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, 10, 3833-3839
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Multidisciplinary Therapy for Scirrhous Gastric Cancer: A Retrospective Analysis and Proposal of New Treatment Strategy

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Multidisciplinary Therapy for Scirrhous Gastric Cancer: A Retrospective Analysis and Proposal of New Treatment Strategy

Sachio Fushida et al. Cancer Manag Res.

Abstract

Background: Scirrhous gastric cancer (SGC) is highly invasive and metastatic because of its interactions with stromal cells, such as fibroblasts and macrophages, and extracellular matrix, leading to a higher incidence of peritoneal metastasis (PM) than other gastric cancers (GCs). Taxane-based intraperitoneal chemotherapy (IPC) is a promising therapy for PM. We retrospectively analyzed outcomes of multidisciplinary therapies that included IPC for SGC.

Patients and therapy: Of 1,679 GC patients treated between 1990 and 2012, we analyzed 119 patients who underwent multidisciplinary therapy for SGC. Patients without PM received gastrectomy with lymphadenectomy and resection of involved adjacent organs followed by intraoperative IPC using cisplatin. Patients with PM received chemotherapy using fluorouracil, with or without methotrexate plus IPC using cisplatin before 2000, and S-1 plus IPC using paclitaxel or docetaxel since 2000.

Results: Of the 119 patients, 73 (61%) had PM and 63 (53%) had positive peritoneal lavage cytology. Of the 89 gastrectomy patients, 30 (34%) had macroscopic residual tumors (R2). Of the patients treated since 2000, 66 (100%) received S-1 plus taxanes and 44 patients (67%) received taxane-based IPC. Median survival time was significantly longer in the post-2000 group (22.8 months) than in the pre-2000 group (9.5 months). In univariate analysis, lavage cytology, PM, taxane-based IPC, gastrectomy, and R2 resection were significant prognostic factors. However, only R2 resection was an independent prognostic factor in multivariate analysis (hazard ratio: 5.53, 95% CI: 2.05-14.93).

Conclusion: As use of taxane-based IPC is not an independent prognostic factor, new multidisciplinary therapies are necessary to avoid R2 resections.

Keywords: intraperitoneal chemotherapy; peritoneal metastasis; taxanes.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Kaplan–Meyer curve showing OS in all study patients. Abbreviation: OS, overall survival.
Figure 2
Figure 2
Kaplan–Meyer curve showing OS rates in patients with or without PM. Abbreviations: P1, peritoneal metastasis positive; P0, peritoneal metastasis negative; OS, overall survival.
Figure 3
Figure 3
Kaplan–Meyer curve showing OS in patients with gastrectomy and those with CTX alone. Abbreviations: R0–1, gastrectomy without macroscopic residual tumor; R2, gastrectomy with macroscopic residual tumor; CTX, chemotherapy; OS, overall survival.

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