Extent of gastrectomy and lymphadenectomy for gastric adenocarcinoma

Proximal gastrectomy as an alternative to total gastrectomy in patients with advanced proximal gastric cancer: propensity score matching analysis of the 2-center study in European population

BACKGROUND

Proximal gastric cancer (PGC) is more common in the West than in the East. Improvements related to the minimally invasive approach in GC surgery and benefits to quality of life may be reasons for adopting proximal gastrectomy (PG). This study aimed to compare short- and long-term oncologic and surgical outcomes among patients with PGC with advanced PGC undergoing total gastrectomy (TG) vs PG in 2 expert centers in a European population.

METHODS

Patients with locally advanced PGC treated between 2010 and 2020 were included in the study. Patients who had not undergone gastrectomy, had early or metastatic GC, underwent palliative care, or had incomplete clinical or pathologic information were excluded. Propensity score matching (PSM) analysis was used to balance known covariates.

RESULTS

After PSM, patients who underwent TG had a higher incidence of positive margins (19.1% vs 8.6%; P =.0064), a higher median number of harvested lymph nodes (LNs) (26 vs 18 LNs; P <.0001), and a higher incidence of serious postoperative complications (35.2% vs 20.4%; P =.0030) than individuals who underwent PG. Older age (≥65 years) was related to a higher risk of serious postoperative complications (odds ratio [OR], 1.91). The use of neoadjuvant chemotherapy was related to a lower risk of serious postoperative complications (OR, 0.36). TG was independently associated with a higher risk of serious postoperative complications (OR, 2.02). Median overall survival for PG and TG groups was 44 and 23 months, respectively (hazard ratio, 1.22; 95% CI, 0.94-1.60; P =.1340).

CONCLUSION

PG may be considered as an alternative approach to TG in well-selected patients with locally advanced PGC. This surgical approach was associated with fewer serious postoperative complications.

Bright and Specific Targeting of Metastatic Lymph Nodes in Orthotopic Mouse Models of Gastric Cancer with a Fluorescent Anti-CEA Antibody

BACKGROUND

Gastric cancer poses a major diagnostic and therapeutic challenge. Improved visualization of tumor margins and lymph node metastases with tumor-specific fluorescent markers could improve outcomes.

METHODS

To establish orthotopic models of gastric cancer, one million cells of the human gastric cancer cell line, MKN45, were suspended in 50 μl of equal parts PBS and Matrigel and injected into the nude mouse stomach with a 29-gauge needle. Tumors were allowed to grow for 8-12 weeks before performing imaging studies. For tumor labeling, M5A (humanized anti-CEA mAb) and IgG as a control, were conjugated with the near-infrared dye IRDye800CW. Mice were randomized to receive 50 μg of M5A-IR800 (n = 14) or 50 μg of IgG-IR800 (n = 14) intravenously and were imaged 72 hours later. Fluorescence imaging was performed using the LI-COR Pearl Imaging System.

RESULTS

Forty-two lymph nodes were collected from 28 mice, of which 59.5% were found to contain metastatic gastric cancer cells on pathologic examination. In mice that received M5A-IR800, there was a statistically significant difference in the mean fluorescence signal for cancer-positive lymph nodes at 0.431 (SE ± 0.224) compared with 0.105 (SE ± 0.009) for cancer-negative nodes (p: 0.002). For IgG-IR800, there was no significant difference in the mean fluorescence signal for cancer-positive nodes (0.057) compared with cancer-negative nodes (0.064), p-value 0.677.

CONCLUSIONS

Humanized anti-CEA (M5A) antibodies conjugated to fluorescent dyes provide bright labeling of lymph nodes containing metastatic gastric cancer. This tumor-specific fluorescent antibody is a promising clinical tool for identifying lymph nodes containing metastatic gastric cancer.

Sensitive detection of miR-21 and miR-25 in gastric adenocarcinoma patient serum using a SERS sensor based on AuNT and enzyme cleavage strategy

MicroRNA (miRNA) detection has significant application value for early cancer diagnosis. In this study, a surface-enhanced Raman scattering (SERS) sensor was developed for detecting miR-21 and miR-25 in the serum of Gastric adenocarcinoma (GAC) patients. The sensor was constructed using arrays of Au trioctahedral nanoparticles (AuNT) and enzyme cleavage techniques. The AuNT was obtained by self-assembly at the oil-water interface, and the Cy5-labeled miR-21 and 5-FAM-labeled miR-25 complementary single-stranded ssDNA-21 and ssDNA-25 were connected with the AuNT to form the SERS sensor. When miR-21 and miR-25 were present, ssDNA-21 and ssDNA-25 were paired and hybridized to form miR-21-ssDNA-21 and miR-25-ssDNA-25 double strands. Duplex-specific nuclease (DSN) could act on the DNA phosphodiester bond in the double strand, causing Cy5 and 5-FAM to be far away from the AuNT, which resulted in a reduction of the SERS signal. In the range of 10 aM to 1 pM, the logarithm of miR-25 concentration was linearly related to the intensity of the characteristic peak of 5-FAM at 1178 cm-1, and the limit of detection (LOD) was determined to be 8.12 aM. The logarithm of miR-21 concentration was linearly related to the characteristic peak intensity of Cy5 at 1367 cm-1, and the LOD was determined to be 4.29 aM. Furthermore, the accuracy of the SERS sensor for the detection of miR-21 and miR-25 in clinical serum samples was evaluated using real-time quantitative polynucleotide chain reaction (qRT-PCR) technology as the gold standard. The relative errors of the two methods miR-21 in healthy people and gastric adenocarcinoma patients were 1.71% and -2.40%. The relative errors of miR-25 were 2.74% and -2.67%. There was no significant difference between the two methods, and the expression levels of miR-21 and miR-25 in the serum of GAC patients were found to be higher than those in healthy individuals. Consequently, this method offers a reliable solution for the early diagnosis of gastric cancer.

Prediction models for the survival in patients with intestinal-type gastric adenocarcinoma: a retrospective cohort study based on the SEER database

OBJECTIVE

To explore the influencing factors of survival in intestinal-type gastric adenocarcinoma (IGA) and set up prediction model for the prediction of survival of patients diagnosed with IGA.

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

A total of 2232 patients with IGA who came from the Surveillance, Epidemiology, and End Results database.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patients' overall survival (OS) rate and cancer-specific survival (CSS) at the end of follow-up.

RESULTS

Of the total population, 25.72% survived, 54.93% died of IGA and 19.35% died of other causes. The median survival time of patients was 25 months. The result showed that age, race, stage group, T stage, N stage, M stage, grade, tumour size, radiotherapy, number of lymph nodes removed and gastrectomy were independent prognostic factors of OS risk for patients with IGA; age, race, race, stage group, T stage, N stage, M stage, grade, radiotherapy and gastrectomy were associated with CSS risk for patients with IGA. In view of these prognostic factors, we developed two prediction models for predicting the OS and CSS risk for patients with IGA separately. For the developed OS-related prediction model, the C-index was 0.750 (95% CI: 0.740 to 0.760) in the training set, corresponding to 0.753 (95% CI: 0.736 to 0.770) in the testing set. Likewise, for the developed CSS-related prediction model, the C-index was 0.781 (95% CI: 0.770 to 0.793) in the training set, corresponding to 0.785 (95% CI: 0.766 to 0.803) in the testing set. The calibration curves of the training set and testing set revealed a good agreement between model predictions in the 1-year, 3-year and 5-year survival for patients with IGA and actual observations.

CONCLUSION

Combining demographic and clinicopathological features, two prediction models were developed to predict the risk of OS and CSS in patients with IGA, respectively. Both models have good predictive performance.

Gastrectomy with or without Complete Omentectomy for Advanced Gastric Cancer: A Meta-Analysis

Background and Objectives: Surgery remains the only possible curative treatment for advanced gastric cancer (AGC). Peritoneal metastases are estimated to occur in approximately 55–60% AGC patients. Greater omentum is the most common metastatic area in AGC. At present, omentectomy alone or bursectomy are usually carried out during gastric cancer surgery. We performed a meta-analysis in order to evaluate long-term and short-term outcomes among AGC patients, who have undergone radical gastrectomy with or without complete omentectomy (CO). Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed by use of RevMan (Computer program) Version 5.4. Results: The eight included studies covered an approximately 20 years long study period (2000–2018). Almost all included studies were retrospective ones and originated from Asian countries. Meta-analysis indicated gastrectomy without CO as significantly associated with longer 3-year (RR: 0.94, 95% CI: 0.90–0.98, p = 0.005) and 5-year overall survivals (OS) (RR: 0.93, 95% CI: 0.88–0.98, p = 0.007). Moreover, we found longer operative time (MD: 24.00, 95% CI: −0.45–48.45, p = 0.05) and higher estimated blood loss (MD: 194.76, 95% CI: 96.40–293.13, p = 0.0001) in CO group. Conclusions: Non-complete omentectomy (NCO) group had a statistically greater rate in 3-year and 5-year OSs than the CO group, while the CO group had significantly longer operative time and higher estimated blood loss than the NCO group. Further randomized, possibly multi-center trials may turn out of paramount importance in confirming our results.

Neoadjuvant Treatment Strategies for Resectable Proximal Gastric, Gastroesophageal Junction and Distal Esophageal Cancer

Neoadjuvant treatment strategies for resectable proximal gastric, gastroesophageal junction (GEJ), and distal esophageal cancer have evolved over several decades. Treatment recommendations differ based on histologic type-squamous cell carcinoma (SCC) versus adenocarcinoma (AC)-as well as the exact location of the tumor. Recent and older clinical trials in this area were critically reviewed. Neoadjuvant chemoradiation with concurrent taxane- or fluoropyrimidine-based chemotherapy has an established role for both AC and SCC of the distal esophagus and GEJ. The use of perioperative chemotherapy for gastric AC is based on the FLOT4 and MAGIC trials; however, the utility of neoadjuvant chemoradiation in this setting requires further evaluation. Additional clinical trials evaluating chemotherapy, targeted therapy, immunotherapy, and radiation that are currently in process are highlighted, given the need for further disease control.