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The article presents a study which evaluates the staging accuracy and prognostic role of preoperative endoscopic ultrasound (EUS) and computed tomography (CT) in patients with locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy. Results show that restaging by EUS and CT after neoadjuvant chemotherapy in patients with LAGC was found to be inaccurate, but suggests that downstaging by EUS is a useful clinical parameter to predict a better outcome for LAGC patients.

OBJECTIVES: Helicobacter pylori ( H. pylori) eradication is strongly recommended for gastric cancer patients who undergo subtotal gastrectomy. The efficacy of proton pump inhibitor-based triple therapy for H. pylori eradication has not been adequately assessed in the gastric remnant. The aim of this study was to compare the efficacy of postoperative versus preoperative H. pylori eradication therapy. METHODS: A total of 138 distal gastric cancer patients with H. pylori infection were randomized to receive either preoperative (preop, N = 68) or postoperative (postop, N = 70) proton pump inhibitor-based triple therapy for H. pylori eradication. The regimen consisted of rabeprazole 10 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg, all twice daily for 7 days. Eradication was assessed by rapid urease test and histology 12 wk after surgery. RESULTS: By intention-to-treat (ITT) analysis, H. pylori eradication rates were 84.6% (95% CI 73.5–92.4) in the preop group and 83.1% (95% CI 71.7–91.2) in the postop group ( P= 0.99). By per protocol (PP) analysis, the rates were 87.3% (95% CI 76.5–94.4) in the preop group and 86.9% (95% CI 75.8–94.2) in the postop group ( P= 0.99). In the postop group, eradication rates did not differ with reconstruction method (Billroth I vs II, 80.4%[95% CI 66.1–90.6] vs 89.5%[95% CI 66.9–98.7] by ITT analysis ( P= 0.49), and 85.7%[95% CI 71.5–94.6] vs 89.5% (95% CI 66.9–98.7) by PP analysis, P= 0.99). CONCLUSIONS: In distal gastric cancer patients, the effect of proton pump inhibitor-based triple therapy for H. pylori eradication was not different whether given postoperatively or preoperatively. [ABSTRACT FROM AUTHOR]

Background. Response of metastatic sites on computed tomography (CT) has been used to assess response in metastatic gastric carcinoma (MGC); however, the role of endoscopy to evaluate the response of the primary gastric lesion is unclear. We undertook a prospective study to compare prognostic values of endoscopy-based response criteria with those of CT-based response criteria in MGC patients treated with 5-fluorouracil (5-FU) and cisplatin. Methods. MGC patients naive to chemotherapy were treated with 5-FU (1000 mg/m², days 1.5) and cisplatin (60 mg/m², day 1) (FP) every 21 days. Response was assessed by CT [World Health Organization (WHO) criteria/Response Evaluation Criteria In Solid Tumors (RECIST)] every three cycles and/or endoscopy after the third cycle. Results. With a median follow-up of 26.2 months, 103 patients were assessed by CT and endoscopy. There was good concordance between the WHO and RECIST criteria (κ = 0.91; P = 0.0001), but poor agreement between CT and endoscopic assessments (κ = 0.17; P = 0.01). On multivariate analysis, both CT (WHO/RECIST) (hazard ratio, 5.20; P < 0.0001) and endoscopic response (hazard ratio, 2.78; P < 0.0001) were significantly associated with survival. The combination of CT and endoscopy defined patients into four groups with distinct prognoses according to chemotherapy response: responders on both tests, responders on CT alone, responders on endoscopy alone, and nonresponders on both tests (hazard ratio, 1.00 versus 2.87 versus 5.35 versus 12.3; P < 0.0001). Conclusions. The use of endoscopy together with CT provides a better prognostic tool than CT alone in MGC patients treated with FP. [ABSTRACT FROM AUTHOR]

Background/Aims Prospective cohort studies have reported that operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) staging systems could predict the risk of gastric epithelial neoplasia progression in patients without gastric cancer. We evaluated metachronous gastric neoplasia risk after endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) patients without Helicobacter pylori infection according to the OLGA and OLGIM stages. Methods This retrospective study included 568 EGC patients who underwent ESD for EGC between 2004 and 2015. OLGA and OLGIM stages were determined when H. pylori status was all negative at biopsy specimens from the antrum, corpus lesser and greater curvature. OLGA and OLGIM stages III-IV was defined as high-risk group. Primary outcome was risk of metachronous gastric neoplasia including adenoma and cancer, and age-sex adjusted hazard ratio (aHR) was calculated using the Cox-proportional hazard model. Results During a median follow-up of 5.0 years, metachronous neoplasia developed in 71 of the 568 patients (12.5%; 42 cancer and 29 adenoma). Of 519 patients evaluated by OLGA stage, aHR for metachronous neoplasia was 6.81 in stage I, 4.71 in stage II, 7.68 in stage III, and 8.71 in stage IV. High-risk OLGA group (aHR, 1.82; p=0.028) had a significantly increased risk of metachronous neoplasia compared with low-risk group. OLGIM stages were evaluated in all included 568 patients, and risk of metachronous neoplasia increased with advanced OLGIM stages: aHR 2.25 in stage I, 2.56 in stage II, 3.35 in stage III, and 4.36 in stage IV. High-risk OLGIM group had also significantly increased metachronous neoplasia risk (aHR, 1.81; p=0.026). Conclusions OLGA and OLGIM stages may be a risk assessment tool for the prediction of metachronous gastric neoplasia development after ESD in EGC patients who had negative H. pylori infection. [ABSTRACT FROM AUTHOR]

Background: Patients with early gastric cancers that are limited to gastric mucosa or submucosa usually have an advanced loss of mucosal glandular tissue (glandular atrophy) and are at high risk for subsequent (metachronous) development of new gastric cancer. The long-term effects of treatment to eradicate Helicobacter pylori on histologic improvement and the prevention of metachronous gastric cancer remain unclear.Methods: In this prospective, double-blind, placebo-controlled, randomized trial, we assigned 470 patients who had undergone endoscopic resection of early gastric cancer or high-grade adenoma to receive either H. pylori eradication therapy with antibiotics or placebo. Two primary outcomes were the incidence of metachronous gastric cancer detected on endoscopy performed at the 1-year follow-up or later and improvement from baseline in the grade of glandular atrophy in the gastric corpus lesser curvature at the 3-year follow-up.Results: A total of 396 patients were included in the modified intention-to-treat analysis population (194 in the treatment group and 202 in placebo group). During a median follow-up of 5.9 years, metachronous gastric cancer developed in 14 patients (7.2%) in the treatment group and in 27 patients (13.4%) in the placebo group (hazard ratio in the treatment group, 0.50; 95% confidence interval, 0.26 to 0.94; P=0.03). Among the 327 patients in the subgroup that underwent histologic analysis, improvement from baseline in the atrophy grade at the gastric corpus lesser curvature was observed in 48.4% of the patients in the treatment group and in 15.0% of those in the placebo group (P<0.001). There were no serious adverse events; mild adverse events were more common in the treatment group (42.0% vs. 10.2%, P<0.001).Conclusions: Patients with early gastric cancer who received H. pylori treatment had lower rates of metachronous gastric cancer and more improvement from baseline in the grade of gastric corpus atrophy than patients who received placebo. (Funded by the National Cancer Center, South Korea; ClinicalTrials.gov number, NCT02407119 .). [ABSTRACT FROM AUTHOR]

Over the last decade, as the number of patients with early gastric cancer increased and the subsequent survival rate improved, there has been a consistent effort to verify the applicability of the sentinel node concept in gastric cancer in a bid to improve postoperative quality of life in these patients. During sentinel node navigation surgery in gastric cancer patients, intraoperative pathologic examination of the retrieved sentinel nodes plays a critical role in determining the extent of surgery, but the optimal method is still under debate. Currently, a multicenter, phase III clinical trial is underway to compare laparoscopic sentinel basin dissection with stomach preserving surgery and standard laparoscopic gastrectomy in terms of oncologic outcomes in patients with clinical stage T1N0 gastric cancer. Herein, the currently available intraoperative pathologic techniques are reviewed and their clinical significance and applicability are appraised based on the published literature. The proper pathologic examination of the sentinel lymph nodes in an upcoming clinical trial (SENORITA trial) is also proposed here based on this review. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether individuals with gastric cancer (GC) are diagnosed earlier if they have first-degree relatives with GC., Methods: A total of 4282 patients diagnosed with GC at National Cancer Center Hospital from 2002 to 2012 were enrolled in this retrospective study. We classified the patients according to presence or absence of first-degree family history of GC and compared age at diagnosis and clinicopathologic characteristics. In addition, we further classified patients according to specific family member with GC (father, mother, sibling, or offspring) and compared age at GC diagnosis among these patient groups. Baseline characteristics were obtained from a prospectively collected database. Information about the family member's age at GC diagnosis was obtained by questionnaire., Results: A total of 924 patients (21.6%) had a first-degree family history of GC. The mean age at GC diagnosis in patients having paternal history of GC was 54.4 ± 10.4 years and was significantly younger than in those without a first-degree family history (58.1 ± 12.0 years, P < 0.001). However, this finding was not observed in patients who had an affected mother (57.2 ± 10.0 years) or sibling (62.2 ± 9.8 years). Among patients with family member having early-onset GC (< 50 years old), mean age at diagnosis was 47.7 ± 10.3 years for those with an affected father, 48.6 ± 10.4 years for those with an affected mother, and 57.4 ± 11.5 years for those with an affected sibling. Thus, patients with a parent diagnosed before 50 years of age developed GC 10.4 or 9.5 years earlier than individuals without a family history of GC (both P < 0.001)., Conclusion: Early-onset GC before age of 50 was associated with parental history of early-onset of GC. Individual having such family history need to start screening earlier.

Aim: To evaluate the effect of gastrectomy on diabetes mellitus (DM) and hypertension (HTN) in non-obese gastric cancer patients., Methods: A total of 100000 patients, diagnosed with either type 2 DM or HTN, were randomly selected from the 2004 Korean National Health Insurance System claims. Among them, 360 diabetes and 351 hypertensive patients with gastric cancer who had been regularly treated without chemotherapy from January 2005 to December 2010 were selected. They were divided into three groups according to their treatment methods: total gastrectomy (TG), subtotal gastrectomy (STG) and endoscopic resection (ER)., Results: The drug discontinuation rate of anti-diabetic and anti-hypertensive agents after gastric cancer treatment was 9.7% and 11.1% respectively. DM appeared to be improved more frequently (22.8%) and earlier (mean±SE 28.6±1.8 mo) in TG group than in the two other groups [improved in 9.5% of ER group (37.4±1.1 mo) and 6.4% of STG group (47.0±0.8 mo)]. The proportion of patients treated with multiple drugs decreased more notably in TG group compared to others (P=0.001 in DM, and P=0.035 in HTN). In TG group, adjusted hazard ratio for the improvement of DM was 2.87 (95%CI: 1.15-7.17) in a multi-variate analysis and better control of DM was observed with survival analysis (P<0.001)., Conclusion: TG was found to decrease the need for anti-diabetic medications which can be reflective of improved glycemic control, to a greater extent than either ER or STG in non-obese diabetic patients.