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Background: Surgical resection of oligo-metastasis in gastric cancer (GC) is weakly recommended for patients without other incurable factors in the Japanese GC Treatment Guidelines. While post-operative chemotherapy is the standard treatment in patients with stage II or III GC, its efficacy for resected stage IV GC is unclear. This study aimed to evaluate the efficacy of post-operative chemotherapy after curative resection of GC with oligo-metastasis. Methods: We retrospectively reviewed the medical records of patients with GC who were diagnosed with synchronous oligo-metastasis at 20 institutions in Japan between 2007 and 2012. The selection criteria were: adenocarcinoma, stage IV with oligo-metastasis at liver or lymph node without other distant metastasis, curative resection including synchronous oligo-metastasis, and no prior treatment of GC before surgery. Results: A total of 110 patients were collected. Of the 94 eligible patients, 84 underwent gastrectomy with surgical resection of oligo-metastasis (39 [41%] liver metastasis and 55, [59%] distant lymph node metastasis), followed by post-operative chemotherapy with S-1 (S1: n = 55), S1 plus cisplatin (CS: n = 22), or Others (n = 7). Moreover, 10 patients did not receive post-operative chemotherapy (Non-Cx). The median overall survival (OS) was 35.2 and 11.1 months in the post-operative chemotherapy and Non-Cx groups (hazard ratio, 3.56; 95% confidence interval, 1.74–7.30; p < 0.001), respectively. In multivariable analysis, Non-Cx and age over 70 years were identified as poor prognostic factors for OS (p < 0.05). Conclusions: Curative resection followed by post-operative chemotherapy in patients with GC with synchronous oligo-metastasis showed favorable survival. [ABSTRACT FROM AUTHOR]

Background: Cancer cells are often found postoperatively at surgical resection margins (RM) in patients with gastric cancer because of submucosal infiltration or hesitation to secure adequate RM. This study was designed to evaluate risk factors for microscopic positive RM and to clarify which patients should undergo intraoperative frozen section diagnosis (IFSD).Methods: Patients who underwent R0/1 gastrectomy for gastric adenocarcinoma between 2000 and 2018 in a single cancer center in Japan were studied. We divided the patients into a positive RM group and negative RM group according to the results of definitive histopathological examinations. We performed multivariate analysis to analyze risk factors for positive RM by and used the identified risk factors to risk stratify the patients.Results: A total of 2757 patients were studied, including 49 (1.8%) in the positive RM group. The risk factors significantly associated with positive RM were remnant gastric cancer (odds ratio [OR] 4.7), esophageal invasion (OR 6.3), tumor size ≥80 mm (OR 3.9), and a histopathological diagnosis of undifferentiated type (OR 3.6), macroscopic type 4 (OR 3.7), or pT4 disease (OR 4.6). On risk stratification analysis, the incidence of positive RM was 0.1% without any risk factors, increasing to 0.4% with one risk factor, 3.1% with two risk factors, 5.3% with three risk factors, 21.3% with four risk factors, and 85.7% with five risk factors.Conclusions: The risk of macroscopically positive RM increased in patients who have risk factors. IFSD should be performed in patients who have four or more risk factors. [ABSTRACT FROM AUTHOR]

Background: Surgery for gastric cancer should be performed as soon as possible after diagnosis. However, sometimes the waiting time for surgery tends to be longer. The relation between the waiting time for surgery and survival in patients with gastric cancer remains to be fully investigated. Methods: This retrospective, single-center cohort study evaluated patients with gastric cancer who underwent curative surgery from 2006 through 2012 at Kanagawa Cancer Center in Japan. Patients who received neoadjuvant chemotherapy were excluded. The waiting time for surgery was defined as the time between the first visit and surgery. We investigated whether the waiting time for surgery has a linear negative impact on outcomes by using a Cox regression model with clinical prognostic factors. Results: In total, 801 patients were eligible. The median waiting time was 45 days (range 10–269 days). The restricted cubic spline regression curve showed that the adjusted time-specific hazard ratios of waiting times did not indicate a linear negative trend on survival between 20 and 100 days (p = 0.759). In the Cox model with a quartile of waiting times, waiting times in the 32–44-day group, 43–62-day group, and ≥63 day groups were not associated with poorer overall survival as compared with the ≤31 day group (HR: 1.01, 95% CI 0.63–1.60, p = 0.984, HR: 1.17, 95% CI 0.70–1.94, p = 0.550, HR: 1.06, 95% CI 0.60–1.88, p = 0.831, respectively). Conclusions: There was no negative relation between the waiting time for surgery (within 100 days) and survival in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Background Patients with advanced esophageal cancer may have dysphagia and weight loss from the first visit, and it is necessary to evaluate their nutritional status before starting treatment, especially for preoperative patients. On the other hand, since 2018, the global diagnostic criteria for malnutrition, the GLIM criteria, have been proposed to define malnutrition and its severity. Purpose The aim of the study is to examine the impact of malnutrition severity assessment using the GLIM criteria at the time of first visit in patients with advanced esophageal cancer on short-term prognosis (length of hospital stay after surgery) and long-term prognosis (presence or absence of recurrence, OS) in patients undergoing surgery for esophageal cancer. Method From 2011 to 2018, 197 advanced esophageal cancer patients have undergone esophagectomy, and we examined the distribution of malnutrition at the first visit of these patients. Based on the GLIM criteria, low BMI in Asians (<18.5: less than 70 years old, <20: over 70 years old) is defined as malnutrition, and moderate malnutrition and severe malnutrition are defined according to the weight loss rate. Result 42 patients (21.3%) were judged to be malnourished according to the GLIM criteria at the first visit. 23 patients were judged moderately malnourished, and 19 patients were judged severely malnourished. There was no significant difference in postoperative length of hospital stay between the normal nutrition group and the malnutrition group, regardless of the severity of the disease. There was no significant difference in recurrence, but the severely undernourished group had a significantly high rate of recurrences (p < 0.01). Regarding prognosis, the 3-year survival rate tended to be slightly lower in the malnutrition group (p = 0.081), but the 3-year survival rate was significantly lower in the severely malnutrition group (p < 0.001). Conclusion In patients with advanced esophageal cancer, the severe malnutrition group in the GLIM criteria at the time of the first visit was considered to have a poor long-term prognosis, although the short-term prognosis was similar to that of the eutrophic group. Currently, in Japan, NAC is usually performed for operable advanced esophageal cancer, so in the future, we plan to focus on improving the nutritional status from the beginning of NAC to surgery. [ABSTRACT FROM AUTHOR]

Background: Previous studies comparing survival between gastric cancer (GC) patients from the West and the East were based on the assumption that background factors and prognostic factors were identical. The aim of the current study was to compare the survival of GC patients from the UK and Japan using weighted propensity score analysis after identifying all different background factors. Methods: Data from 464 patients from the Leeds Teaching Hospital NHS Trust, Leeds, UK (LTHT), and 465 patients from the Kanagawa Cancer Center Hospital, Yokohama, Japan (KCCH), who had surgery for GC were analyzed. Prognostic factors for overall survival (OS) and cancer-specific survival (CSS) were identified by univariate and multivariate analyses. Survival was compared by propensity score weighting after adjusting for all significantly different background factors. Results: Most background factors were different between LTHT and KCCH patients. Unadjusted stage-specific OS and CSS were significantly better in KCCH. Independent prognostic factors for unadjusted OS and CSS were pT and pN in KCCH and in addition tumor location, pancreatectomy, resection margin status and number of examined lymph nodes in LTHT. Even after adjusting for all background characteristics, survival remained better in KCCH. Conclusions: These results suggest that differences in background factors are unable to fully explain the survival difference of GC patients between UK and Japan. Comprehensive studies into the biology of GC and/or host factors are needed to fully understand the survival difference. [ABSTRACT FROM AUTHOR]