The first European Union Network of Excellence for Gastric Cancer conference, Rome, Italy, April 2008

Clinical significance of zinc-finger E-box binding homeobox 1 mRNA levels in peritoneal washing for gastric cancer

Zinc-finger E-box binding homeobox 1 (ZEB1) is an important regulator of epithelial-to-mesenchymal transition and is associated with various types of metastasis. Gastric cancer patients often develop peritoneal carcinomatosis, of which the detection of free cancer cells in the peritoneal washes is an important predictor. We analyzed the correlation of ZEB1 mRNA levels in the peritoneal washing (pZEB1) with clinicopathological variables and survival in 107 gastric cancer patients who underwent surgery and peritoneal washing cytology. Reverse transcription-polymerase chain reaction was performed to quantify pZEB1. The patients were classified into the pZEB1^High (n=27) and the pZEB1^Low (n=80) groups based on their pZEB1 expression. pZEB1 was statistically correlated with pathological T stage (P=0.03) and vascular involvement (P=0.03). At 5 years, the disease-specific survival was 36.4% for the pZEB1^High group and 64.7% for the pZEB1^Low group (P=0.02), whereas the disease-free survival rate was 46.9% for the pZEB1^High group and 83.0% for the pZEB1^Low group (P=0.03). When subclassified into 4 categories based on washing cytology and pZEB1, survival was significantly lower in the pZEB1^High compared to the pZEB1^Low group (cytology -negative group, P=0.01; cytology -positive group, P=0.13). Therefore, pZEB1 may add valuable information to conventional peritoneal washing cytology as a prognostic determinant in gastric cancer.

The treatment of peritoneal carcinomatosis in advanced gastric cancer: state of the art

Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world; 53–60% of patients show disease progression and die of peritoneal carcinomatosis (PC). PC of gastric origin has an extremely inauspicious prognosis with a median survival estimate at 1–3 months. Different studies presented contrasting data about survival rates; however, all agreed with the necessity of a complete cytoreduction to improve survival. Hyperthermic intraperitoneal chemotherapy (HIPEC) has an adjuvant role in preventing peritoneal recurrences. A multidisciplinary approach should be empowered: the association of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), cytoreductive surgery (CRS), HIPEC, and early postoperative intraperitoneal chemotherapy (EPIC) could increase the rate of completeness of cytoreduction (CC) and consequently survival rates, especially in patients with Peritoneal Cancer Index (PCI) ≤6. Neoadjuvant chemotherapy may improve survival also in PC from GC and adjuvant chemotherapy could prevent recurrence. In the last decade an interesting new drug, called Catumaxomab, has been developed in Germany. Two studies showed that this drug seems to improve progression-free survival in patients with GC; however, final results for both studies have still to be published.

Tratamento paliativo do adenocarcinoma gástrico

INTRODUÇÃO: Embora decrescendo nos países do chamado primeiro mundo, o adenocarcinoma gástrico mantém-se como terceiro tumor mais frequente no sexo masculino mundialmente. Sua mortalidade é muito elevada, fruto do diagnóstico tardio em lesões muito avançadas, o que frequentemente torna paliativo seu tratamento, motivos pelos quais se justificam estudos no sentido de melhorar estes resultados. MÉTODO: Revisão da literatura através do portal de periódicos da CAPES indicados por busca no sites da Bireme e PubMed. Além disso, foram consultados os sumários do 8º Congresso Internacional de Câncer Gástrico em 2009. Foi apresentada uma sugestão de algoritmo de atendimento destes pacientes. CONCLUSÕES: O surgimento de novas drogas anticancer, mais efetivas, está propiciando novas alternativas para a ressecção gástrica como tratamento paliativo. Novos protocolos estão surgindo mostrando boas perspectivas para melhorar os resultados desta doença.