Proximal Gastric Resection with Posterior Esophago-Gastrostomy and Partial Neo-Fundoplication in the Treatment of Advanced Upper Gastric Carcinoma.

BACKGROUND: Proximal gastric resection (PGR) is rarely used in western countries because of frequent postoperative reflux and uncommon diagnosis of early gastric cancer (GC). OBJECTIVES: We hypothesized that the PGR with an anti-reflux procedure may be an attractive option even in advanced proximal GC after downstaging with the neo-adjuvant chemotherapy. METHOD: A novel technique of end-to-side esophago-gastrostomy with the posterior wall of the gastric stump and partial neo-fundoplication to prevent reflux symptoms has been introduced. An observational retrospective study was undertaken to evaluate early and late outcomes of the innovative technique in patients with advanced proximal GC after neoadjuvant chemotherapy. RESULTS: Twenty consecutive patients with the diagnosis of loco-regionally advanced GC, localized in the subcardiac region or proximal upper third of the stomach, were selected for the study. Eleven (55%) patients completed preoperative neo-adjuvant chemotherapy. The mean postoperative hospitalization time was 13.3 (± 8.3) days. There was one postoperative in-hospital death due to acute circulatory insufficiency. The mean comprehensive complication index was 11.94 (±24.82). Two patients were diagnosed with a complete pathological response (ypT0N0). Median survival was 41.8 (95% CI 27.9-41.8) months. The 5-year survival rate was 42%. At a median follow-up of 26 months, reflux symptoms were present in 7 (35%) patients who had to use antireflux medication. Anastomotic stenosis was observed in 1 patient during the follow-up. Mean scores of reflux symptoms on medication were not significantly different to those in patients without medication. The Overall Satisfaction Score for patients on medication was 7.57 ± 1.92, whereas it was 8.83 ± 1.34 (p = 0.2; Student t test) for those with no medication. CONCLUSIONS: Proximal gastrectomy is feasible and may be safely used in patients with advanced GC after neo-adjuvant chemotherapy with acceptable survival. Posterior esophago-gastrostomy with partial neo-fundoplication reduces the postoperative reflux, while patients with persistent reflux symptoms can be effectively treated with an antireflux therapy.

Decline of serum CA724 as a probable predictive factor for tumor response during chemotherapy of advanced gastric carcinoma.

OBJECTIVE: To evaluate the predictive value of decline in the serum level of carbohydrate antigen 724 (CA724) on tumor response during the chemotherapy in patients with advanced gastric carcinoma (GC). METHODS: The serum CA724 level was determined by electrochemiluminescence immunoassay, while the objective response rate (ORR) was assessed according to response evaluation criteria in solid tumors (RECIST). The association of the changes of serum concentration of CA724 with ORR was analyzed. RESULTS: The ORR in CA724 (pretreatment serum level) high and low groups was 32.3% (20/62) and 52.8% (19/36), respectively (P=0.045). The relationship between the reduction of CA724 and the ORR was statistically significant (P=0.044). Receiver operating characteristic (ROC) curve established the best cutoff value of the decrease ratio of CA724 as 20.5%. CONCLUSIONS: CA724 decline seems to indicate chemotherapy efficacy in patients with advanced GC, and an average drop of 20.5% in serum CA724 appears to predict the sensitivity to chemotherapy.

Effect of cetuximab plus FOLFOX4 regimen on clinical outcomes in advanced gastric carcinoma patients receiving evidence-based care.

BACKGROUND: Although chemotherapy is effective for treating advanced gastric carcinoma (aGC), it may lead to an adverse prognosis. Establishing a highly effective and low-toxicity chemotherapy regimen is necessary for improving efficacy and outcomes in aGC patients. AIM: To determine the efficacy and safety of cetuximab (CET) combined with the FOLFOX4 regimen (infusional fluorouracil, folinic acid, and oxaliplatin) as first-line therapy for patients with aGC, who received evidence-based care (EBC). METHODS: A total of 117 aGC patients who received EBC from March 2019 to March 2022 were enrolled. Of these, 60 in the research group (RG) received CET + FOLFOX4 as first-line therapy, whereas 57 in the control group (CG) received FOLFOX4. The efficacy [clinical response rate (RR) and disease control rate (DCR)], safety (liver and kidney dysfunction, leukopenia, thrombocytopenia, rash, and diarrhea), serum tumor marker expression [STMs; carbohydrate antigen (CA) 19-9, CA72-4, and carcinoembryonic antigen (CEA)], inflammatory indicators [interleukin (IL)-2 and IL-10], and quality of life (QOL) of the two groups were compared. RESULTS: A markedly higher RR and DCR were observed in the RG compared with the CG, with an equivalent safety profile between the two groups. RG exhibited notably reduced CA19-9, CA72-4, CEA, and IL-2 levels following treatment, which were lower than the pre-treatment levels and those in the CG. Post-treatment IL-10 was statistically increased in RG, higher than the pre-treatment level and the CG. Moreover, a significantly improved QOL was evident in the RG. CONCLUSION: The CET + FOLFOX4 regimen is highly effective as first-line treatment for aGC patients receiving EBC. It facilitates the suppression of STMs, ameliorates the serum inflammatory microenvironment, and enhances QOL, without increased adverse drug effects.

Machine learning models based on quantitative dynamic contrast-enhanced MRI parameters assess the expression levels of CD3+, CD4+, and CD8+ tumor-infiltrating lymphocytes in advanced gastric carcinoma.

Objective: To explore the effectiveness of machine learning classifiers based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the expression levels of CD3+, CD4+, and CD8+ tumor-infiltrating lymphocytes (TILs) in patients with advanced gastric cancer (AGC). Methods: This study investigated 103 patients with confirmed AGC through DCE-MRI and immunohistochemical staining. Immunohistochemical staining was used to evaluate CD3+, CD4+, and CD8+ T-cell expression. Utilizing Omni Kinetics software, radiomics features (Ktrans, Kep, and Ve) were extracted and underwent selection via variance threshold, SelectKBest, and LASSO methods. Logistic regression (LR), support vector machine (SVM), random forest (RF), and eXtreme Gradient Boosting (XGBoost) are the four classifiers used to build four machine learning (ML) models, and their performance was evaluated using 10-fold cross-validation. The model's performance was evaluated and compared using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: In terms of CD3+, CD4+, and CD8+ T lymphocyte prediction models, the random forest model outperformed the other classifier models in terms of CD4+ and CD8+ T cell prediction, with AUCs of 0.913 and 0.970 on the training set and 0.904 and 0.908 on the validation set, respectively. In terms of CD3+ T cell prediction, the logistic regression model fared the best, with AUCs on the training and validation sets of 0.872 and 0.817, respectively. Conclusion: Machine learning classifiers based on DCE-MRI have the potential to accurately predict CD3+, CD4+, and CD8+ tumor-infiltrating lymphocyte expression levels in patients with AGC.

Apatinib plus chemotherapy versus chemotherapy alone as neoadjuvant therapy in locally advanced gastric carcinoma patients: a prospective, cohort study.

BACKGROUND: Apatinib, a small molecule targeting VEGFR2, is commonly used for advanced gastric cancer treatment. This prospective cohort study further investigated the efficacy and safety of neoadjuvant apatinib plus chemotherapy in locally advanced gastric carcinoma patients. METHODS: Ninety-six locally advanced gastric carcinoma patients were divided into the apatinib plus chemotherapy group (N = 45) and chemotherapy group (N = 51) according to their chosen treatment. Apatinib was administered (375 mg/day), and S-1 plus oxaliplatin (SOX) or oxaliplatin plus capecitabine (CapOx) was given as chemotherapy, for 3 cycles with 3 weeks a cycle before surgery. RESULTS: The objective response rate (62.2% vs. 37.3%, P = 0.015) and pathological response grade (P = 0.011) were better; meanwhile, the tumor-resection rate (95.6% vs. 84.3%, P = 0.143) and pathological complete response rate (23.3% vs. 9.3%, P = 0.080) exhibited increasing trends (without statistical significance) in the apatinib plus chemotherapy group compared with the chemotherapy group. Additionally, the apatinib plus chemotherapy group achieved prolonged disease-free survival (DFS) (P = 0.019) and overall survival (OS) (P = 0.047) compared with the chemotherapy group. After adjusted by multivariate Cox's regression analysis, neoadjuvant apatinib plus chemotherapy was still superior to chemotherapy regarding DFS (hazard ratio (HR): 0.277, P = 0.014) and OS (HR: 0.316, P = 0.038). Notably, the incidences of adverse events between the two groups were not different (P > 0.050). Moreover, the most common adverse events of neoadjuvant apatinib plus chemotherapy were leukopenia (42.2%), fatigue (37.8%), hypertension (37.8%), and anemia (31.1%). CONCLUSION: Neoadjuvant apatinib plus chemotherapy realizes better clinical response, pathological response, survival profile, and non-inferior safety profile compared to chemotherapy in locally advanced gastric carcinoma.

Corrigendum: A Recombinant Human Adenovirus Type 5 (H101) Combined With Chemotherapy for Advanced Gastric Carcinoma: A Retrospective Cohort Study.

[This corrects the article DOI: 10.3389/fonc.2021.752504.].

Neoadjuvant apatinib plus tegafur/gimeracil/oteracil potassium (S­1)/oxaliplatin chemotherapy vs. chemotherapy alone in patients with locally advanced gastric carcinoma.

The current study aimed to evaluate the efficacy and safety of neoadjuvant apatinib plus tegafur/gimeracil/oteracil potassium (S-1) plus oxaliplatin (SOX) chemotherapy in patients with locally advanced gastric carcinoma (LAGC). Therefore, patients with LAGC treated with neoadjuvant apatinib plus SOX chemotherapy (apatinib + SOX group; n=25) or SOX chemotherapy (SOX group; n=35) were enrolled in the present study. Subsequently, the objective response (ORR) and disease control rates (DCR), pathological response, disease-free survival (DFS), overall survival (OS) and adverse events were recorded. The results showed that patients in the apatinib + SOX group exhibited a higher ORR (64.0 vs. 37.1%; P=0.040), but a similar DCR (96.0 vs. 88.6%; P=0.580), compared with those in the SOX group. The pathological response rates in patients with grade 0, 1, 2 and 3 LAGC were 0.0, 20.8, 62.5 and 16.7%, respectively, in the apatinib + SOX group, while in those treated with SOX alone they were 9.1, 39.4, 42.4 and 9.1%, respectively. By contrast, the pathological response was elevated in the apatinib + SOX group compared with the SOX group (P=0.030). During a median follow-up period of 21.0 months (range, 6.4-38.1 months), median DFS and OS were not reached. More specifically, the 1-, 2- and 3-year DFS rates were 91.7, 75.2 and 75.2% in the apatinib + SOX group and 71.8, 59.6 and 44.7% in the SOX group, respectively. In addition, the 1-, 2- and 3-year OS rates were 100.0, 89.6 and 78.4% in the apatinib + SOX group, while those in the SOX group were 90.3, 69.2 and 55.4%, respectively. However, no differences in DFS (P=0.094) or OS (P=0.155) were observed between the two groups. Additionally, the most common adverse events in the SOX group were mild leukopenia (42.9%) and fatigue (34.3%), while those in the apatinib + SOX group were tolerable leukopenia (44.0%) and hypertension (44.0%). In conclusion, the present study suggested that neoadjuvant apatinib plus SOX chemotherapy could be more effective and tolerable compared with SOX chemotherapy alone in patients with LAGC.

Comparison of PD-L1 immunohistochemical assays in advanced gastric adenocarcinomas using endoscopic biopsy and paired resected specimens.

Immunohistochemical (IHC) assays for programmed death ligand 1 (PD-L1) expression are crucial for guiding immune checkpoint inhibitor therapies in advanced gastric adenocarcinoma (AGC). The results from clinical trials of various PD-L1 antibody clones are variable and the exchangeability of these assays is a highly sought goal. The aim of this study was to determine whether three different PD-L1 assays (SP263 and 22C3 on the Dako and Ventana platforms) are interchangeable through analysis of their concordance rate within samples between biopsy and paired resected specimens. One hundred pairs of biopsied and resected AGC specimens were collected and stained for PD-L1. The combined positive score (CPS) was used for the IHC analysis and a four tiered system was applied, i.e., <1, 1 to < 5, 5 to 50, and >50. The agreement for the different IHC assays was low across all cut-offs with the biopsied or resected specimens (biopsy, κ=0.17-0.453; resection, κ=0.02-0.311). The overall positive agreement (OPA) for the PD-L1 results from the biopsy and resection tissues was 100% (SP263, κ=1), 86% (22C3 on the Dako platform, κ=0.693) and 93% (22C3 on the Ventana platform, κ=0.82) at the CPS1 cut-off. The low concordances among the three PD-L1 IHC assays indicated that they cannot be used interchangeably in clinical practice. The results of the SP263 assay using CPS1 showed the highest agreement between the biopsy and resection specimens, suggesting SP263 may provide the most representative approach for the evaluation of PD-L1 status in gastric cancer.

A Recombinant Human Adenovirus Type 5 (H101) Combined With Chemotherapy for Advanced Gastric Carcinoma: A Retrospective Cohort Study.

BACKGROUND: This retrospective cohort study aimed to evaluate the clinical outcomes of H101 combined with chemotherapy for advanced gastric carcinoma (GC) patients. METHODS: The advanced GC patients, who were treated with H101 and/or chemotherapy, were enrolled and divided into three groups according to treatment method. The clinical characteristics of patients, clinical short-term and long-term outcomes, followed up, and complication were analyzed. RESULTS: A total of 95 patients (30 patients in group A were treated with H101, 33 in group B patients were treated with chemotherapy, 32 patients in group C were treated with H101 combined with chemotherapy) were retrospectively reviewed. The disease control rate (DCR) and overall response rate (ORR) were significantly greater in group C (81.3% and 50.0%) than in groups A (63.3% and 30.0%) and B (66.7% and 33.3%, all p < 0.05). The 1- and 2-year survival rates and progression-free survival were significantly greater in group C than in groups A and B (all p < 0.05). There was no significant difference in complication among the three groups. At dose levels of 0.5 × 1012 vp/day, 1.0 × 1012 vp/day, and 1.5 × 1012 vp/day, complications were not increased as increased of dose. CONCLUSIONS: H101 combined with chemotherapy may be a potential therapeutic option for patients with advanced GC, and prospective studies with proper assessment of toxicity will be needed in the future.

[Efficacy and Safety of FOLFIRI after Failure of FOLFOX-4 in Advanced Gastric Cancer].

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of irinotecan based FOLFIRI chemotherapy as a second-line treatment after failure of FOLFOX-4 chemotherapy in patients with advanced gastric cancer. METHODS: Fifty-two patients who were pathologically diagnosed with unresectable gastric cancer and received FOLFIRI chemotherapy after failure of FOLFOX-4 chemotherapy between September 2005 and February 2012 were enrolled in this study. Data were collected by retrospectively reviewing the medical records. The response to chemotherapy was assessed every 3 cycles by World Health Organization criteria and long term survival was analyzed. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institution (NCI) toxicity criteria version 3.0. RESULTS: Median age of the patients was 57 years. Median overall survival (OS) and time to progression (TTP) were 7.8 and 5 months, respectively. The number of patients showing complete remission, partial remission, stable disease, and progressive disease were 0 (0.0%), 9 (17.3%), 30 (57.7%), and 13 (25.0%), respectively. The overall response rate was 17.3%. During a total of 345 cycles, anemia worse than NCI toxicity grade 3 occurred in 2.9%, leukopenia in 20.3%, neutropenia in 12.2%, and thrombocytopenia in 1.5%. Patients with less organ involvement by metastasis, less than 34 U/mL of CA 19-9 and good responsiveness to third cycle of second line chemotherapy were associated with longer OS and TTP. CONCLUSIONS: FOLFIRI chemotherapy has a modest efficacy with acceptable toxicities in patients with advanced gastric cancer as a second-line treatment. Further well-controlled studies are needed to elucidate the efficacy of FOLFIRI chemotherapy as second-line treatment in patients with advanced stomach cancer.

(18)F-FDG PET/CT of advanced gastric carcinoma and association of HER2 expression with standardized uptake value.

OBJECTIVES: Expression of HER2 in gastric carcinoma has direct prognostic and therapeutic implications in patient management. The aim of this study is to determine whether a relationship exists between standardized uptake value (SUV) and expression of HER2 in advanced gastric carcinoma. METHODS: We analyzed the (18)F-FDG PET/CT results of 109 patients that underwent gastrectomy for advanced gastric carcinoma. The (18)F-FDG PET/CT imaging was requested at the initial staging before surgery. The examinations were evaluated semi-quantitatively, with calculation of maximum standardized uptake values (SUVmax). The clinicopathologic factors, including HER2 overexpression, were determined from tissue obtained from the primary tumor. Metabolic and clincopathologic parameters were correlated using a t-test, one way ANOVA and chi-square test. RESULTS: Immunohistochemically, 26 patients (23.8%) showed HER2 overexpression. This overexpression was significantly associated with high SUV level (P=0.02). The SUV level was significantly correlated with tumor size (P=0.02) and differentiation (P<0.001), and Lauren histologic type (P=0.04). Multivariate analysis showed HER2 overexpression, large tumor size, and differentiation (P=0.022, P=0.002, P<0.001) were significantly correlated with the high level of SUV in advanced gastric carcinoma. No association was found between SUV and T stage and lymph node metastasis. A receiver-operating characteristic curve demonstrated a SUVmax of 3.5 to be the optimal cutoff for predicting HER2 overexpression (sensitivity; 76.9%, specificity; 60.2%). CONCLUSION: An association exists between high SUV and HER2 overexpression and (18)F-FDG PET/CT could be a useful tool to predict the biological characteristics of gastric carcinoma.

Analysis of the Efficacy of Neoadjuvant Chemotherapy in Advanced Gastric Carcinoma Patients before Laparoscopic Minimally Invasive Resection / 中国药房

OBJECTIVE:To observe the efficacy and safety of neoadjuvant chemotherapy in advanced gastric carcinoma patients before laparoscopic minimally invasive resction.METHODS:In retrospective analysis,93 patients with advanced gastric carcinoma were divided into single group (55 cases) and combined group (38 cases).Single group received laparoscopic minimally invasive operation.Combination group was given Tetrahydrofolate injection 400 mg/m2+Oxaliplatin injection 85 mg/m2,i.v.,2 h,d1+ Fluorouracil injection 2 400 mg/m2,i.v.,46 h,d2.A treatment course lasted for 2 weeks,both received 2-4 courses of treatment and 4 weeks later received laparoscopic minimally invasive resection.Both groups received routine treatment as parenteral nutrition and preventive anti-inflammation.They were given oxaliplatin+capecitabine or gimeracil oteracil potassium capsule+oxaliplatin chemotherapy for 6 courses.Clinical efficacies and ADR of combination group were observed.Operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,complete resection and postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay and complications were observed in 2 groups.RESULTS:The objective remission rate and disease control rate of combination group were 44.8％ and 92.2％;there were 23 case time of grade Ⅰ ADR,13 case time of grade Ⅱ ADR and 3 case time of grade Ⅲ ADR.Complete resection rate of combination group was significantly higher than that of single group,with statistical significance (P＜0.05).There was no statistical significance in operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay or the incidence of complications between 2 groups (P＞0.05).CONCLUSIONS:For advanced gastric carcinoma patients before laparosapic minimally invasive resection,tetrahydrofolate,oxaliplatin and fluorouracil neoadjuvant chemotherapy show therapeutic efficacy and can improve the rate of complete resection without increasing the incidence of ADR.

Analysis of the Efficacy of Neoadjuvant Chemotherapy in Advanced Gastric Carcinoma Patients before Laparoscopic Minimally Invasive Resection / 中国药房

OBJECTIVE:To observe the efficacy and safety of neoadjuvant chemotherapy in advanced gastric carcinoma patients before laparoscopic minimally invasive resction.METHODS:In retrospective analysis,93 patients with advanced gastric carcinoma were divided into single group (55 cases) and combined group (38 cases).Single group received laparoscopic minimally invasive operation.Combination group was given Tetrahydrofolate injection 400 mg/m2+Oxaliplatin injection 85 mg/m2,i.v.,2 h,d1+ Fluorouracil injection 2 400 mg/m2,i.v.,46 h,d2.A treatment course lasted for 2 weeks,both received 2-4 courses of treatment and 4 weeks later received laparoscopic minimally invasive resection.Both groups received routine treatment as parenteral nutrition and preventive anti-inflammation.They were given oxaliplatin+capecitabine or gimeracil oteracil potassium capsule+oxaliplatin chemotherapy for 6 courses.Clinical efficacies and ADR of combination group were observed.Operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,complete resection and postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay and complications were observed in 2 groups.RESULTS:The objective remission rate and disease control rate of combination group were 44.8％ and 92.2％;there were 23 case time of grade Ⅰ ADR,13 case time of grade Ⅱ ADR and 3 case time of grade Ⅲ ADR.Complete resection rate of combination group was significantly higher than that of single group,with statistical significance (P＜0.05).There was no statistical significance in operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay or the incidence of complications between 2 groups (P＞0.05).CONCLUSIONS:For advanced gastric carcinoma patients before laparosapic minimally invasive resection,tetrahydrofolate,oxaliplatin and fluorouracil neoadjuvant chemotherapy show therapeutic efficacy and can improve the rate of complete resection without increasing the incidence of ADR.

The comparison of clinical efficacy of SOX and XELOX in the neoadjuvant chemotherapy for advanced gastric carcinoma / 实用肿瘤学杂志

Objective To investigate the clinical efficacy of SOX and XELOX in neoadjuvant chemo-therapy for advanced gastric carcinoma .Methods Seventy-five cases with advanced gastric carcinoma were se-lected from our hospital from Feb 1,2011 to Oct 1,2015.SOX and XELOX were used to these patients treatment . The relationship between SOX and XELOX with tumor stage ,clinical curative effect evaluation ,operation ,postop-erative pathology ,adverse reaction ,survival analysis with advanced gastric carcinoma had been analyzed retrospec -tively.Results The efficacy of SOX and XELOX were 47.22%,41.03%.Compared with the two groups ,the CT curative effect evaluation,effective rate,disease control rate had no significant differences (P>0.05).The median survival time of DFS and OS were significant between the two groups (P<0.05).Conclusion The SOX and XELOX for neoadjuvant chemotherapy of advanced gastric carcinoma treatment is safety and effective , and the XELOX is better than SOX in terms of long -term effect,prognosis and clinical benefits .

A pilot study evaluating the safety and toxicity of epirubicin, cisplatin, and UFT (ECU regimen) in advanced gastric carcinoma.

BACKGROUND: Best response rates have been achieved with three-drug regimens containing 5-FU in the treatment of advanced gastric cancer (AGC) and oral fluoropyrimidines are the best alternatives as substitutes for infusional 5-FU. This study aimed to evaluate the safety and toxicity of epirubicin, cisplatin, and UFT (ECU regimen) regimens in AGC outpatients. MATERIALS AND METHODS: Forty-one patients with AGC received epirubicin, cisplatin, and oral UFT plus leucovorin. Epirubicin 50 mg/m(2) and cisplatin 60mg/m(2) were administered on Day 1. Three hundreds (300) mg/m(2)/day UFT was administered with leucovorin at a fixed oral dose of 90 mg/day for 21 days, followed by a 7-day rest period. Cycles were repeated every 4 weeks. Performance status was either as 0 and 1. RESULTS: Among the 41 patients enrolled, complete and partial response was achieved in 7.3% and 36.6% of patients, respectively, with an overall response rate of 43.9%. Stable disease was observed in 34.1% of patients and 22% showed disease progression. Median time to progression was 5.2 months and median survival was 12.3 months. A median of 4 cycles (range: 1-6) of chemotherapy were administered. The main grade III-IV toxicities were nausea/vomiting (19.4%) and neutropenia (12.1%). Grade IV toxicities were gastric perforation and renal failure. CONCLUSION: ECU appears to be an effective regimen in the treatment of AGC, with acceptable tolerability and manageable toxicity. In three-drug regimens, substitution of infusional 5-FU by UFT offers the possibility of increased AGC outpatient compliance.

Meta-analysis of regimen SOX versus XELOX in treatment of Chinese patients with advanced gastric carcinoma / 中国生化药物杂志

Objective To compare clinical outcome and adverse reactions between the regimens SOX and XELOX for chemotherapy of advanced gastric carcinoma in Chinese population.Methods The original articles on randomized controlled trials ( RCTs) comparing the chemotherapy of SOX and XELOX in Chinese patients with advanced gastric carcinoma were recruited from the PUBMED, WANFANG, VIP and CNKI databases.The quality of the selected trials were assessed by JADAD method.Meta-analysis about the efficacy and safety of the two chemotherapy methods was performed by Rev Man 5.2.0 software ( Cochrane-information Management System) .Results Eight RCT studies were recruited in our work, including 293 patients in the SOX treatment group and 310 in the XELOX treatment group.The analysis results showed that there was no significant difference in the effect of the two chemotherapy methods (OR=1.19, 95%CI:0.86-1.64,P=0.29), and referred to the safety evaluation, the stomatitis (OR=2.29, 95%CI:1.74-4.89, P<0.0001) incidence in SOX treatment group was higher than XELOX treatment group, and in total, there was no significant difference in adverse reaction incidence of the two chemotherapy methods(OR =0.88, 95%CI: 0.66-1.19, P =0.41).Conclusion In the chemotherapy of advanced gastric carcinoma in Chinese population, there is no significant difference in clinical response rate between SOX and XELOX, and the stomatitis incidence of SOX is significantly higher than that of XELOX.

Experience of improving safety in radical operation for gastric cancer / 中国医师进修杂志

Objective To explorer the safety of D2 lymphadenectomy in open distal gastrectomy for distal gastric cancer with the surgical approach from bottom to top,from left to right and from surrounding to middle.Methods 100 advanced distal gastric cancer patients selected from General Surgery Department of Chang Hai Hospital from December 2012 to November 2013 were analyzed retrospectively.All the patients were performed D2 lymphadenectomy in open distal gastrectomy with surgical approach from bottom to top,from left to right and from surrounding to middle.The operation time,amount of bleeding,the number of lymph nodes,postoperative complications and follow-up observation were recorded.Ruselts All patients had successful operation.The operation time was 90 to 190 mins,the average (125.00 ± 21.43) mins;intraoperative blood was 90 to 400 ml,the average (178.00 ± 73.74) ml;number of lymph node dissection was 17 to 41,the average (26.00 ± 6.72).One patient suffered from abdominal hemorrhage,recoverd and discharged after conservative treatment.Conclusions Surgical approach from bottom to top,from left to right and from surrounding to middle can improve the safety of D2 lymphadenectomy for distal gastric cancer.

Efficacy and Safety of FOLFIRI after Failure of FOLFOX-4 in Advanced Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of irinotecan based FOLFIRI chemotherapy as a second-line treatment after failure of FOLFOX-4 chemotherapy in patients with advanced gastric cancer. METHODS: Fifty-two patients who were pathologically diagnosed with unresectable gastric cancer and received FOLFIRI chemotherapy after failure of FOLFOX-4 chemotherapy between September 2005 and February 2012 were enrolled in this study. Data were collected by retrospectively reviewing the medical records. The response to chemotherapy was assessed every 3 cycles by World Health Organization criteria and long term survival was analyzed. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institution (NCI) toxicity criteria version 3.0. RESULTS: Median age of the patients was 57 years. Median overall survival (OS) and time to progression (TTP) were 7.8 and 5 months, respectively. The number of patients showing complete remission, partial remission, stable disease, and progressive disease were 0 (0.0%), 9 (17.3%), 30 (57.7%), and 13 (25.0%), respectively. The overall response rate was 17.3%. During a total of 345 cycles, anemia worse than NCI toxicity grade 3 occurred in 2.9%, leukopenia in 20.3%, neutropenia in 12.2%, and thrombocytopenia in 1.5%. Patients with less organ involvement by metastasis, less than 34 U/mL of CA 19-9 and good responsiveness to third cycle of second line chemotherapy were associated with longer OS and TTP. CONCLUSIONS: FOLFIRI chemotherapy has a modest efficacy with acceptable toxicities in patients with advanced gastric cancer as a second-line treatment. Further well-controlled studies are needed to elucidate the efficacy of FOLFIRI chemotherapy as second-line treatment in patients with advanced stomach cancer.

Effects of FOLFOX neoadjuvant chemotherapy protocol on non-resectable advanced gastric Cancer / 国际外科学杂志

Objective To study the clinical efficacy and adverse reactions of the preoperative neo-adjuvant chemotherapy with oxaliplatin plus fluorouracil and calcium folinate (FOLFOX) in the treatment of advanced gastric carcinoma that was difficult to undergo radical operation. Methods We enrolled 16 patients with advanced gastric carcinomas that were unable to undergo radical operation admitted to our hospital from April 2008 to October 2009. The neo-adjuvant chemotherapy regimen was oxaliplatin 130 mg/m~2 for first one, fluorouracil 500 mg/m~2 and calcium folinate 200 mg/m~2 from first day to fifth day,and one treatment course was three weeks and the patients underwent two courses.The changes of the primary lesion and the adverse reactions of the patients were observed. Results Carcinomas of 13 patients were degraded after the treatment, of which, 11 patients underwent radical resections after 4-6 weeks after operation.There were two cases of complete remission (CR) , 10 cases of partial remission (PR), three cases of stable disease(SD) and one case of progress disease(PD) , and the total effective rate was 75.0% (12/16). Adverse reactions included bone marrow suppression, diarrhea, nausea and vomiting and paresthesia, which were relieved after appropriate symptomatic treatment. Conclusions Neoadjuvant chemotherapy with FOLFOX can improve the resection rate of the advanced gastric carcinoma that is unable to undergo radical resection, and the patients' tolerability to this regimen is favorable.Thus, the regimen is worthy of generalizing.

Diagnostic value of 18F-FDG PET/CT in the preoperative advanced gastric carcinoma comparing with multi-slice spiral computed tomography / 国际外科学杂志

Objective Evaluate the diagnostic value of PET/CT in the preoperative advanced gastric carcinoma comparing with mult;-slice spiral computed tomography. Methods Thirty-nine advanced gastric carcinoma patients taking PET/CT and abstract 40 advanced gastric carcinoma patients performing MSCT before operation,were done the TNM staging, and the Results were compared with the operation histopathology. Results For diagnosing primary lesions, regional lymph nodes, N3 lymph nodes ,PET/CT was accurate in 92.3% , 66.7% and 100.0%.Instead, MSCT was accurate in 82.0% , 50.0% and 62.5%. Conclusions (1) PET/CT and MSCT have high accuracy in diagnosing primary lesions and regional lymph nodes. But for detecting the N3 lymph nodes and distant metastasis, PET/CT has higher accuracy than MSCT. PET/CT combining abdominoscopy may decrease or avoid exploratory laparotomy.