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15 pages, 3561 KiB

Open AccessArticle

Prognostic Factors and the Role of Adjuvant Chemotherapy in Pathological Node-Negative T3 Gastric Cancer

by Yi-Fu Chen, Ming-Yang Chen, Puo-Hsien Le, Tsung-Hsing Chen, Chia-Jung Kuo, Shang-Yu Wang, Shih-Chiang Huang, Wen-Chi Chou, Ta-Sen Yeh and Jun-Te Hsu

J. Pers. Med. 2023, 13(3), 553; https://doi.org/10.3390/jpm13030553 - 20 Mar 2023

Cited by 3 | Viewed by 2036

Abstract

The role of adjuvant chemotherapy in pathological T3N0M0 (pT3N0M0) gastric cancer (GC) remains unclear. The aim of this study was to analyze the prognostic factors of patients with pT3N0M0 GC and to clarify which ones could benefit from adjuvant chemotherapy. A total of [...] Read more.

The role of adjuvant chemotherapy in pathological T3N0M0 (pT3N0M0) gastric cancer (GC) remains unclear. The aim of this study was to analyze the prognostic factors of patients with pT3N0M0 GC and to clarify which ones could benefit from adjuvant chemotherapy. A total of 137 patients with pT3N0M0 GC were recruited between 1994 and 2020. Clinicopathological factors and adjuvant chemotherapy regimens were retrospectively collected. Prognostic factors of disease-free survival (DFS) and cancer-specific survival (CSS) were determined using univariate and multivariate analyses. The chemotherapy group was younger (p = 0.012), had had more lymph nodes retrieved (p = 0.042) and had higher percentages of vascular invasion (p = 0.021) or perineural invasion (p = 0.030) than the non-chemotherapy group. There were no significant differences in DFS (p = 0.222) and CSS (p = 0.126) between patients treated with or without adjuvant chemotherapy. Stump cancer, tumor size and perineural invasion were associated with higher rates of recurrence. Tumor size was an independent prognostic factor for DFS (hazard ratio, 4.55; confidence interval, 1.59–12.99; p = 0.005) and CSS (hazard ratio, 3.97; confidence interval, 1.38–11.43; p = 0.011). Tumor size independently influenced survival outcomes in pT3N0M0 patients who underwent radical surgery with and without adjuvant chemotherapy. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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12 pages, 1571 KiB

Open AccessArticle

Prognostic Nomogram Combining Preoperative Neutrophil to Lymphocyte Ratio and Clinicopathologic Features for Gastric Cancer Patients after Distal Radical Gastrectomy: Based on Propensity Score Matching

by Yi Liu, Chuandong Wang, Huan Wang, Changshun Yang, Xuefei Cheng and Weihua Li

J. Pers. Med. 2023, 13(1), 86; https://doi.org/10.3390/jpm13010086 - 29 Dec 2022

Cited by 2 | Viewed by 1618

Abstract

Background: Preoperative inflammatory status has been widely used in assessing the prognosis of malignant tumor. This study aimed to establish a novel nomogram combining preoperative inflammatory factors and clinicopathologic features to predict the prognosis of gastric cancer (GC) patients after distal radical gastrectomy. [...] Read more.

Background: Preoperative inflammatory status has been widely used in assessing the prognosis of malignant tumor. This study aimed to establish a novel nomogram combining preoperative inflammatory factors and clinicopathologic features to predict the prognosis of gastric cancer (GC) patients after distal radical gastrectomy. Methods: A total of 522 GC patients from Fujian Provincial Hospital were retrospectively reviewed. Propensity score matching was performed and Cox regression models were used to analyze the clinical and pathological factors to determine their impact on survival. A prognostic nomogram was established and validated based on these factors. Results: The multivariate analysis indicated that tumor stage, pathological type, and neutrophil to lymphocyte ratio (NLR) were independent risk factors for the prognosis of GC patients. The nomogram was established based on these factors. In the primary cohort, the concordance index (C-index) of the nomogram was 0.753 (95% CI 0.647–0.840), which was higher than that of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) stage. The calibration curve showed the actual overall survival (OS) probabilities were in good keeping with those predicted by the nomogram. Furthermore, we divided the patients into two distinct risk groups for OS according to the nomogram points: low and high risk. The OS rates were significantly different among the subgroups (p ˂ 0.001). Conclusions: We proposed a novel nomogram combining preoperative NLR and clinicopathologic features that is economical, routinely available, and highly predictive of OS in GC patients after distal radical gastrectomy. Compared with the current AJCC TNM staging, this model was more accurate in prognostic prediction. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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9 pages, 768 KiB

Open AccessArticle

Influence of Obesity and Fluid Balance on Operative Outcomes in Hepatic Resection

by Suk-Won Suh

J. Pers. Med. 2022, 12(11), 1897; https://doi.org/10.3390/jpm12111897 - 13 Nov 2022

Cited by 1 | Viewed by 1240

Abstract

As the number of obese patients requiring hepatic resection is increasing, efforts to understand their operative risk and determine proper perioperative management are necessary. A total of 175 patients who underwent hepatic resection between March 2015 and July 2021 were evaluated. The patients [...] Read more.

As the number of obese patients requiring hepatic resection is increasing, efforts to understand their operative risk and determine proper perioperative management are necessary. A total of 175 patients who underwent hepatic resection between March 2015 and July 2021 were evaluated. The patients were divided into two groups by their body mass index (BMI) using the World Health Organization definition of obesity for Asians: obese patients (BMI ≥ 25 kg/m², n = 84) and non-obese patients (BMI < 25 kg/m², n = 91). The operative duration (195.7 ± 62.9 min vs. 176.0 ± 53.6 min, p = 0.027) was longer and related to a higher estimated blood loss (EBL) ≥ 500 mL (61.9% vs. 40.7%, p = 0.005) in the obese patients than in the non-obese patients. Obesity (odds ratio (OR), 2.204; 95% confidence interval (CI), 1.177–4.129; p = 0.014) and central venous pressure (CVP) ≥ 5 (OR, 2.733; 95% CI, 1.445–5.170; p = 0.002) at the start of the surgery were significant risk factors for EBL ≥ 500 mL. Obese patients with low CVP showed significantly lower EBL than those with high CVP, but a similar EBL to non-obese patients (p = 0.003). In conclusion, fluid restriction before hepatic resection would be important, especially in obese patients, to improve their operative outcomes. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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11 pages, 2231 KiB

Open AccessArticle

Clinical Utility of Circulating Tumor Cells for Predicting Major Histopathological Response after Neoadjuvant Chemoradiotherapy in Patients with Esophageal Cancer

by Xing Gao, Osbert Qi-Yao Leow, Chien-Hung Chiu, Ming-Mo Hou, Jason Chia-Hsun Hsieh and Yin-Kai Chao

J. Pers. Med. 2022, 12(9), 1440; https://doi.org/10.3390/jpm12091440 - 31 Aug 2022

Cited by 4 | Viewed by 1592

Abstract

Background: A “surgery as needed” approach may be offered to patients with esophageal cancer (EC) who achieve major histopathological response (MaHR) after neoadjuvant chemoradiotherapy (nCRT). However, the utility of clinical response assessment (CRE) for predicting histopathological response to nCRT remains limited. Circulating tumor [...] Read more.

Background: A “surgery as needed” approach may be offered to patients with esophageal cancer (EC) who achieve major histopathological response (MaHR) after neoadjuvant chemoradiotherapy (nCRT). However, the utility of clinical response assessment (CRE) for predicting histopathological response to nCRT remains limited. Circulating tumor cells (CTCs) hold promise as biomarkers of response to nCRT. Methods: We analyzed the clinical utility of post-nCRT CTCs, alone or in combination with CRE, in the prediction of MaHR. We defined MaHR as either the lack or a limited presence (≤10%) of vital residual tumor cells in the resected esophageal specimen in the absence of nodal involvement. Results: Of the 48 study patients, 27 (56%) achieved MaHR. Patients with MaHR had a significantly lower CTCs count compared with those without (3.61 ± 4.53 versus 6.83 ± 5.22 per mL of blood, respectively; P = 0.027). Using a cutoff for positivity of 5 CTCs per mL of blood, the combination of CTCs and CRE allowed achieving a negative predictive value for MaHR of 93% (95% confidence interval [CI] = 70–99%) along with a false negative rate of 5% (95% CI = 1–33%). Conclusion: CTCs count assessed in combination with CRE can potentially help identify patients with EC who achieved MaHR after nCRT. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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12 pages, 1731 KiB

Open AccessArticle

Prognostic Significance of Perineural Invasion in Patients with Stage II/III Gastric Cancer Undergoing Radical Surgery

by Yi-Fu Chen, Shan-Yu Wang, Puo-Hsien Le, Tsung-Hsing Chen, Chia-Jung Kuo, Chun-Jung Lin, Wen-Chi Chou, Ta-Sen Yeh and Jun-Te Hsu

J. Pers. Med. 2022, 12(6), 962; https://doi.org/10.3390/jpm12060962 - 12 Jun 2022

Cited by 14 | Viewed by 2253

Abstract

The prognostic significance of perineural invasion in patients with gastric cancer (GC) is controversial. This study aimed to determine the prognostic value of perineural invasion in patients with stage II/III GC undergoing radical surgery. A total of 1913 patients with stage II/III GC [...] Read more.

The prognostic significance of perineural invasion in patients with gastric cancer (GC) is controversial. This study aimed to determine the prognostic value of perineural invasion in patients with stage II/III GC undergoing radical surgery. A total of 1913 patients with stage II/III GC who underwent curative resection between 1994 and 2015 were recruited. Clinicopathological factors, tumor recurrence patterns, disease-free survival, and cancer-specific survival were compared in terms of perineural invasion. The prognostic factors of disease-free survival and cancer-specific survival were determined using univariate and multivariate analyses. Perineural invasion was found in 57.1% of the patients. Age of <65 years, female sex, large tumor size, upper tumor location, total gastrectomy, advanced tumor invasion depth and nodal involvement, greater metastatic to examined lymph node ratio, undifferentiated tumor, and presence of lymphatic or vascular invasion were significantly associated with perineural invasion. The patients with perineural invasion had higher locoregional/peritoneal recurrence rates than those without. Perineural invasion was independently associated with disease-free survival and cancer-specific survival. In conclusion, perineural invasion positivity is associated with aggressive tumor behaviors and higher locoregional/peritoneal recurrence rates in patients with stage II/III GC undergoing curative surgery. It is an independent unfavorable prognostic factor of disease recurrence and cancer-specific survival. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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11 pages, 1231 KiB

Open AccessArticle

Preferred Treatment with Curative Intent for Left Lateral Segment Early Hepatocellular Carcinoma under the Era of Minimal Invasive Surgery

by Tsung-Han Wu, Yu-Chao Wang, Hao-Chien Hung, Jin-Chiao Lee, Chia-Ying Wu, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan and Wei-Chen Lee

J. Pers. Med. 2022, 12(1), 79; https://doi.org/10.3390/jpm12010079 - 9 Jan 2022

Cited by 20 | Viewed by 1911

Abstract

Background: Hepatocellular carcinoma (HCC) occurring at the left lateral segment (LLS) is relatively susceptible to treatment with curative intent in terms of tumor location. However, outcomes might vary depending on the selection of treatment modalities. This study aimed to analyze patients who had [...] Read more.

Background: Hepatocellular carcinoma (HCC) occurring at the left lateral segment (LLS) is relatively susceptible to treatment with curative intent in terms of tumor location. However, outcomes might vary depending on the selection of treatment modalities. This study aimed to analyze patients who had undergone curative treatment for early HCC at LLS. Methods: A retrospective analysis of 179 patients who underwent curative treatment for early HCC at LLS was performed. Patients were grouped based on treatment modalities, including radiofrequency ablation (RFA) and liver resection (LR). The long-term outcomes of the two groups were compared. Additionally, the impact of the LR approach on patient outcomes was analyzed. Results: Among these patients, 60 received RFA and 119 underwent LR as primary treatment with curative intent. During follow-up, a significantly higher incidence of HCC recurrence was observed in the RFA group (37/60, 61.7%) than in the LR group (45/119, 37.8%) (p = 0.0025). The median time of HCC recurrence was 10.8 (range: 1.1–60.9 months) and 17.6 (range: 2.4–94.8 months) months in the RFA and LR groups, respectively. In addition, multivariate analysis showed that liver cirrhosis, multiple tumors, and RFA treatment were significant risk factors for HCC recurrence. The 1-, 2-, and 5-year overall survival rates in the RFA and LR groups were 96.4%, 92.2%, and 71.5% versus 97.3%, 93.6%, and 87.7%, respectively. (p = 0.047). Moreover, outcomes related to LR were comparable between laparoscopic and conventional open methods. The 1-, 2-, and 5-year recurrence free survival rates in the laparoscopic (n = 37) and conventional open (n = 82) LR groups were 94.1%, 82.0%, and 66.9% versus 86.1%, 74.6%, and 53.1%, respectively. (p = 0.506) Conclusion: Early HCC at LLS had satisfactory outcomes after curative treatment, in which LR seems to have a superior outcome, as compared to RFA treatment. Moreover, laparoscopic LR could be considered a preferential option in the era of minimally invasive surgery. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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9 pages, 1004 KiB

Open AccessArticle

Does Neutrophil to Lymphocyte Ratio Have a Role in Identifying Cytokeratin 19-Expressing Hepatocellular Carcinoma?

by Chao-Wei Lee, Sey-En Lin, Ming-Chin Yu, Hao-Wei Kou, Cheng-Han Lee, Tony Kuo, Kuan-Chieh Lee and Hsin-I Tsai

J. Pers. Med. 2021, 11(11), 1078; https://doi.org/10.3390/jpm11111078 - 24 Oct 2021

Cited by 4 | Viewed by 2024

Abstract

Background: Cytokeratin 19-positive (CK19(+)) hepatocellular carcinomas (HCC) are generally associated with poor prognosis after hepatectomy. It is typically detected from postoperative immunochemistry. We have analyzed several clinically available biomarkers, in particular, neutrophil to lymphocyte ratio (NLR) and aim to develop a panel of [...] Read more.

Background: Cytokeratin 19-positive (CK19(+)) hepatocellular carcinomas (HCC) are generally associated with poor prognosis after hepatectomy. It is typically detected from postoperative immunochemistry. We have analyzed several clinically available biomarkers, in particular, neutrophil to lymphocyte ratio (NLR) and aim to develop a panel of biomarkers in identifying CK19 expression in (HCC) preoperatively. Methods: We retrospectively reviewed 36 HCC patients who underwent liver resections during January 2017 to March 2018 in Chang Gung Memorial Hospital. Patients were grouped based on the status of CK19 expression and their baseline characteristics, perioperative and oncologic outcomes were compared. Novel biomarkers including NLR, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and uric acid were analyzed and correlated with CK19 expression. Results: NLR is highly associated with CK19 expression. NLR alone gave an AUROC of 0.728 (p-value = 0.043), higher than AFP, CEA or tumor size alone. NLR when combined with AFP, CEA and uric acid, gave an AUROC as high as 0.933 (p-value = 0.004). Conclusion: The current study demonstrated the predictive capability of NLR in combination with AFP, CEA and uric acid for CK19 expression in HCC patients preoperatively. Further prospective, large-scale studies are warranted to validate our findings. Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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3 pages, 188 KiB

Open AccessComment

Some Concerns from a Radiological Point of View. Comment on Huang et al. Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone. J. Pers. Med. 2022, 12, 555

by Maria Antonietta Mazzei, Giulio Bagnacci, Armando Perrella, Nunzia Di Meglio, Stefania Angela Piccioni, Francesco Bloise, Daniele Marrelli, Carlo Milandri and Gianni Mura

J. Pers. Med. 2022, 12(7), 1061; https://doi.org/10.3390/jpm12071061 - 29 Jun 2022

Cited by 1 | Viewed by 1163

Abstract

We read, with great interest, the article by Huang Ruo-Yi and colleagues entitled “Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery Plus Palliative Chemotherapy or In-Front Surgery Alone”, published on 1 April 2022 [...] Full article

(This article belongs to the Special Issue Upper Digestive Surgical Oncology)

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