Staging I in a Gastric Adenocarcinoma Cohort Description of Clinical, Imaging and Pathological Findings

Main Article Content

Paola Engelmann Arantes, Ms. http://orcid.org/0000-0003-3813-3178 Gisele Aparecida Fernandes, Dr. http://orcid.org/0000-0002-5978-3279 Diego Rodrigues Mendonça e Silva, Dr. http://orcid.org/0000-0001-8469-8415 Felipe José Fernandez Coimbra, Dr. http://orcid.org/0000-0001-5068-0639 Vinícius Fernando Calsavara, Dr. http://orcid.org/0000-0003-2332-5863 Tatiane Tiengo, Ms. http://orcid.org/0000-0002-7004-6579 Maria Paula Curado, Dr. http://orcid.org/0000-0001-8172-2483

Abstract

Background: Gastric cancer was the fourth cause of cancer-related deaths in 2020 in the world. The aim of this study was to describe the characteristics of patients with gastric adenocarcinoma Stage I describing clinical, pathological, and neoadjuvant staging in a prospective cohort at A.C. Camargo Cancer Center (ACCCC).


Methods: Sixty-three patients with Stage I gastric adenocarcinoma treated at ACCCC were evaluated for clinical, pathological, and clinical Stages. For the comparison between the clinical staging and the post-treatment one (surgical and neoadjuvant): tumor (T) and lymph nodes (N) were evaluated.


Results: Of the 63 patients, 29/63 (46%) were clinical Stage I, and 34/63 (54%) were initially staged as clinical Stage II and III that migrated to Stage I after surgical and neoadjuvant treatment. As for the clinical aspects, 36/63 patients (57%) were men with an average age of 58.7 years, 63% patients were Caucasian and 83% (52) had private medical insurance. In the endoscopic reports, 68.3% (n=43) of the lesions were ulcerated and the histological type, 55.6% (n=35) were diffuse. Patients treated with neoadjuvant therapy had a 100% reduction of tumors T3/T4 to T1/T2 (p<0.001) and 78.5% of the regional lymph nodes, N+ to N0. (p=0.001).


Conclusion: The neoadjuvant therapy on patients with gastric adenocarcinoma led to significant tumor (T) and regional lymph nodes (N) regressions, thus, increasing the migration of cases from T3/T4 to T1 /T2 and N+ to N0 in this cohort.

Keywords: Stomach Neoplasms, Neoadjuvant Therapy, Neoplasm Staging

Article Details

How to Cite
ARANTES, Paola Engelmann et al. Staging I in a Gastric Adenocarcinoma Cohort. Medical Research Archives, [S.l.], v. 11, n. 9, sep. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4251>. Date accessed: 11 may 2024. doi: https://doi.org/10.18103/mra.v11i9.4251.
Section
Research Articles

References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2021;71(3):209–49. Available from: http://dx.doi.org/10.3322/caac.21660

2. Zali H, Rezaei-Tavirani M, Azodi M. Gastric cancer: prevention, risk factors and treatment. Gastroenterol Hepatol Bed Bench. 2011 Autumn; 4(4):175–85.

3. Rawla P, Barsouk A. Epidemiology of gastric cancer: global trends, risk factors and prevention. Prz Gastroenterol [Internet]. 2019;14(1):26–38. Available from: https://pubmed.ncbi.nlm.nih.gov/30944675/

4. American joint committee on cancer [Internet]. ACS. [cited 2023 Jul 18]. Available from: https://cancerstaging.org

5. Gress DM, Edge SB, Greene FL, Washington MK, Asare EA, Brierley JD, et al. Principles of cancer staging. In: AJCC Cancer Staging Manual. Cham: Springer International Publishing; 2017. p. 3–30.

6. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJH, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med [Internet]. 2006; 355(1): 11–20. Available from: http://dx.doi.org/10.1056/nejmoa055531

7. Ao S, Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China, Wang Y, Song Q, Ye Y, Lyu G, et al. Current status and future perspectives on neoadjuvant therapy in gastric cancer. Chin J Cancer Res [Internet]. 2021; 33(2):181–92. Available from: http://dx.doi.org/10.21147/j.issn.1000-9604.2021.02.06

8. Tenório PP, Melo Junior MR de. Correlação entre a histopatologia e teste da urease para pesquisa de H. pylori em pacientes portadores de gastrite. Rev Ciênc Médicas Biol [Internet]. 2009; 8(3):301. Available from: http://dx.doi.org/10.9771/cmbio.v8i3.4473

9. Lee S. Grading stomach cancer [Internet]. Canadian Cancer Society. [cited 2023 Jul 18]. Available from: http://www.cancer.ca/en/cancer-information/cancer-type/stomach/grading/?region=on

10. CID-O: Classificação Internacional de Doença para Oncologia. [Internet] Edusp; 1996*. [cited 2023 Jul 18]. Available from: https://apps.who.int/iris/bitstream/handle/10665/42344/9241545348_por.pdf?sequence=5&isAllowed=y

11. Miao Z-F, Liu X-Y, Wang Z-N, Zhao T-T, Xu Y-Y, Song Y-X, et al. Effect of neoadjuvant chemotherapy in patients with gastric cancer: a PRISMA-compliant systematic review and meta-analysis. BMC Cancer [Internet]. 2018;18(1). Available from: http://dx.doi.org/10.1186/s12885-018-4027-0

12. Ychou M, Boige V, Pignon J-P, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy Compared with surgery alone for resectable gastroesophageal adenocarcinoma: An FNCLCC and FFCD multicenter phase III trial. J Clin Oncol [Internet]. 2011; 29(13):1715–21. Available from: http://dx.doi.org/10.1200/jco.2010.33.0597

13. Coccolini F, Nardi M, Montori G, Ceresoli M, Celotti A, Cascinu S, et al. Neoadjuvant chemotherapy in advanced gastric and esophago-gastric cancer. Meta-analysis of randomized trials. Int J Surg [Internet]. 2018 [cited 2023 Jul 18];51:120–7. Available from: https://pubmed.ncbi.nlm.nih.gov/29413875/

14. Xu A-M, Huang L, Liu W, Gao S, Han W-X, Wei Z-J. Neoadjuvant chemotherapy followed by surgery versus surgery alone for gastric carcinoma: Systematic review and meta-analysis of randomized controlled trials. PLoS One [Internet]. 2014; 9(1):e86941. Available from: http://dx.doi.org/10.1371/journal.pone.0086941

15. Zhao J-H, Gao P, Song Y-X, Sun J-X, Chen X-W, Ma B, et al. Which is better for gastric cancer patients, perioperative or adjuvant chemotherapy: a meta-analysis. BMC Cancer [Internet]. 2016;16(1). Available from: http://dx.doi.org/10.1186/s12885-016-2667-5

16. El-Serag HB. Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut [Internet]. 2002; 50(3):368–72. Available from: http://dx.doi.org/10.1136/gut.50.3.368

17. Petrelli F, Berenato R, Turati L, Mennitto A, Steccanella F, Caporale M, et al. Prognostic value of diffuse versus intestinal histotype in patients with gastric cancer: a systematic review and meta-analysis. J Gastrointest Oncol [Internet]. 2017; 8(1):148–63. Available from: http://dx.doi.org/10.21037/jgo.2017.01.10

18. Lorant K, Roland K, Bianca O, Sorin Z. Histopathological lauren classification of gastric carcinoma with biopsy specimen and a histological difference with dysplasia. Clin Med Invest [Internet]. 2019;4(1). Available from: http://dx.doi.org/10.15761/cmi.1000174

19. Fava BEC, da Costa WL Jr, Medeiros MLL, Sonagli M, de Castro Ribeiro HS, Diniz AL, et al. Neoadjuvant intraperitoneal chemotherapy followed by radical surgery and HIPEC in patients with very advanced gastric cancer and peritoneal metastases: report of an initial experience in a western single center. World J Surg Oncol [Internet]. 2018;16(1). Available from: http://dx.doi.org/10.1186/s12957-018-1363-0

20. Hu Y, Hu D, Li W, Yu X. Neoadjuvant chemotherapy brings more survival benefits than postoperative chemotherapy for resectable gastric cancer: a Meta-analysis of randomized controlled trials. J BUON [Internet]. 2019 [cited 2023 Jul 18];24(1):201–14. Available from: https://pubmed.ncbi.nlm.nih.gov/30941971/

21. de Jesus VHF, da Costa Junior WL, Felismino TC, Calsavara VF, Diniz AL, de Castro Ribeiro HS, et al. Survival outcomes of patients with pathological stage I gastric cancer using the competing risks survival method. J Gastrointest Oncol [Internet]. 2019; 10(6):1110–9. Available from: http://dx.doi.org/10.21037/jgo.2019.10.04

22. Curado MP, Silva DRM e., Oliveira MM de, Soares F, Begnami MD, Coimbra FJF, et al. Disparities in epidemiological profile of gastric adenocarcinoma in selected cities of Brazil. Asian Pac J Cancer Prev [Internet]. 2019;20(8):2253–8. Available from: http://dx.doi.org/10.31557/apjcp.2019.20.8.2253

23. Coimbra FJF, de Jesus VHF, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, et al. Impact of ypT, ypN, and adjuvant therapy on survival in gastric cancer patients treated with perioperative chemotherapy and radical surgery. Ann Surg Oncol [Internet]. 2019; 26(11):3618–26. Available from: http://dx.doi.org/10.1245/s10434-019-07454-0