that age, to varying degrees, affects the prognosis of patients with GC. Therefore, this study retrospectively analyzed the clinical and pathologic data of patients with GC to explore the differences in the clinical characteristics and prognostic factors in different age groups.
AIM To explore the difference in clinicopathological characteristics and prognostic factors in GC patients in different age groups.
METHODS In this retrospective study, we analyzed 1037 GC patients admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2010 to January 2013. The patients were divided into two groups based on age: Younger group (less than 70 years old) and older group (no less than 70 years old). In the younger group, we subdivided the patients in two subgroups by a cut-off value of 45 years. The clinical features and prognostic factors were analyzed in both groups. Subsequently, we retrieved studies that evaluated the predictive role of neutrophil-lymphocyte ratio (NLR) by searching two medical databases, PubMed and EMBASE, to conduct a meta-analysis. Random-effects model was used to pool the data.
RESULTS In the retrospective study, the mean OS time of the younger group (64.7 mo) was significantly longer than that of the older group (48.1 mo) (P < 0.001). Among patients under 70 years of age, hospitalization time, tumor–node–metastasis (TNM) stage, vascular invasion, and preoperative low pre-albumin were independently associated with OS (P < 0.005). In patients aged 70 years and above, TNM stage, esophageal invasion, histological type, and preoperative NLR were independent factors for OS (P < 0.05). The OS of these older patients was also significantly shorter (P < 0.05). In the meta-analysis, 19 retrieved studies included a total of 8312 patients, among whom 3558 had elevated NLR values. The results showed that high NLR value was a risk factor for the prognosis of GC (P < 0.01).
CONCLUSION The OS of elderly patients is significantly worse than that of younger patients. There are significant differences in clinicopathological characteristics and prognostic factors between younger and older patients. NLR is a convenient, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC.
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Affiliation(s)
- Qiong Li
- Department ofGastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
| | - Lin-Yi Huang
- Department ofGastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
| | - Hui-Ping Xue
- Department ofGastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
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16
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Chen E, Senders ZJ, Hardacre J, Kim J, Ammori J. Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric adenocarcinoma. J Surg Oncol 2020; 121:1015-1021. [PMID: 32090338 DOI: 10.1002/jso.25866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current data are conflicting as to whether the outcomes of octogenarians undergoing resection for esophagogastric adenocarcinoma are comparable to younger patients. This study aims to compare perioperative outcomes and survival of patients ≥80 years old with younger patients undergoing curative resection for esophagogastric adenocarcinoma. METHODS Retrospective data were collected on 190 patients who underwent resection with curative intent for adenocarcinomas found in the stomach and esophagogastric junction from 2004 to 2015 at a single institution. RESULTS Of the 190 patients, 34 (18%) were ≥80 years old. Octogenarians were more likely to have chronic kidney disease (CKD) and were less likely to have received neoadjuvant chemotherapy. Pathologic features were similar between groups. Octogenarians' tumors were more likely to be located in the gastric body as compared to the esophagogastric junction in younger patients. Although the length of stay was comparable, octogenarians were significantly less likely to be discharged home (P < .01). Both groups had a single death during the index admission. Incidence and severity of 90 days postoperative complications were not significantly different between groups. There was no difference in 30-day, 90-day, 1-year, or median survival. CONCLUSIONS Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric cancer are comparable to younger patients at our institution.
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Affiliation(s)
- Eric Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Zachary J Senders
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Hardacre
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Julian Kim
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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17
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Abstract
As one of the most serious cancers, gastric cancer (GC) represents the third leading cause of malignancy-related deaths. G9a is a histone lysine methyltransferase and has been reported to be involved in the progression of some human cancers. In the present study, we aimed to explore the expression patterns and clinical value of G9a in GC patients.The expression of G9a in 142 paired GC tissues and adjacent non-cancerous tissues (no less than 5 cm from tumor edge) was examined with quantitative real-time polymerase chain reaction (qRT-PCR). To estimate the association of G9a expression with clinical characteristics of GC patients, Chi-square test and t test were conducted. Kaplan-Meier survival and multivariate Cox regression analyses were performed to explore the prognostic value of G9a in GC.Upregulated expression of G9a was found in GC tissues compared with noncancerous tissues (P < .001). Elevated G9a expression was significantly correlated with patients' lymph node metastasis (P = .007) and TNM stage (P < .001). Kaplan-Meier survival curves demonstrated that patients with high G9a expression had shorter survival time than those with low expression (log-rank test, P < .05), reaching a median OS of 24 months. According to the results of Cox regression, G9a could be considered as an independent prognostic biomarker in patients with GC (HR = 3.912, 95% CI = 2.213-6.915, P < .001). Additionally, the diagnosis cut-off value of G9a in GC patients was 1.515.Taken together, G9a expression was upregulated in GC tissues and could be an effective prognostic biomarker for GC.
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18
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Hsieh HL, Tsai MM. Tumor progression-dependent angiogenesis in gastric cancer and its potential application. World J Gastrointest Oncol 2019; 11:686-704. [PMID: 31558974 PMCID: PMC6755109 DOI: 10.4251/wjgo.v11.i9.686] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/05/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023] Open
Abstract
Despite improvements in the early diagnosis, prognosis and therapeutic strategies for gastric cancer (GC), human GC remains one of the most frequently diagnosed malignant tumors in the world, and the survival rate of GC patients remains very poor. Thus, a suitable therapeutic strategy for GC is important for prolonging survival. Both tumor cells themselves and the tumor microenvironment play an important role in tumorigenesis, including angiogenesis, inflammation, immunosuppression and metastasis. Importantly, these cells contribute to gastric carcinogenesis by altering the angiogenic phenotype switch. The development, relapse and spreading of tumors depend on new vessels that provide the nutrition, growth factors and oxygen required for continuous tumor growth. Therefore, a state of tumor dormancy could be induced by blocking tumor-associated angiogenesis. Recently, several antiangiogenic agents have been identified, and their potential for the clinical management of GC has been tested. Here, we provide an up-to-date summary of angiogenesis and the angiogenic factors associated with tumor progression in GC. We also review antiangiogenic agents with a focus on the anti-vascular endothelial growth factor receptor (VEGFR)-mediated pathway for endothelial cell growth and their angiogenesis ability in GC. However, most antiangiogenic agents have reported no benefit to overall survival (OS) compared to chemotherapy alone in local or advanced GC. In phase III clinical trials, only ramucirumab (anti-VEGFR blocker) and apatinib (VEGFR-TKI blocker) have reported an improved median overall response rate and prolonged OS and progression-free survival outcomes as a 2nd-line agent combined with chemotherapy treatment in advanced GC. By providing insights into the molecular mechanisms of angiogenesis associated with tumor progression in GC, this review will hopefully aid the optimization of antiangiogenesis strategies for GC therapy in combination with chemotherapy and adjuvant treatment.
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Affiliation(s)
- Hsi-Lung Hsieh
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Ming Tsai
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
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19
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Ma F, Li X, Ren J, Guo R, Li Y, Liu J, Sun Y, Liu Z, Jia J, Li W. Downregulation of eukaryotic translation initiation factor 3b inhibited proliferation and metastasis of gastric cancer. Cell Death Dis 2019; 10:623. [PMID: 31423012 PMCID: PMC6698483 DOI: 10.1038/s41419-019-1846-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022]
Abstract
Eukaryotic translation initiation factor 3 (eIF3) plays an important role in the regulation of mRNA translation, cell growth and cancer development. eIF3b is the main scaffolding subunit in the eIF3 complex and has been demonstrated to contribute to the development of several cancers. First, our study found that the downregulation of eIF3b could inhibit the proliferation and metastasis of gastric cancer cells by regulating the expression of cancer-related genes. In addition, the expression of eIF3b correlated with the stage and progression of gastric cancer and was shown to be upregulated in human chronic gastritis and in gastric cancer tissues compared with the expression of eIF3b in normal gastric tissues. Moreover, Helicobacter pylori (H. pylori) infection could upregulate the expression of eIF3b in gastric cancer cells, suggesting that eIF3b might be involved in the carcinogenic process of H. pylori. The above findings identified the oncogenic role of eIF3b in gastric cancer development, and this may contribute to the exploration and discovery of novel therapeutic targets for gastric cancer treatment.
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Affiliation(s)
- Fang Ma
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Xue Li
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Juchao Ren
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China
| | - Ruiting Guo
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Yuwei Li
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Jichang Liu
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Yundong Sun
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Zhifang Liu
- Department of Biochemistry and Molecular Biology, School of basic medical sciences, Shandong University, Jinan, PR China
| | - Jihui Jia
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China
| | - Wenjuan Li
- Key Laboratory for Experimental Teratology of Chinese Ministry of Education, The Shandong Provincial Key Laboratory of Infection and Immunology, Department of Microbiology, School of basic medical sciences, Shandong University-Karolinska Institutet Collaborative Laboratory for Cancer Research, Shandong University, Jinan, PR China.
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20
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Aoyama T, Maezawa Y, Yoshikawa T, Segami K, Kano K, Hayashi T, Yamada T, Numata M, Goda M, Tamagawa H, Sato T, Yukawa N, Rino Y, Masuda M, Ogata T, Cho H, Oshima T. Comparison of Weight and Body Composition After Gastrectomy Between Elderly and Non-elderly Patients With Gastric Cancer. In Vivo 2018; 33:221-227. [PMID: 30587627 DOI: 10.21873/invivo.11463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Body weight, especially lean body mass, significantly decreases after gastrectomy for gastric cancer due to surgical invasion, reduced food intake, and reduced mobility, which can reduce the quality of life and induce associated toxicity or reduce compliance with adjuvant chemotherapy. Such risks can be particularly high in elderly patients with gastric cancer. However, whether or not changes in the weight and body composition differ between elderly and non-elderly patients remains unclear. PATIENTS AND METHODS This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, at 1 week after surgery, and at 1 and at 3 months after surgery. Patients were classified as elderly (≥80 years) or non-elderly (<80 years). RESULTS Eight-hundred and eighty-eight patients (84 elderly and 804 non-elderly) were entered into the present study. Patient background, surgical and clinicopathological factors, and surgical complications did not significantly differ between the two groups. Body weight loss at 1 week, and at 1 and 3 months after surgery, defined as the decrease from the preoperative value, were -2.8%, -6.5%, and -9.0%, respectively, in the elderly and -3.5%, -6.0%, and -8.1%, respectively, in the non-elderly patients (p=0.111, 0.125, and 0.153, respectively). The corresponding losses of lean body mass were -2.6%, -6.0%, and -6.4%, respectively, in the elderly and -3.5%, -4.9%, and -4.7%, respectively, in the non-elderly patients, with p-values of 0.056, 0.036, and 0.029, respectively. CONCLUSION Decreases in lean body mass after gastrectomy were greater in elderly than in non-elderly patients. In order to maintain lean body mass among elderly patients, additional care and treatments are needed.
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Affiliation(s)
- Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan .,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yukio Maezawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan .,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kenki Segami
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kazuki Kano
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Hayashi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Motohico Goda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Sato
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
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21
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Liu D, Mehta D, Kaur S, Kumar A, Parikh K, Chawla L, Patel S, Devi A, Saha A. Decreasing mortality and hospitalizations with rising costs related to gastric cancer in the USA: an epidemiological perspective. J Hematol Oncol 2018; 11:138. [PMID: 30545376 PMCID: PMC6293615 DOI: 10.1186/s13045-018-0682-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022] Open
Abstract
Background There is no convincing data on the trends of hospitalizations, mortality, cost, and demographic variations associated with inpatient admissions for gastric cancer in the USA. The aim of this study was to use a national database of US hospitals to evaluate the trends associated with gastric cancer. Methods We analyzed the National Inpatient Sample (NIS) database for all patients in whom gastric cancer (ICD-9 code: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9) was the principal discharge diagnosis during the period, 2003–2014. The NIS is the largest publicly available all-payer inpatient care database in the US. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by regression analysis. Results In 2003, there were 23,921 admissions with a principal discharge diagnosis of gastric cancer as compared to 21,540 in 2014 (P < 0.01). The mean length of stay for gastric cancer decreased by 17% between 2003 and 2014 from 10.9 days to 8.95 days (P < 0.01). However, during this period, the mean hospital charges increased significantly by 21% from $ 75,341 per patient in 2003 to $ 91,385 per patient in 2014 (P < 0.001). There was a more significant reduction in mortality over a period of 11 years from 2428 (10.15%) in 2003 to 1345 (6.24%) in 2014 (P < 0.01). The aggregate charges (i.e., “national bill”) for gastric cancer increased significantly from 1.79 bn $ to 1. 96 bn $ (P < 0.001), despite decrease in hospitalization (inflation adjusted). Conclusion Although the number of inpatient admissions for gastric cancer have decreased over the past decade, the healthcare burden and cost related to it has increased significantly. Inpatient mortality is decreasing which is consistent with overall decrease in gastric cancer-related deaths. Cost increase associated with gastric cancer contributed significantly to the national healthcare bill.
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Affiliation(s)
- Delong Liu
- Department of Oncology, The First affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. .,New York Medical College and Westchester Medical Center, Valhalla, NY, USA.
| | - Dhruv Mehta
- New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Supreet Kaur
- Department of Hematology and Oncology, St Joseph's Regional Medical Center, Patterson, NJ, USA
| | - Arun Kumar
- New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Kaushal Parikh
- New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Lavneet Chawla
- New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Shanti Patel
- Department of Internal Medicine, Maimonides Medical Center, Valhalla, NY, USA
| | - Amirta Devi
- Dow University of Health Sciences, Karachi, Pakistan
| | - Aparna Saha
- Department of Nephrology, Icahn School of Medicine, New York, NY, USA
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22
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Miki Y, Makuuchi R, Honda S, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Yurikusa T, Tanuma A, Terashima M. Prospective phase II study evaluating the efficacy of swallow ability screening tests and pneumonia prevention using a team approach for elderly patients with gastric cancer. Gastric Cancer 2018; 21:353-359. [PMID: 28612219 DOI: 10.1007/s10120-017-0736-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aging partly impairs swallowing function, which is considered a risk factor for postoperative pneumonia (PP). We evaluated the efficacy of a new team-based strategy to reduce the incidence of PP in elderly patients with gastric cancer. METHODS This single-center, prospective phase II study included elderly patients (≥75 years old) with gastric cancer undergoing gastric surgery. The primary endpoint was the incidence of Clavien-Dindo grade II or higher PP. Patients were initially screened using three swallowing function screening tests: a symptom questionnaire, the modified water swallow test (MSWT), and the repetitive saliva swallowing test (RSST). All patients were provided standard preoperative oral checks and care and simple neck muscle training. For patients who screened positive, a videofluorographic swallowing study was performed; if an abnormality was found, the patient was given intensive swallowing rehabilitation both pre- and postoperatively. RESULTS Of 86 eligible patients enrolled, PP developed in 3 (3.5%). The 60% confidence interval of 1.8-6.3% had an upper limit below the prespecified threshold of 7.8%. Positive screening results were found for 19 patients (22.1%) on the symptom questionnaire, 3 (3.5%) on the MSWT, and 1 (1.2%) on the RSST. PP was not observed in any patients who screened positive. CONCLUSION In conclusion, although the screening tests we adopted here were not sufficient to identify patients at high risk of aspiration pneumonia, perioperative interventions using a team approach might be effective in reducing the incidence of PP in elderly patients with gastric cancer.
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Affiliation(s)
- Yuichiro Miki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.,Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Shinsaku Honda
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Takashi Yurikusa
- Division of Dentistry and Oral Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Tanuma
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
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23
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Pisanu A, Montisci A, Piu S, Uccheddu A. Curative Surgery for Gastric Cancer in the Elderly: Treatment Decisions, Surgical Morbidity, Mortality, Prognosis and Quality of Life. TUMORI JOURNAL 2018; 93:478-84. [DOI: 10.1177/030089160709300512] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Surgical risk is deemed to be higher in the aged population because there are often comorbidities that may affect the postoperative result. This consideration is important for the treatment decision-making for gastric cancer in the elderly. The aim of this study was to identify factors influencing mortality, morbidity, survival and quality of life after curative surgery for gastric cancer in patients aged 75 years and older, and to plan their appropriate management. Methods and Study Design From January 1993 to December 2004, 135 patients underwent surgery at our department because of gastric cancer. Ninety-four of these patients (69.6%) underwent potentially curative gastrectomy. A cross-sectional study of 23 patients aged 75 years and older and 71 younger patients who underwent curative gastrectomy was carried out: patient characteristics, tumor characteristics, management, morbidity, mortality, survival, and quality of life were evaluated. Results Elderly patients had significantly more comorbidities and a poorer nutritional status than younger patients. The surgical procedures were similar in both groups and the overall morbidity rate was 27.9% and the overall mortality rate 8.5%. Medical mortality was significantly higher in elderly patients, and the presence of comorbidities was the only independent factor affecting mortality. The 5-year survival rate was 56.2% in the older group versus 62.1% in the younger group and tumor stage was the only prognostic factor influencing survival. Quality of life after surgery was similar in both groups. The significantly better postoperative functional outcome after subtotal gastrectomy suggested a better compliance of elderly patients with subtotal than total gastrectomy. Conclusions In the elderly, surgical strategies must be modulated on the basis of comorbidities, tumor stage and future quality of life. Since elderly patients have no worse prognosis than younger patients, age is not a contraindication to curative resection for gastric cancer. Subtotal gastrectomy should be the procedure of choice mainly in elderly patients as it offers better quality of life.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Alessandro Montisci
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Sara Piu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Alessandro Uccheddu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
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24
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Yao Q, Gu A, Wang Z, Xue Y. MicroRNA-144 functions as a tumor suppressor in gastric cancer by targeting cyclooxygenase-2. Exp Ther Med 2018; 15:3088-3095. [PMID: 29456712 DOI: 10.3892/etm.2018.5763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/29/2017] [Indexed: 12/23/2022] Open
Abstract
Gastric cancer (GC) poses a serious public health threat and the 5-year survival rate of patients with GC is low. MicroRNAs (miRNAs/miRs) may serve oncogenic or tumor suppressor functions during tumorigenesis by regulating cell proliferation, apoptosis, migration and invasion and it has been demonstrated that they may be dysregulated in various types of cancer. The present study demonstrated that miR-144 and GATA4 were downregulated in GC tissues and cell lines and suggested that this may be due to hypermethylation. Additionally, miR-144 and GATA4 had synergistic effects on GC cells by repressing cell proliferation and inducing cell cycle arrest and apoptosis. The results of bioinformatics and a luciferase reporter assay indicated that cyclooxygenase-2 (COX-2) is a direct target of miR-144 and that miR-144 negatively regulated the expression of COX-2, which inhibits the viability of GC cells. GATA4 also induced a similar effect on COX-2. Taken together, the results of the present study may improve understanding of the underlying mechanism of miR-144 and GATA4 in GC.
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Affiliation(s)
- Qiang Yao
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150000, P.R. China
| | - Anxin Gu
- Department of Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150000, P.R. China
| | - Zhuozhong Wang
- Department of Statistics, Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Yingwei Xue
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150000, P.R. China
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25
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Choo JW, Ju Y, Lim H, Youn SH, Soh JS, Park JW, Kang HS, Kim SE, Moon SH, Kim JH, Park CK, Ha HI, Kim MJ, Kim KC, Cho JW. Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer? Scand J Gastroenterol 2017. [PMID: 28639835 DOI: 10.1080/00365521.2017.1339828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES With the aging population, the number of elderly patients diagnosed with gastric cancer is increasing. However, determining treatment strategies for elderly patients with gastric cancer is controversial. The aim of this study is to evaluate the usefulness of surgical treatment on elderly patients aged ≥80 years with advanced gastric cancer. METHODS A total of 147 elderly patients who were diagnosed with advanced gastric cancer from August 2001 to December 2015 were retrospectively analyzed. We compared the clinicopathological features and prognoses of 94 elderly patients (80-85 years) and 53 extreme-elderly patients (≥86 years) according to treatment modalities. RESULTS In the elderly group, the 3-year overall survival (OS) rates of the surgical resection group and supportive care group were 42.1% and 4.0%, respectively (p < .001). In the extreme-elderly group, the 3-year OS rates of the surgical resection group and supportive care group were 36.4% and 8.0%, respectively (p = .028). The post-operative mortality rate of the elderly group and extreme-elderly group was 5.6% and 9.1%, respectively. In the analysis of risk factors associated with survival, surgical resection was a significantly good prognostic factor in the elderly group (hazard ratio [HR] = 0.277; p = .003) compared with supportive care. In the extreme-elderly group, surgical resection was associated with good prognosis but did not reach statistical significance (HR = 0.491; p = .099). CONCLUSIONS These results suggest that elderly patients aged 80-85 years with advanced gastric cancer could expect a better prognosis with surgical resection. However, extreme-elderly patients aged ≥86 years should consider the risks and benefits of surgical treatment.
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Affiliation(s)
- Jin Woo Choo
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Yeonmi Ju
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Hyun Lim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Hee Youn
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Jae Seung Soh
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ji Won Park
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ho Suk Kang
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Eun Kim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Sung Hoon Moon
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Jong Hyeok Kim
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Choong Kee Park
- a Department of Internal Medicine , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Hong Il Ha
- b Department of Radiology , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Min-Jeong Kim
- b Department of Radiology , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Kab-Choong Kim
- c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea
| | - Ji Woong Cho
- c Department of Surgery , University of Hallym College of Medicine, Hallym University Sacred Heart Hospital , Anyang , Republic of Korea.,d Department of Surgery , University of Hallym College of Medicine, Kangnam Sacred Heart Hospital , Seoul , Republic of Korea
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26
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Park KB, Park JY, Lee SS, Kwon OK, Chung HY, Yu W. Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer. Cancer Res Treat 2017; 50:852-860. [PMID: 28903552 PMCID: PMC6056960 DOI: 10.4143/crt.2017.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/04/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose We evaluated the impact of postoperative body mass index (BMI) shifts on the quality of life (QoL) following total gastrectomy in patients with gastric cancer. Materials and Methods QoL data collected from the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-STO22 questionnaires were obtained from 417 patients preoperatively and 1 year after surgery. Patients were divided into two groups based on changes in BMI: group 1 comprised patientswhose BMIrange category dropped, and group 2 included patients who maintained or rose to a higher category compared to their preoperative BMI category. Results There were 276 patients in group 1 and 141 in group 2. QoLs with respect to the global health status and functional scales were not significantly different between the groups 1 year after surgery. However, there were significantly greater decreases in QoL in group 1 due to gastrointestinal symptoms, such as nausea and vomiting (p=0.008), appetite loss (p=0.001), and constipation (p=0.038). Of the QLQ-STO22 parameters, dysphagia (p=0.013), pain (p=0.012), reflux symptoms (p=0.017), eating restrictions (p=0.007), taste (p=0.009), and body image (p=0.009) were associated with significantly worse QoL in group 1 than in group 2 1 year after surgery. Conclusion Patients have significantly different QoLs depending on the BMI shift after total gastrectomy. Efforts to reduce the gap in QoL should include intensive nutritional support and restoration of dietary behaviors. Appropriate clinical and institutional approaches, plus active medical interventions, are required for maintaining patients' BMIs after surgery.
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Affiliation(s)
- Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Yeon Park
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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27
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Park KB, Lee SS, Kwon OK, Chung HY, Yu W. Chronological Changes in Quality of Life after Distal Gastrectomy for Gastric Cancer. J Gastric Cancer 2017; 17:110-119. [PMID: 28680716 PMCID: PMC5489540 DOI: 10.5230/jgc.2017.17.e14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Patient quality of life (QoL) may be severely disrupted following distal gastrectomy for gastric cancer. This issue should be addressed to improve postoperative care. MATERIALS AND METHODS QoL data from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and its gastric cancer-specific module, were administered to 202 patients preoperatively, and 5 years postoperatively. Patients were classified into subgroups based on their answers to each questionnaire item: group I (good), answering "not at all"; group II (fair), answering "a little"; group III (poor), answering "quite a bit" or "very much." RESULTS At 5 years post-operation, the proportion of patients in group III on the functional scales ranged from 4.3% to 5.7%. The proportions of patients in group III with fatigue, insomnia, diarrhea, and financial difficulties were 8.9%, 9.0%, 11.5%, and 9.1%, respectively. The proportions of patients in group III with anxiety, dry mouth, body image concerns, and hair loss were 12.8%, 10.5%, 9.9%, and 12.6%, respectively. These proportions were less than 5% for other QoL symptom scales/items and for the gastric cancer-specific module. CONCLUSIONS Most patients reported good or fair QoL following surgery. However, symptom management of fatigue, insomnia, diarrhea, anxiety, dry mouth, body image, and hair loss should be specifically targeted for long-term patient care in approximately 10% of patients.
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Affiliation(s)
- Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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28
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Kao HW, Pan CY, Lai CH, Wu CW, Fang WL, Huang KH, Lin WC. Urine miR-21-5p as a potential non-invasive biomarker for gastric cancer. Oncotarget 2017; 8:56389-56397. [PMID: 28915598 PMCID: PMC5593569 DOI: 10.18632/oncotarget.16916] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/14/2017] [Indexed: 12/12/2022] Open
Abstract
Many reports have implicated that microRNAs involve in cancer development and progression, such as miR-155 in breast cancers and miR-196 in gastric cancers. Furthermore, microRNAs are more stable than typical protein-coding gene mRNAs in varieties of clinical samples including body fluids. This suggests that they are potentially valuable biomarkers for cancer monitoring. In this study, we have used urine samples of gastric cancer patients to demonstrate the feasibility of urine microRNAs for gastric cancer detection. Urine samples of gastric cancer patients were extracted for total RNA, which were examined for the expression of miR-21-5p using quantitative stem-loop PCR. Our results demonstrated that miR-21-5p could be detected in small amounts of urine samples with good stability, and the expression levels of miR-21-5p were reduced following surgical removal of gastric cancer tissues. These results implicate that urine miR-21-5p could be utilized as a novel non-invasive biomarker of gastric cancer detection and monitoring.
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Affiliation(s)
- Hsiao-Wei Kao
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chao-Yu Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Hung Lai
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chew-Wun Wu
- Department of Surgery, Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Wen-Liang Fang
- Department of Surgery, Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Hung Huang
- Department of Surgery, Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chang Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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29
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A potential anticancer ability of 1,2-di(quinazolin-4-yl)diselane against gastric cancer cells through ROS signaling pathway. Med Chem Res 2017. [DOI: 10.1007/s00044-017-1799-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Nelen SD, Verhoeven RHA, Lemmens VEPP, de Wilt JHW, Bosscha K. Increasing survival gap between young and elderly gastric cancer patients. Gastric Cancer 2017; 20:919-928. [PMID: 28275933 PMCID: PMC5658460 DOI: 10.1007/s10120-017-0708-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/26/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study investigates the treatment and survival of young versus elderly potentially curable gastric cancer patients in the Netherlands. PATIENTS AND METHODS All noncardia gastric cancer patients with potentially curable gastric cancer according to stage (cTx-3, cNx-3, and cMx-0) diagnosed between 1989 and 2013 were selected from the Netherlands Cancer Registry. Trends in treatment and overall survival were compared between young patients (younger than 70 years) and elderly patients (70 years or older). Multivariable logistic regression analysis was used to examine the probability of patients undergoing surgery and chemotherapy in the most recent period. Multivariable Cox regression analysis was used to identify independent factors associated with survival. RESULTS In total, 8107 young and 13,814 elderly gastric cancer patients were included. There was a major increase in the proportion of patients treated with resection and chemotherapy after 2004-2008. In young patients the increase was from 2.6% in 1999-2003 to 63% in 2009-2013 (p < 0.01). Also an increase was noticed among elderly patients, from 0.1% to 16% (p < 0.01). Median survival increased from 2004 to 2008 onward particularly in young patients and to a lesser extent in elderly patients (from 28 to 41 months vs from 11 to 13 months). Multivariable Cox regression analyses confirmed that overall survival improved for young and elderly patients. DISCUSSION Young patients experienced a stronger improvement in survival than elderly patients, resulting in an increasing survival gap. The literature shows this is a problem not only in the Netherlands but also throughout Europe. The dissimilarity in treatment between young and elderly patients could be the reason for this difference.
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Affiliation(s)
- S. D. Nelen
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10, Route 618, P.O. 9101, 6500 HB Nijmegen, The Netherlands
| | - R. H. A. Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - V. E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands ,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J. H. W. de Wilt
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein 10, Route 618, P.O. 9101, 6500 HB Nijmegen, The Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
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Kim MS, Kim S. Outcome of Gastric Cancer Surgery in Elderly Patients. J Gastric Cancer 2016; 16:254-259. [PMID: 28053812 PMCID: PMC5206316 DOI: 10.5230/jgc.2016.16.4.254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/05/2016] [Accepted: 10/08/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose Owing to increased life expectancy, the number of elderly patients with gastric cancer has increased. This study aimed to identify the outcomes of gastric cancer patients aged 80 years or older through comparison of their clinicopathological characteristics, surgical outcomes, and oncologic outcomes. Materials and Methods Between January 2006 and December 2013, the records of 478 patients who underwent surgery for gastric cancer were retrospectively evaluated. Patients were divided into two groups: patients <80 years old (n=446) and patients ≥80 years old (n=32). Results There were no significant differences in sex, body mass index, length of hospital stay, duration of surgery, depth of invasion, nodal metastasis, histologic type, or tumor size between the two groups. However, significant differences were found for the American Society of Anesthesiologist score and the serum albumin level between the two groups. Postoperative morbidity, mortality, disease-free survival, and recurrence rate did not differ between curatively resected patients in the two groups. Conclusions In elderly patients with gastric cancer, active treatment including radical gastrectomy is necessary.
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Affiliation(s)
- Min Sung Kim
- Department of Surgery, School of Medicine, Chosun University, Gwangju, Korea
| | - Sungsoo Kim
- Department of Surgery, School of Medicine, Chosun University, Gwangju, Korea
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Polom K, Marrelli D, Roviello G, Pascale V, Voglino C, Rho H, Marini M, Macchiarelli R, Roviello F. Molecular key to understand the gastric cancer biology in elderly patients-The role of microsatellite instability. J Surg Oncol 2016; 115:344-350. [PMID: 27859280 DOI: 10.1002/jso.24513] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Microsatellite instability (MSI) in gastric cancer (GC) is associated with older age. We present the clinicopathological results of younger and older patients with MSI GC. METHODS We analyzed 472 patients with GC. MSI analysis was done on fresh frozen tissue using five quasimonomorphic mononucleotide repeats: NR-21, NR-24, NR-27, BAT-25, and BAR-26. Clinical and pathological analysis was performed for different age groups. RESULTS We observed better survival in elderly MSI GC patients compared to younger patients. The percentage of MSI GC increases gradually with increasing age, accounting for 48% of patients over the age of 85 years. A difference in survival was seen between MSI and MSS groups of patients older than 65 years, while no statistical difference was seen for younger groups. Multivariate analysis revealed that MSI status has a significant prognostic factor in patients aged over 70 years (MSS vs. MSI; HR 1.82, P = 0.013). CONCLUSION MSI is an important prognostic factor above all in elderly GC patients. It is associated with favorable prognosis and may help in planning different approaches to treatment in this subgroup. J. Surg. Oncol. 2017;115:344-350. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Karol Polom
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Daniele Marrelli
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Giandomenico Roviello
- Department of Molecular and Translational Medicine, Section of Pharmacology and University Center DIFF-Drug Innovation Forward Future, University of Brescia, Brescia, Italy
| | - Valeria Pascale
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Costantino Voglino
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Henry Rho
- University of Medical Sciences, Poznan, Poland
| | - Mario Marini
- Department of Medicine, Surgery and Neurosciences, Unit of Endoscopy and Gastroenterology, University of Siena, Siena, Italy
| | - Raffaele Macchiarelli
- Department of Medicine, Surgery and Neurosciences, Unit of Endoscopy and Gastroenterology, University of Siena, Siena, Italy
| | - Franco Roviello
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
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Potential Diagnostic, Prognostic and Therapeutic Targets of MicroRNAs in Human Gastric Cancer. Int J Mol Sci 2016; 17:ijms17060945. [PMID: 27322246 PMCID: PMC4926478 DOI: 10.3390/ijms17060945] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/01/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022] Open
Abstract
Human gastric cancer (GC) is characterized by a high incidence and mortality rate, largely because it is normally not identified until a relatively advanced stage owing to a lack of early diagnostic biomarkers. Gastroscopy with biopsy is the routine method for screening, and gastrectomy is the major therapeutic strategy for GC. However, in more than 30% of GC surgical patients, cancer has progressed too far for effective medical resection. Thus, useful biomarkers for early screening or detection of GC are essential for improving patients’ survival rate. MicroRNAs (miRNAs) play an important role in tumorigenesis. They contribute to gastric carcinogenesis by altering the expression of oncogenes and tumor suppressors. Because of their stability in tissues, serum/plasma and other body fluids, miRNAs have been suggested as novel tumor biomarkers with suitable clinical potential. Recently, aberrantly expressed miRNAs have been identified and tested for clinical application in the management of GC. Aberrant miRNA expression profiles determined with miRNA microarrays, quantitative reverse transcription-polymerase chain reaction and next-generation sequencing approaches could be used to establish sample specificity and to identify tumor type. Here, we provide an up-to-date summary of tissue-based GC-associated miRNAs, describing their involvement and that of their downstream targets in tumorigenic and biological processes. We examine correlations among significant clinical parameters and prognostic indicators, and discuss recurrence monitoring and therapeutic options in GC. We also review plasma/serum-based, GC-associated, circulating miRNAs and their clinical applications, focusing especially on early diagnosis. By providing insights into the mechanisms of miRNA-related tumor progression, this review will hopefully aid in the identification of novel potential therapeutic targets.
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Passot G, Vaudoyer D, Messager M, Brudvik KW, Kim BJ, Mariette C, Glehen O. Is Extended Lymphadenectomy Needed for Elderly Patients With Gastric Adenocarcinoma? Ann Surg Oncol 2016; 23:2391-7. [PMID: 27169773 DOI: 10.1245/s10434-016-5260-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extensive surgery is associated with greater mortality for elderly patients. For gastric adenocarcinoma (GA), it is unclear whether the benefit of an extended lymphadenectomy in this population outweighs the associated risks. This study aimed to determine the impact of lymphadenectomy on postoperative outcomes and survival for the elderly. OBJECTIVE To determine the impact of lymphadenectomy on postoperative outcomes and survival for elderly. METHODS From a cohort of 19 centers, patients who underwent resection of GA with curative intent between 1997 and 2010 were included in this study. Lymphadenectomy was defined according to the total number of lymph nodes in the surgical specimen (limited, <15; intermediate, 15-25; extended, >25). Postoperative outcomes and survival were compared between elderly (≥75 years) and younger patients and regarding the extent of lymphadenectomy for the elderly. RESULTS Of 1348 patients, 386 were elderly. The elderly presented with a higher American Society of Anesthesiologist (ASA) score (ASA 3-4: 45 vs. 16.5 %; p < 0.001) as well as greater postoperative morbidity (45 vs. 37 %; p = 0.009) and mortality (8 vs. 2.5 %; p < 0.001) despite less aggressive treatment including less neoadjuvant chemotherapy (5 vs. 20 %; p < 0.001) and adjuvant chemotherapy (7 vs. 44 %; p < 0.001), fewer total gastrectomies (41.5 vs. 60 %; p < 0.001), and less extended lymphadenectomy (38 vs. 48.5 %; p < 0.001). Among the elderly patients, limited lymphadenectomy (n = 116), intermediate lymphadenectomy (n = 125), and extended lymphadenectomy (n = 145) were comparable with respect to tumor stage, perioperative treatment, morbidity, and mortality. For the elderly patients, overall survival (OS) was 30.8 months, and disease-specific survival (DSS) was 63.9 months. The extent of the lymphadenectomy did not have an impact on OS or DSS for the elderly patients. CONCLUSION The expected benefit in terms of long-term survival did not justify an extended lymphadenectomy for elderly patients.
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Affiliation(s)
- Guillaume Passot
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France. .,EMR 3738, Lyon 1 University, Lyon, France.
| | - Delphine Vaudoyer
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France
| | - Mathieu Messager
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Kristoffer W Brudvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Bradford J Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Olivier Glehen
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
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Al Mansour M, Izzo L, Mazzone G, Gabriele R, Di Cello P, Basso L, Ranieri E, Costi U, Jovanovic T, Izzo P. Curative gastric resection for the elderly patients suffering from gastric cancer. G Chir 2016; 37:13-8. [PMID: 27142820 DOI: 10.11138/gchir/2016.37.1.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The improvement of the socio-economic conditions and the progress of medicine have extended the life span of the world's population and as a result, the number of patients with malignant neoplasms has increased. Gastric cancer is the third most common cancer (after lung and prostate) and the second leading cause of death caused by cancer (after lung bronchogenic cell carcinoma) in males; while it's the fifth cancer by frequency and the fourth cause of cancer death in females. It presents a peculiar geographical distribution with a lower incidence in Western Europe and North America, and higher incidence in the Far East, South America and Eastern Europe. Its incidence in Italy is 122 cases per 100000 inhabitants in males and 83 cases per 100000 inhabitants in females (in Italy). It occurs more frequently in old age, is quite rare in individuals under the age of 45. The aim of this work is to analyze the clinical and pathological characteristics of gastric carcinoma and the feasibility of curative surgery in patients over 75, identifying the factors affecting mortality, morbidity, survival and quality of life after surgery. These data have been compared with those of younger patients to assess the correct type of surgery.
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Kang SC, Kim HI, Kim MG. Low Serum Albumin Level, Male Sex, and Total Gastrectomy Are Risk Factors of Severe Postoperative Complications in Elderly Gastric Cancer Patients. J Gastric Cancer 2016; 16:43-50. [PMID: 27104026 PMCID: PMC4834620 DOI: 10.5230/jgc.2016.16.1.43] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose It is well known that old age is a risk factor for postoperative complications. Therefore, this study aimed to explore the risk factors for poor postoperative surgical outcomes in elderly gastric cancer patients. Materials and Methods Between January 2006 and December 2015, 247 elderly gastric cancer patients who underwent curative gastrectomy were reviewed. In this study, an elderly patient was defined as a patient aged ≥65 years. All possible variables were used to explore the risk factors for poor early surgical outcomes in elderly gastric cancer patients. Results Based on multivariate analyses of preoperative risk factors, preoperative low serum albumin level (<3.5 g/dl) and male sex showed statistical significance in predicting severe postoperative complications. Additionally, in an analysis of surgery-related risk factors, total gastrectomy was a risk factor for severe postoperative complications. Conclusions Our study findings suggest that low serum albumin level, male sex, and total gastrectomy could be risk factors of severe postoperative complications in elderly gastric cancer patients. Therefore, surgeons should work carefully in cases of elderly gastric cancer patients with low preoperative serum albumin level and male sex. We believe that efforts should be made to avoid total gastrectomy in elderly gastric cancer patients.
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Affiliation(s)
- Sung Chan Kang
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyun Il Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Gyu Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Chen FF, Huang DD, Lu JX, Zhou CJ, Zhuang CL, Wang SL, Shen X, Yu Z, Chen XL. Feasibility of Total Gastrectomy with D2 Lymphadenectomy for Gastric Cancer and Predictive Factors for Its Short- and Long-Term Outcomes. J Gastrointest Surg 2016; 20:521-30. [PMID: 26691150 DOI: 10.1007/s11605-015-3059-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the short- and long-term outcomes after total gastrectomy (TG) with D2 lymphadenectomy. METHODS Patients undergoing TG with D2 lymphadenectomy for gastric cancer between December 2008 and December 2011 were enrolled. Univariate and multivariate analyses were performed to evaluate the risk factors for the short- and long-term outcomes. RESULTS A total of 229 patients were analyzed, and 22.3 % developed complications within 30 days of surgery. No patient died within 30 days, while 2.6 % died within 90 days of the operation. In the multivariate analysis, age ≥65 years and cardiopulmonary comorbidities were associated with morbidity, whereas hypoproteinemia and tumor-node-metastasis (TNM) stage III were associated with the disease-free survival (DFS) and overall survival (OS). The number of preoperative risk factors stratified the morbidity from 10.3 % in those without any risk factors to 40.5 % in patients with both risk factors. Similarly, 5-year survival rates decreased from 68.9 % (DFS) and 71.1 % (OS) in those without risk factors to 20.2 % (DFS) and 22.9 % (OS) in patients with both risk factors. CONCLUSION TG with D2 lymphadenectomy has acceptable short- and long-term outcomes. Patient risk stratification may allow for more rational selection of patients and therapeutic strategies for gastric resection.
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Affiliation(s)
- Fan-Feng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Jin-Xiao Lu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Chong-Jun Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Su-Lin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China.
- Department of Surgery, Shanghai Tenth People's Hospital Affiliated to TongJi University, Shanghai, 200072, China.
| | - Xiao-Lei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, Wenzhou, 325000, Zhejiang, China.
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Zhou CJ, Chen FF, Zhuang CL, Pang WY, Zhang FY, Huang DD, Wang SL, Shen X, Yu Z. Feasibility of radical gastrectomy for elderly patients with gastric cancer. Eur J Surg Oncol 2016; 42:303-11. [DOI: 10.1016/j.ejso.2015.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/30/2015] [Accepted: 11/20/2015] [Indexed: 12/30/2022] Open
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Tsai MS, Wang YC, Kao YH, Jeng LB, Kao CH. Preexisting Diabetes and Risks of Morbidity and Mortality After Gastrectomy for Gastric Cancer: A Nationwide Database Study. Medicine (Baltimore) 2015; 94:e1467. [PMID: 26376386 PMCID: PMC4635800 DOI: 10.1097/md.0000000000001467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to determine the risk of surgical mortality and morbidity in patients with diabetes mellitus (DM) undergoing a gastrectomy for gastric cancer (GC). Using the Taiwan National Health Insurance Research Database, we identified 6284 patients who underwent gastrectomy for GC from 1999 to 2010. In addition, we created a non-DM control cohort consisting of 6268 patients who received gastrectomy during the same period. Compared with the non-DM cohort, the DM cohort exhibited a higher prevalence of preoperative coexisting medical conditions, namely hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease, chronic pulmonary disease, stroke, and cirrhosis. The odds ratio (OR) of 30-day postoperative mortality after gastrectomy in the DM cohort was 1.04 (95% confidence interval 0.78-1.40) after we adjusted for covariates. The DM cohort did not exhibit a significantly higher risk of 30-day postoperative morbidities. Further analysis revealed that only patients with a history of a DM-related coma exhibited a higher risk of 30-day postoperative mortality (adjusted OR 2.46, 95% confidence interval 1.10 - 5.54). Moreover, the risk of 90-day postoperative mortality was significantly higher in patients with DM-related eye involvement, coma, peripheral circulatory disease, and renal manifestations, in comparison with the non-DM cohort. The risk of 90-day mortality after gastrectomy for GC is higher in patients with DM-related manifestations than those without DM.
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Affiliation(s)
- Ming-Shian Tsai
- From the Department of Surgery (M-ST), E-Da Hospital and I-Shou University, Kaohsiung; Management Office for Health Data; College of Medicine (Y-CW), China Medical University, Taichung; Department of Medical Research (Y-HK), E-Da Hospital and I-Shou University, Kaohsiung; Department of Surgery (L-BJ), Organ Transplantation Center, China Medical University Hospital; Graduate Institute of Clinical Medical Science and School of Medicine (L-BJ, C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Straatman J, van der Wielen N, Joosten PJ, Terwee CB, Cuesta MA, Jansma EP, van der Peet DL. Assessment of patient-reported outcome measures in the surgical treatment of patients with gastric cancer. Surg Endosc 2015; 30:1920-9. [PMID: 26310527 PMCID: PMC4848335 DOI: 10.1007/s00464-015-4415-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Background Gastric cancer is responsible for 10 % of all cancer-related deaths worldwide. With improved operative techniques and neo-adjuvant therapy, survival rates are increasing. Outcomes of interest are shifting to quality of life (QOL), with many different tools available. The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after a gastrectomy for cancer. Methods A comprehensive search was conducted for original articles investigating QOL after gastrectomy. Two authors independently selected relevant articles, conducted clinical appraisal and extracted data (P.J. and J.S.). Results Out of 3414 articles, 26 studies were included, including a total of 4690 patients. These studies included ten different PROMs, which could be divided into generic, symptom-specific and disease-specific questionnaires. The EORTC and the FACT questionnaires use an oncological overall QOL module and an organ-specific module. Only one validation study regarding the use of the EORTC after surgery for gastric cancer was available, demonstrating good psychometric properties and clinical validity. Conclusions A great variety of PROMs are being used in the measurement of QOL after surgery for gastric cancer. A questionnaire with a general module along with a disease-specific module for the assessment of QOL seems most desirable, such as the EORTC and the FACT with their specific modules. Both are developed in different treatment modalities, such as in surgical patients. EORTC is the most widely used questionnaire and therefore allows for comparison of new studies to existing data. Future studies are needed to assess content validity in surgical gastric cancer patients.
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Affiliation(s)
- Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Pieter J Joosten
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Elise P Jansma
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
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Miki Y, Makuuchi R, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Risk factors for postoperative pneumonia after gastrectomy for gastric cancer. Surg Today 2015; 46:552-6. [PMID: 26077287 DOI: 10.1007/s00595-015-1201-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/12/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE The number of elderly patients undergoing gastrectomy for gastric cancer is increasing. Yet, although elderly patients are at high risk of postoperative pneumonia, no study has sufficiently investigated which clinicopathological factors are significant risk factors for the development of this complication after gastrectomy with lymph node dissection. METHODS We reviewed the medical records of 750 patients who underwent gastrectomy between January 2010 and May 2012, to establish the incidence of postoperative pneumonia (Clavien-Dindo grade II or higher). Univariate and multivariate analyses were performed to identify the risk factors for postoperative pneumonia. RESULTS Thirty-two patients (4.3 %) suffered postoperative pneumonia, diagnosed as grades I, II, IIIa, and IVa, in 2 (0.3 %), 28 (3.7 %), 1 (0.2 %), and 1 (0.2 %) patient(s), respectively. Univariate analysis revealed that age (≥75 years), sex (male), diabetes mellitus (DM), a history of smoking, and impairment of respiratory function were significantly associated with postoperative pneumonia. Multivariate analysis revealed that age, impaired postoperative respiratory function, DM, and blood transfusion were independent risk factors for postoperative pneumonia. CONCLUSIONS Age, impaired postoperative respiratory function, DM, and blood transfusion were identified as independent risk factors for postoperative pneumonia after gastrectomy.
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Affiliation(s)
- Yuichiro Miki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.
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Sakurai K, Muguruma K, Nagahara H, Kimura K, Toyokawa T, Amano R, Kubo N, Tanaka H, Ohtani H, Yashiro M, Maeda K, Ohira M, Hirakawa K. The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol 2015; 111:848-54. [PMID: 25753213 PMCID: PMC5023995 DOI: 10.1002/jso.23896] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/07/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to clarify the operative mortality and long-term survival of gastrectomy for elderly patients with gastric cancer. METHODS A total of 461 patients who underwent gastrectomy for gastric cancer in our hospital were classified as elderly group (≥80 years-old, 95 patients) and control group (60-69 years-old, 366 patients). RESULTS The frequency of comorbidities was significantly (P < 0.05) higher in elderly group (74.7%) than that in the control group (49.5%). No significant difference of the postoperative complication rate was found between the elderly group (23.2%) and the control group (23.2%). Adjuvant chemotherapy was 9.5% in the elderly group, which was significantly less than 29.0% of the control group (P < 0.05). Stage II and III elderly patients had worse disease specific survival (DSS) than controls did. In the elderly, overall survival (OS) was significantly worse than DSS in stage I patients (P < 0.05). CONCLUSIONS The operative complication rate of elderly patients was comparable to the control group. Comorbidity and occurrence of secondary malignant disease should be followed for elderly patients at stage I. For stage II and III disease patients, a novel drug which is acceptable for the elderly is needed as a postoperative therapy.
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Affiliation(s)
- Katsunobu Sakurai
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kazuya Muguruma
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Hisashi Nagahara
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kenjiro Kimura
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Takahiro Toyokawa
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Ryosuke Amano
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Naoshi Kubo
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Hiroaki Tanaka
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Hiroshi Ohtani
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Masakazu Yashiro
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kiyoshi Maeda
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Masaichi Ohira
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Kosei Hirakawa
- Department of Surgical OncologyOsaka City University Graduate School of MedicineOsakaJapan
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Takeshita H, Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg 2015; 37:2891-8. [PMID: 24081528 DOI: 10.1007/s00268-013-2210-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study was designed to determine the surgical outcomes of gastric cancer in elderly patients. This information can help establish appropriate treatment for these patients. METHODS A total of 1,193 patients with gastric cancer who underwent gastrectomy between 1995 and 2010 were enrolled in this retrospective study. The clinicopathologic features of 104 elderly patients (aged ≥80 years) were compared with those of 1,089 nonelderly patients. RESULTS (1) Tumors located in the lower-third of the stomach, differentiated cancer, and surgery with limited lymph node dissection were more common in elderly patients. However, there was no difference in the proportion of laparoscopic gastrectomy between elderly and nonelderly patients. (2) Although surgical complication rates were similar in the two groups, the operative mortality rate was higher in elderly patients (1.9 %) than in nonelderly patients (0.7 %). (3) Elderly patients had a significantly poorer overall survival rate, whereas the disease-specific survival rates of the two groups were similar. Limited lymph node dissection did not influence the disease-specific survival rate of elderly patients. (4) The median life expectancy of elderly gastric cancer survivors was 9.8 years in patients aged 80-84 years and 6.0 years in those ≥85 years. The patients with limited lymph node dissection had slightly better prognosis. CONCLUSIONS The treatment results in elderly patients were comparable to those in nonelderly patients. These findings suggest that R0 resection with at least limited lymph node dissection according to Japanese guidelines should be considered, even for elderly patients.
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Affiliation(s)
- Hiroki Takeshita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Jeuck TLA, Wittekind C. Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases. Gastric Cancer 2015; 18:100-8. [PMID: 24550066 DOI: 10.1007/s10120-014-0352-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis. METHODS Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1). RESULTS Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients. CONCLUSION Immunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.
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Affiliation(s)
- Theresa L A Jeuck
- Institute of Pathology, University Hospital Leipzig, Liebigstrasse 24, 04103, Leipzig, Germany,
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Shin HS, Oh SJ, Suh BJ. Factors related to morbidity in elderly gastric cancer patients undergoing gastrectomies. J Gastric Cancer 2014; 14:173-9. [PMID: 25328762 PMCID: PMC4199884 DOI: 10.5230/jgc.2014.14.3.173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/19/2023] Open
Abstract
Purpose The prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients. Materials and Methods For this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups (<70 years vs. ≥70 years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality. Results Comorbidities were more prevalent in the elderly group (≥70 years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group. Conclusions Pulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer.
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Affiliation(s)
- Ha Song Shin
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Kim KH, Kim MC, Jung GJ. Is the rate of postoperative complications following laparoscopy-assisted gastrectomy higher in elderly patients than in younger patients? World J Surg Oncol 2014; 12:97. [PMID: 24736010 PMCID: PMC3990240 DOI: 10.1186/1477-7819-12-97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/07/2014] [Indexed: 01/12/2023] Open
Abstract
Background With an increase in life expectancy, very elderly patients are presenting with gastric cancer more commonly than ever. The present study retrospectively analyzed the surgical outcomes of laparoscopy-assisted gastrectomy for gastric cancer in the young, elderly, and very elderly age groups. Methods The study group consisted of 1,055 patients who underwent laparoscopy-assisted gastrectomy between February 2002 and December 2012. We divided these patients into three groups; group 1 (young age, <65 years), group 2 (elderly age, 65–74 years), and group 3 (very elderly age, ≥75 years). Results There were statistical differences in the rates of postoperative complications among the three groups (P = 0.008). However, when assessed according to the severity of postoperative complications based on the Clavien-Dindo classification, there was no statistical difference among the three groups (P = 0.562). Conclusions Laparoscopy-assisted gastrectomy for gastric cancer can be performed in very elderly patients. In analyzing studies of elderly patients with postoperative complications following the procedure, not only should the rate of postoperative complications be taken into consideration, but also the severity of any postoperative complications.
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Affiliation(s)
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan 602-715, Korea.
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Abstract
Carcinoma of the stomach is one of the most prevalent cancer types in the world. Although the incidence of gastric cancer is declining, the outcomes of gastric cancer patients remain dismal because of the lack of effective biomarkers to detect early gastric cancer. Modern biomedical research has explored many potential gastric cancer biomarker genes by utilising serum protein antigens, oncogenic genes or gene families through improving molecular biological technologies, such as microarray, RNA-Seq and the like. Recently, the small noncoding microRNAs (miRNAs) have been suggested to be critical regulators in the oncogenesis pathways and to serve as useful clinical biomarkers. This new class of biomarkers is emerging as a novel molecule for cancer diagnosis and prognosis, including gastric cancer. By translational suppression of target genes, miRNAs play a significant role in the gastric cancer cell physiology and tumour progression. There are potential implications of previously discovered gastric cancer molecular biomarkers and their expression modulations by respective miRNAs. Therefore, many miRNAs are found to play oncogenic roles or tumour-suppressing functions in human cancers. With the surprising stability of miRNAs in tissues, serum or other body fluids, miRNAs have emerged as a new type of cancer biomarker with immeasurable clinical potential.
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Wang Z, Tan K, Tan P. Functional Outcomes in Elderly Adults Who Have Undergone Major Colorectal Surgery. J Am Geriatr Soc 2013; 61:2249-2250. [PMID: 24329835 DOI: 10.1111/jgs.12584] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Zhongkai Wang
- Geriatric Surgery Service Department of Surgery Khoo Teck Puat Hospital Singapore
| | - Kok‐Yang Tan
- Geriatric Surgery Service Department of Surgery Khoo Teck Puat Hospital Singapore
| | - Phyllis Tan
- Geriatric Surgery Service Department of Surgery Khoo Teck Puat Hospital Singapore
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Terazawa T, Iwasa S, Takashima A, Nishitani H, Honma Y, Kato K, Hamaguchi T, Yamada Y, Shimada Y. Impact of adding cisplatin to S-1 in elderly patients with advanced gastric cancer. J Cancer Res Clin Oncol 2013; 139:2111-6. [PMID: 24129809 DOI: 10.1007/s00432-013-1537-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/04/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE We retrospectively examined the efficacy and safety of S-1 alone or S-1 plus cisplatin (SP) for elderly patients with advanced gastric cancer because the benefit of adding cisplatin in these patients still remains unclear. PATIENTS AND METHODS Among 175 patients aged 70 years or older who received S-1 alone or SP as a first-line therapy between April 2000 and November 2010 at our institution, 104 patients who met eligibility criteria were examined. We investigated safety and efficacy of S-1 and SP. RESULTS Among these 104 patients, 73 patients received S-1 and 31 patients received SP. The median age was 75 years in the S-1 group and 74 years in the SP group. The response rate was 26.3 % in the S-1 group and 44.0 % in the SP group. Major grade 3 or higher adverse events were observed as follows (S-1 vs. SP): nausea (1.4 vs. 16.1 %), anorexia (16.4 vs. 41.9 %), neutropenia (4.1 vs. 35.5 %), and febrile neutropenia (0 vs. 9.7 %). The median overall survival (OS) was 10.4 months in the S-1 group and 17.8 months in the SP group. Treatment of SP and histology of intestinal type were detected as independent, good prognostic factors in multivariate analysis. CONCLUSION SP might improve OS with some added toxicity compared to S-1 alone in elderly patients with advanced gastric cancer.
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Affiliation(s)
- Tetsuji Terazawa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Liang YX, Deng JY, Guo HH, Ding XW, Wang XN, Wang BG, Zhang L, Liang H. Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol 2013; 19:6568-6578. [PMID: 24151383 PMCID: PMC3801370 DOI: 10.3748/wjg.v19.i39.6568] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/28/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.
METHODS: We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003 and December 2007 in our center. Patients were categorized into three groups: younger group (age < 50 years), middle-aged group (50-69 years), and elderly group (≥ 70 years). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The log-rank test was used to assess statistical differences between curves. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of age on survival at each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. We analyzed the potential prognostic factors for patients aged ≥ 70 years. Finally, the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.
RESULTS: In the elderly group, there was a male predominance. At the same time, cancers of the upper third of the stomach, differentiated type, and less-invasive surgery were more common than in the younger or middle-aged groups. Elderly patients were more likely to have advanced tumor-node-metastasis (TNM) stage and larger tumors, but less likely to have distant metastasis. Although 5-year overall survival (OS) rate specific to gastric cancer was not significantly different among the three groups, elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients (elderly vs middle-aged vs younger patients = 22.0% vs 36.6% vs 38.0%, respectively). In the TNM-stratified analysis, the differences in OS were only observed in patients with II and III tumors. In multivariate analysis, only surgical margin status, pT4, lymph node metastasis, M1 and sex were independent prognostic factors for elderly patients. The 5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection, and these patients benefited little from chemotherapy.
CONCLUSION: Age ≥ 70 years was an independent prognostic factor for gastric cancer after gastrectomy. D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.
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