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URAKAWA NAOKI, KANAJI SHINGO, KATO TAKASHI, SAWADA RYUICHIRO, HARADA HITOSHI, GOTO HIRONOBU, HASEGAWA HIROSHI, YAMASHITA KIMIHIRO, MATSUDA TAKERU, OSHIKIRI TARO, KAKEJI YOSHIHIRO. Neutrophil-lymphocyte Ratio and Histological Response Correlate With Prognosis of Gastric Cancer Undergoing Neoadjuvant Chemotherapy. In Vivo 2023; 37:378-384. [PMID: 36593034 PMCID: PMC9843807 DOI: 10.21873/invivo.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIM Neoadjuvant chemotherapy (NAC) for advanced gastric cancer (GC) and esophagogastric junction cancer (EGC) is expected to effectively control the tumor; however, histological tumor response and immune function markers as prognostic factors for NAC remain unknown. This study assessed the prognostic significance of histological response and immune function markers in patients undergoing NAC for GC and EGC. PATIENTS AND METHODS Forty-two patients who underwent NAC followed by surgical resection for operable advanced GC or EGC from January 2007 to December 2019 were divided into two groups based on histological response. Overall survival (OS), tumor response, and immune function markers, such as the neutrophil/lymphocyte ratio (NLR), were the outcomes analyzed. RESULTS The 5-year OS for Grade 2b-3 (n=10, responder group) according to the Japanese Gastric Cancer Classification was 72.0% with a favorable prognosis, compared with 33.3% for Grade 0-1a (n=18), and 46.8% for Grade 1b-2a (n=14) in the non-responder group. There was no significant difference in the background between the two groups regarding clinical status or immune function markers. In a multivariate analysis of immune function markers, the NLR value before NAC was significantly associated with prognosis (p=0.048). Patients with an NLR value <3.4 had a favorable OS (p=0.03). CONCLUSION Histological response scores for Grade 2b or higher may help predict a favorable prognosis for patients undergoing NAC for advanced GC and EGC. The outcomes may be further improved by considering NLR values.
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Zhu FH, Wang YK, Zhou JL, Meng NL, Wang Y, Jiang B, Wang SN. The Histopathological Types and Distribution Characteristics of Gastric Mixed Tumors. Front Oncol 2022; 12:873005. [PMID: 35785186 PMCID: PMC9247174 DOI: 10.3389/fonc.2022.873005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The present study aimed to investigate the histopathological types and distribution characteristics of gastric mixed tumors. Methods Detailed histological observations, together with related immunohistochemical and genetic tests, were analyzed on 960 surgically resected samples in 6 hospitals with gastric mixed tumors from May 2017 to May 2021 in this retrospective study. Results Epithelial-derived tumors accounted for 80.10% (769/960) of the gastric mixed tumor samples studied, and tumors of different tissue origins accounting for 10.83% (104/960), mesenchymal-derived tumors accounting for 6.25% (60/960), neuroendocrine tumors accounting for 2.40% (23/960), and lymphoma accounting for 0.42% (4/960). The histological types of gastric mixed tumors identified as most commonly were epithelial originated, followed by mixed tumors of different tissue originated, then mixed neuroendocrine, lymphoma, and mesenchymal originated in sequence. The histological number of gastric mixed tumors was ≤ 3 in 83.23% (799/960) of cases and > 4 in 16.77% (161/960) of cases. The mixed histological patterns of gastric mixed tumors were divided into three types: those with tumor cells interspersed with each other, those with incomplete fibrous tissue separation, and those without fibrous tissue separation. The gene target characteristics of gastric mixed tumors were the existence of multi-gene mutation, including human epidermalgrowth factor receptor-2 (HER2) gene amplification, key result areas (K-ras) and platelet-derived growth factor receptor alpha (PDGFRA). Conclusion Gastric mixed tumors should be adequately sampled, each piece of tissue should be involved in the morphological proportional division of the tumor, and any independent histological component should be written into the pathological examination report.
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Affiliation(s)
- Fang-Heng Zhu
- Department of Pathology, Xinxiang Central Hospital, Xinxiang, China
| | - Yang-Kun Wang
- Department of Pathology, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
| | - Jun-Ling Zhou
- Shenzhen Nanshan District People’s Hospital, Shenzhen, China
| | - Nian-Long Meng
- Department of Pathology, The 989th Hospital of the Joint Logistics Support Force of The Chinese People’s Liberation Army, Luoyang, China
| | - Yue Wang
- Shenzhen Hezheng Hospital, Shenzhen, China
| | - Bo Jiang
- Department of Pathology, People’s Liberation Army Joint Logistic Support Force 990th Hospital, Zhumadian, China
| | - Su-Nan Wang
- Shenzhen Polytechnic, Shenzhen, China
- *Correspondence: Su-Nan Wang,
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Hayashi M, Fujita T, Matsushita H. Prognostic value of tumor regression grade following the administration of neoadjuvant chemotherapy as treatment for gastric/gastroesophageal adenocarcinoma: A meta-analysis of 14 published studies. Eur J Surg Oncol 2020; 47:1996-2003. [PMID: 33353828 DOI: 10.1016/j.ejso.2020.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The efficacy of neoadjuvant chemotherapy (NAC) for advanced gastric cancer (GC) has recently been revealed. The use of tumor regression grade (TRG) has also been reported, where TRG has been positively correlated with prognosis. However, previous studies included several types of GC and treatments. The prognostic value of TRG in a specific population has not been well investigated. Therefore, a meta-analysis of studies on gastric adenocarcinomas treated with NAC that evaluate the prognostic impact of TRG on overall survival (OS) must be conducted to provide more accurate evidence. METHODS A meta-analysis of studies reporting gastric cancer/gastroesophageal junction (GC/GEJ) adenocarcinoma treated with NAC was performed. Studies that calculate the number of responders and non-responders were considered eligible. The risk ratio (RR) was obtained from the eligible studies, and a random-effects model was used for pooled analysis. RESULTS Fourteen studies, which included a total of 1660 patients, were included in the current study. The responders showed better OS (RR: 0.53, 95% confidence interval (CI): 0.46-0.60, P < 0.001). All subgroup analyses (Asian vs. non-Asian populations, different TRGs, GC/GEJ vs. GC) also revealed the statistical dominance of better TRG over better OS. However, the possibility of some publication bias remained. CONCLUSIONS In this meta-analysis, better TRG was associated with better OS. However, the histology, configuration, and location of GC varied. Hence, a more subdivided analysis is recommended to obtain more solid evidence.
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Affiliation(s)
- Masato Hayashi
- Tochigi Cancer Center, 4-9-13 Yonan, Utsunomiya, 320-0834, Japan.
| | - Takeshi Fujita
- Tochigi Cancer Center, 4-9-13 Yonan, Utsunomiya, 320-0834, Japan
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Kosaka T, Akiyama H, Miyamoto H, Sato S, Tanaka Y, Sato K, Kunisaki C, Endo I. Outcomes of preoperative S-1 and docetaxel combination chemotherapy in patients with locally advanced gastric cancer. Cancer Chemother Pharmacol 2019; 83:1047-1055. [PMID: 30911769 DOI: 10.1007/s00280-019-03813-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/08/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE The therapeutic outcomes of stage III gastric cancer patient receiving D2 gastrectomy and adjuvant chemotherapy remain unsatisfactory. To improve the long-term outcomes in this population, the combination of docetaxel and S-1 (DS) therapy can be expected to be a useful regimen as neoadjuvant chemotherapy (NAC). This study aimed to prospectively evaluate the efficacy of NAC-DS for clinical stage III gastric cancer. METHODS Between January 2010 and December 2013, 26 patients were enrolled. Patients with clinical stage III gastric cancer received two courses of docetaxel 40 mg/m2 on day 1, 15 and S-1 40 mg/m2 bid orally on day 1-7, 15-21 every 4 weeks, followed by radical D2 gastrectomy. Short- and long-term outcomes were evaluated. This study was approved by the ethics committee of Yokohama City University, and was registered in the University Hospital Medical Information Network (UMIN) database (ID: 000011521). RESULTS Of 26 patients, 24 (92.3%) patients completed two courses of NAC. After NAC-DS, Grade 3 neutropenia was observed in 5 (19.2%) patients including one patient with febrile neutropenia, anemia in 1 (3.8%) patient and diarrhea in 1 (3.8%) patient. All patients underwent R0 gastrectomy and pathological response was found in 15 (57.6%) patients. Postoperatively, Clavien-Dindo grade II complication occurred in 8 (30.7%) patients and no mortality was observed. The 5-year overall survival (OS) was 57.7%, median OS was 78.7 months and recurrence free survival (RFS) was 49.0%, median RFS was 45.4 months with 66.5 months median follow-up. Pathological response (HR = 0.091, 95% CI 0.011-0.730, p = 0.016) and > 5% body weight loss before NAC-DS (HR = 0.133, 95% CI 0.023-0.765, p = 0.024) were independent risk factors for recurrence, > 5% body weight loss before NAC-DS (HR = 0.133, 95% CI 0.023-0.765, p = 0.024) were independent risk factors for overall survival by multivariate analysis. CONCLUSIONS NAC-DS demonstrated acceptable toxicity with a high R0 resection rate in clinical stage III gastric cancer patients, especially in patients with good nutritional status. Further prospective study is warranted to compare the long-term outcomes between with and without NAC-DS.
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Affiliation(s)
- Takashi Kosaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiroshi Miyamoto
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Sho Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yusaku Tanaka
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kei Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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