Cancer Research and Treatment

Original Articles

Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer: Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Oh Kyoung Kwon, Ho Young Chung, Wansik Yu; Cancer Res Treat. 2018;50(3):852-860. Published online September 13, 2017; DOI: https://doi.org/10.4143/crt.2017.080

Purpose
We evaluated the impact of postoperative body mass index (BMI) shifts on the quality of life (QoL) following total gastrectomy in patients with gastric cancer.
Materials and Methods
QoL data collected from the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-STO22 questionnaires were obtained from 417 patients preoperatively and 1 year after surgery. Patients were divided into two groups based on changes in BMI: group 1 comprised patientswhose BMIrange category dropped, and group 2 included patients who maintained or rose to a higher category compared to their preoperative BMI category.
Results
There were 276 patients in group 1 and 141 in group 2. QoLs with respect to the global health status and functional scales were not significantly different between the groups 1 year after surgery. However, there were significantly greater decreases in QoL in group 1 due to gastrointestinal symptoms, such as nausea and vomiting (p=0.008), appetite loss (p=0.001), and constipation (p=0.038). Of the QLQ-STO22 parameters, dysphagia (p=0.013), pain (p=0.012), reflux symptoms (p=0.017), eating restrictions (p=0.007), taste (p=0.009), and body image (p=0.009) were associated with significantly worse QoL in group 1 than in group 2 1 year after surgery.
Conclusion
Patients have significantly different QoLs depending on the BMI shift after total gastrectomy. Efforts to reduce the gap in QoL should include intensive nutritional support and restoration of dietary behaviors. Appropriate clinical and institutional approaches, plus active medical interventions, are required for maintaining patients’ BMIs after surgery.

Citations

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Chronological Changes of Quality of Life in Long-Term Survivors after Gastrectomy for Gastric Cancer: Wansik Yu, Ki Bum Park, Ho Young Chung, Oh Kyoung Kwon, Seung Soo Lee; Cancer Res Treat. 2016;48(3):1030-1036. Published online January 6, 2016; DOI: https://doi.org/10.4143/crt.2015.398

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Purpose
A few studies have prospectively evaluated changes in quality of life (QoL) after surgery in short-term survivors; however, no prospective study has evaluated the longitudinal changes in QoL in long-terms survivors. We prospectively evaluated the chronological changes in QoL after a gastrectomy over a 5-year postoperative period in a large group of patients. Materials and Methods QoL data from the European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-STO22 questionnaires were obtained from 254 patients who completed the entire series of QoL assessments preoperatively and at 1, 2, 3, 4, and 5 years after surgery.
Results
There was no statistically significant change in global health status/QoL during the 5-year postoperative period. Decreases in QoL from upper gastrointestinal symptoms including diarrhea (p < 0.001), dysphagia (p < 0.001), reflux symptoms (p=0.029), and eating restrictions (p < 0.001) were observed among the long-term survivors. Decreased physical functioning (p < 0.001), role functioning (p < 0.001), and cognitive functioning (p < 0.001), along with fatigue (p=0.045) and a poor body image (p=0.003), negatively impacted the patients’ QoL for a long time. Conclusion Management of gastrointestinal symptoms should be specifically targeted as a part of longterm patient care after a gastrectomy. Proper nutritional care will improve food intake resulting in weight gain and improved physical functioning, role functioning, and body image. In addition, patients should be encouraged to preserve self-esteem and maintain social activity.

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Seung Soo Lee, Wansik Yu, Ho Young Chung, Oh Kyoung Kwon, Won Kee Lee
Journal of Gastric Cancer.2017; 17(4): 342. CrossRef

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Early Postoperative Intraperitoneal Chemotherapy for Macroscopically Serosa-Invading Gastric Cancer Patients: Oh Kyoung Kwon, Ho Young Chung, Wansik Yu; Cancer Res Treat. 2014;46(3):270-279. Published online July 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.3.270

Abstract PDF PubReader ePub

Purpose
Peritoneal recurrence is one of the most common patterns of recurrence after gastric cancer surgery and it has a poor prognosis despite all efforts. The aim of this study is to evaluate the prognostic impact of early postoperative intraperitoneal chemotherapy (EPIC) after surgery with curative intent for macroscopically serosa-invading gastric cancer patients. Materials and Methods The records of 245 patients under the age of 70 were reviewed. These patients were suffering from macroscopically seroa-invading gastric cancer and they underwent curative surgery from 1995 to 2004 at the Kyungpook National University Hospital, Daegu, Korea. The overall survival, gastric cancer-specific survival, complications, and patterns of recurrence were compared between the patients who were treated with EPIC and those who were not. Results EPIC was administered to 65 patients, and the remaining 180 patients did not receive this treatment. The 5-year overall and gastric cancer-specific survival rates for the EPIC group were 47.4% and 53.1%, respectively, and those for the non-EPIC group were 26.7% and 29.7%, respectively (p=0.012 for overall survival and p=0.011 for gastric cancer-specific survival). The rates of peritoneal recurrence for the EPIC group and the non-EPIC group were 18.5% and 32.2%, respectively (p=0.038). There were no significant differences in the morbidity or mortality between the two groups. Based on a multivariate analysis of the factors with prognostic significance in univariate analyses, EPIC, pathological lymph node metastasis, differentiation, and the extent of gastric resection were independent prognostic factors. Conclusion The use of EPIC to treat gastric cancer patients with macroscopic serosal invasions resulted in better survival rate by reducing the risk of peritoneal recurrence.

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Quality of Life of Long-Term Survivors after a Distal Subtotal Gastrectomy: Seung Soo Lee, Ho Young Chung, Wansik Yu; Cancer Res Treat. 2010;42(3):130-134. Published online September 30, 2010; DOI: https://doi.org/10.4143/crt.2010.42.3.130

Abstract PDF PubReader ePub

Purpose

The aim of this study was to investigate the impact of a distal subtotal gastrectomy on the quality of life (QoL).

Materials and Methods

The QoL data of 126 patients were obtained on their 5th annual follow-up visit after a curative distal subtotal gastrectomy for gastric cancer (Group A). The QoL data of 130 age- and gender-adjusted healthy population were obtained from the individuals who visited the health screening center for a medical check-up (Group B). There were 42 women and 84 men in the study group and their mean age was 56.0±11.1 years. QoL was assessed using the Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30) and QLQ-STO22.

Results

The EORTC QLQ-C30 global health status and QoL scores of Group A and Group B were 63.9±22.7 and 61.3±22.1, respectively (p=0.361). Group A revealed a better score for emotional functioning (84.1±16.1 and 75.2±21.4, respectively; p<0.001), cognitive functioning (82.0±16.4 and 75.0±21.4, respectively; p=0.004) and fatigue (27.7±20.8 and 33.8±23.2, respectively; p=0.028). However, Group A revealed a worse score for nausea and vomiting (14.8±20.0 and 10.2±16.0, respectively; p=0.042), financial difficulties (14.8±22.9 and 7.1±16.1, respectively; p=0.002), reflux (16.7±17.7 and 10.1±17.0, respectively; p=0.003), eating restrictions (13.6±15.2 and 6.6±10.2, respectively; p<0.001) and body image (23.3±25.4 and 16.2±24.6, respectively; p=0.023).

Conclusion

The QoL of long-term survivors after a distal subtotal gastrectomy is still influenced by the surgery itself even though they are considered to be free of disease.

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Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center
Vivian E. Strong, Sepideh Gholami, Manish A. Shah, Laura H. Tang, Yelena Y. Janjigian, Mark Schattner, Luke V. Selby, Sam S. Yoon, Erin Salo-Mullen, Zsofia K. Stadler, David Kelsen, Murray F. Brennan, Daniel G. Coit
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Yumi Lee, Myong Cheol Lim, Yedong Son, Jungnam Joo, KiByung Park, Jung-Sup Kim, Dong Ock Lee, Sang-Yoon Park
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No Association of Vascular Endothelial Growth Factor-A (VEGF-A) and VEGF-C Expression with Survival in Patients with Gastric Cancer: Soo Jung Lee, Jong Gwang Kim, Sang Kyun Sohn, Yee Soo Chae, Joon Ho Moon, Shi Nae Kim, Han-Ik Bae, Ho Young Chung, Wansik Yu; Cancer Res Treat. 2009;41(4):218-223. Published online December 31, 2009; DOI: https://doi.org/10.4143/crt.2009.41.4.218

Abstract PDF PubReader ePub

Purpose

Although the vascular endothelial growth factor (VEGF) superfamily has been identified to critically influence tumor-related angiogenesis, the prognostic significance of a VEGF expression in gastric cancer is still controversial. Accordingly, the present study analyzed the VEGF-A and VEGF-C expressions and their impact on the prognosis of patients with gastric cancer.

Materials and Methods

Three hundred seventy-five consecutive patients who underwent surgical resection for gastric adenocarcinoma with a curative intent were enrolled in the present study. Immunohistochemical staining for VEGF-A and VEGF-C was performed using the formalin fixed, paraffin embedded tumor tissues.

Results

Positive VEGF-A and VEGF-C expressions were observed in 337 (90.1%) and 278 (74.9%) cases, respectively. The survival analysis showed that the expression of VEGF-A and VEGF-C had no effect on the OS and DFS. On the multivariate analysis that included age, gender and the TNM stage, no significant association between the grade of the VEGF-A or VEGF-C expression and survival was observed.

Conclusion

The current study suggests that the tissue expression of VEGF-A or VEGF-C alone is not an independent prognostic marker for patients with surgically resected gastric adenocarcinoma.

Citations

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Mariusz Szajewski, Maciej Ciesielski, Rafał Pęksa, Piotr Kurek, Michał Stańczak, Jakub Walczak, Jacek Zieliński, Wiesław Janusz Kruszewski
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Comparison of Vascular Endothelial Growth Factor C Expression with Lymph Node Metastasis Status and Survival in Gastric Cancer
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Charles S Fuchs, Josep Tabernero, Jiří Tomášek, Ian Chau, Bohuslav Melichar, Howard Safran, Mustapha A Tehfe, Dumitru Filip, Eldar Topuzov, Luis Schlittler, Anghel Adrian Udrea, William Campbell, Stephen Brincat, Michael Emig, Symantha A Melemed, Rebecca
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Fentanyl inhibits the progression of human gastric carcinoma MGC-803 cells by modulating NF-κB-dependent gene expression in vivo
GUODONG HE, LI LI, ENJIAN GUAN, JING CHEN, YI QIN, YUBO XIE
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Piotr Donizy, Julia Rudno-Rudzinska, Maciej Kaczorowski, Jedrzej Kabarowski, Ewelina Frejlich, Wojciech Kielan, Rafal Matkowski, Agnieszka Halon
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Kyung Ho Pak, Ara Jo, Hye Ji Choi, Younghee Choi, Hyunki Kim, Jae-Ho Cheong
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Ismael Riquelme, Kathleen Saavedra, Jaime A. Espinoza, Helga Weber, Patricia García, Bruno Nervi, Marcelo Garrido, Alejandro H. Corvalán, Juan Carlos Roa, Carolina Bizama
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Weiguo Cao, Rong Fan, Weiping Yang, Yunlin Wu
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Prognostic Significance of Serum and Tissue Carcinoembryonic Antigen in Patients with Gastric Adenocarcinomas: Seong-Hoon Park, Ki-Beom Ku, Ho-Young Chung, Wansik Yu; Cancer Res Treat. 2008;40(1):16-21. Published online March 31, 2008; DOI: https://doi.org/10.4143/crt.2008.40.1.16

Abstract PDF PubReader ePub

Purpose

Carcinoembryonic antigen (CEA) is known to be elevated in nearly all solid malignancies. The prognostic role of CEA in gastric cancers however, is still controversial. We evaluated preoperative serum CEA levels and CEA expression from the resected tumor tissues to determine whether they have prognostic significance in gastric cancer patients.

Materials and Methods

Medical records of 810 patients who underwent surgery for gastric adenocarcinoma from June, 1998 to February, 2002 in Kyungpook National University Hospital were reviewed. Serum CEA level was evaluated by radioimmunoassay preoperatively, and the cut-off level for positivity was 7.0 ng/ml. Labeled streptavidin-biotin peroxidase method was used to determine CEA expression from the gastric cancer tissues.

Results

Serum and tissue CEA were positive in 9.3% and 91.1% of the patients, respectively. They had no correlation with each other. The positivity rate of serum CEA had positive correlation with invasion depth (p<0.001), lymph node metastasis (p<0.001), distant metastasis (p=0.006), and final stage (p<0.001). Well differentiated tumors showed higher serum CEA positivity (p=0.002). Patients with positive serum CEA had higher recurrence rate (p<0.001). Multivariate analysis showed significantly lower survival rate in patients with preoperative CEA levels over 7 ng/ml than those with lower levels (48.0% vs. 80.7%; p<0.001). The positivity rates of tissue CEA were higher in advanced cancers (p=0.033) and in more advanced stages (p=0.029). Tissue CEA positivity showed no correlation with recurrence or survival.

Conclusions

Preoperative serum CEA level had correlation with disease progression and survival in gastric cancer patients, and proved to be an independent prognostic factor. Tissue CEA expression in gastric cancers had no prognostic information.

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The Surgeon's Expertise-Outcome Relationship in Gastric Cancer Surgery: Wansik Yu, Young Kook Yun, Ilwoo Whang, Gyu Seok Choi; Cancer Res Treat. 2005;37(3):143-147. Published online June 30, 2005; DOI: https://doi.org/10.4143/crt.2005.37.3.143

Abstract PDF PubReader ePub

Purpose

The surgical caseload or duration of practice of a surgeon may influence the outcomes of gastric cancer surgery. This study aimed to clarify the surgical quality provided by specialized gastric cancer surgeons.

Materials and Methods

The postoperative courses of 1,877 patients who underwent surgery for gastric cancer were retrospectively reviewed. For classification of the surgeon's expertise, the number of yearly resections performed by, and consecutive years of practice of, the surgeons were used. The outcome measures used were the 30-day mortality and long-term survival.

Results

Surgical mortalities of patients who underwent surgery by a specialized surgeon and those by a general surgeon revealed no statistically significant difference. A significant difference in the five-year survival rates was found with surgeons with at least two consecutive years of practice compared to those with less than two years, when 50 or more cases had been conducted per year (63.9% and 59.7%; p=0.0380). In cases of four-years of consecutive practice, the five-year survival rate was significantly improved, even if only 10 cases were performed annually (64.9% and 58.3%; p=0.0023), although the best survival rate was found with surgeons that had performed 50 or more surgeries per year.

Conclusion

Improved survival rates, with acceptable surgical mortality, can be achieved for gastric cancer when the surgery is performed by a specialized surgeon. A specialized gastric cancer surgeon can be defined as one who has operated on more than 50 new cases per year, with 2 or more consecutive years of surgical practice.

Citations

Citations to this article as recorded by

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Jiafu Ji, Leiyu Shi, Xiangji Ying, Xinpu Lu, Fei Shan
Annals of Surgical Oncology.2022; 29(13): 8276. CrossRef
Keratinocyte cancer with incidental perineural invasion: A registry analysis of management and 5‐year outcomes
Agnieszka Adams, Brian De’Ambrosis, Ben Panizza, Paul Belt, James Emmett, Tim Warren, David C. Whiteman
Australasian Journal of Dermatology.2020; 61(3): 226. CrossRef
Operation time as a simple indicator to predict the overcoming of the learning curve in gastric cancer surgery: a multicenter cohort study
Tae-Han Kim, Keun Won Ryu, Jun Ho Lee, Gyu-Seok Cho, Woo Jin Hyung, Chan-Young Kim, Min-Chan Kim, Seung Wan Ryu, Dong Woo Shin, Hyuk-Joon Lee
Gastric Cancer.2019; 22(5): 1069. CrossRef
Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume?
Yosuke Mukai, Yukinori Kurokawa, Shuji Takiguchi, Masaki Mori, Yuichiro Doki
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Full robot-assisted gastrectomy: surgical technique and preliminary experience from a single center
Yolanda Quijano, Emilio Vicente, Benedetto Ielpo, Hipolito Duran, Eduardo Diaz, Isabel Fabra, Luis Malave, Valentina Ferri, Antonio Ferronetti, Carlos Plaza, Vito D’Andrea, Riccardo Caruso
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The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent
Yuexiang Liang, Liangliang Wu, Xiaona Wang, Xuewei Ding, Han Liang
Gastric Cancer.2015; 18(4): 859. CrossRef
Moderating Effect of Structural Complexity on the Relationship between Surgery Volume and in Hospital Mortality of Cancer Patients
Kyungil Youn
Health Policy and Management.2014; 24(4): 380. CrossRef
Robot-Assisted Gastrectomy With Lymph Node Dissection for Gastric Cancer
Jyewon Song, Sung Jin Oh, Wook Ho Kang, Woo Jin Hyung, Seung Ho Choi, Sung Hoon Noh
Annals of Surgery.2009; 249(6): 927. CrossRef

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Phase I and Pharmacokinetic Study of Intraoperative Intraperitoneal Heptaplatin in Patients with Surgically Resected Advanced Gastric Cancer: Wansik Yu, Ho Young Chung, So Hyang Park, Yong Baik Cho, Yang Soo Lim; Cancer Res Treat. 2003;35(1):25-29. Published online February 28, 2003; DOI: https://doi.org/10.4143/crt.2003.35.1.25

Abstract PDF: PURPOSE
Heptaplatin, a new platinum analog, has favorable toxicity profiles and antitumor activity, comparable to those of cisplatin, in the treatment of gastric cancer. This study was designed to define the maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and pharmacokinetics of heptaplatin administered by an intraperitoneal route in patients with resected advanced gastric cancer. MATERIALS AND METHODS: Seventeen patients with resected advanced gastric cancer were entered onto the study. After completion of a curative resection and an astomosis, heptaplatin was administered intraperiton eally in one liter of 5% dextrose solution. The starting heptaplatin dose was 400 mg/m2 of the body surface area, and was escalated in 200 mg/m2 increments, to cohorts of three patients. A pharmacokinetic analysis was carried out to determine the total and ultrafiltratable platinum concentrations in the plasma, peritoneal fluid, and urine. RESULTS: Patients were unable to tolerate a 1, 000 mg/m2 dose level, and at 800 mg/m2, reVersible Grade III toxic ities, including elevated creatinine, proteinuria, hypon- atremia, abdominal pain, and intraabdominal bleeding were noted. No significant toxicity was noted up to a 600 mg/m2 dose level. The ratio of the peak peritoneal to peak plasma drug concentrations were 19.4, 16.6 and 22.8 at doses of 400 mg/m2, 600 mg/m2 and 800 mg/m2, respectively. The pharmacological advantage, expressed as the peritoneal to plasma AUC ratio ranged from 4.3 to 7.0. CONCLUSION: Heptaplatin can be delivered by an intra peritoneal route, with both an acceptable toxicity profile and a major pharmacokinetic advantage for cavity exposure. The MTD of intraperitoneal heptaplatin was 800 mg/m2. The major DLTs were nephrotoxicity and intraabdominal bleeding. The recommended starting dose for a subsequent study would be 600 mg/m2.

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Amplification and Overexpression of c-erbB-2 in Gastric Cancer: Si Youl Jun, Ho Young Chung, Seung Cheol Lee, Tae Lin Huh, Wansik Yu; J Korean Cancer Assoc. 2000;32(3):467-475.

Abstract PDF: PURPOSE
We compared c-erbB-2 oncogene amplification and oncoprotein expression, trying to identify the biologic and prognostic significance of c-erbB-2 in adendegrees Carcinoma of the stomach.
MATERIALS AND METHODS
Formalin-fixed, paraffin-embedded tissue sections from 43 cases of gastric cancer were analyzed for amplification of c-erbB-2 by differential polymerase chain reaction and for overexpression of gene product by immunohistdegrees Chemistry.
RESULTS
The amplification was detected in 13 cases (30%). Enhanced c-erbB-2 immunoreactivity was observed in 30% (13/43) of tumors. Tumors with gene amplification generally stained strongly (p=0.003). Although the frequency of amplification and overexpression of c-erbB-2 was increased with advanced gastric cancer and with lymph node metastasis, this difference was not statistically significant. c-erbB-2 gene amplification or protein overexpression showed a trend toward a better five year survival rate, but this did not reach a statistical significance.
CONCLUSION
Amplification and/or overexpression of the c-erbB-2 may be of value in clarifying the biologic characteristics of the human gastric cancer. However, more sensitive and more speci fic methods of identifying gene amplification are needed and the standardization of the staining method as well as guidelines for interpreting the staining result are mandatory for this purpose.

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Malignant Gastric Tumors Excluding Adenocarcinoma: Byung Jo Bae, Ki Ho Park, Soo Sang Sohn, Sun Kyo Song, Wansik Yu; J Korean Cancer Assoc. 1997;29(2):340-343.

Abstract PDF: No abstract available

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Complications of early postoperative intraperitoneal chemotherapy: Wansik Yu, Ilwoo Whang; J Korean Cancer Assoc. 1991;23(4):821-827.

Abstract PDF: No abstract available.

2,788 View
13 Download

Quantitative Analysis of Metastatic Lymph Nodes after Curative Surgery in Gastric Cancer: Wansik Yu, Yeon Sik Ji, Gyu Seok Choi, Ilwoo Whang, In Soo Suh; J Korean Cancer Assoc. 1997;29(1):62-68.

Abstract PDF: PURPOSE
A consecutive series of 710 patients who underwent curative gastrectomy for carcinoma was studied with a special reference to the number or frequency of lymph node metastasis and the patient's prognosis. MATERIAL AND METHODS: Survival rates were calculated by the Kaplan-Meier method, and the difference between each group was evaluated statistically by the log-rank method. Follow-up was obtained for 709 patients (99.9%).
RESULTS
According to the number of lymph nodal metastases, the five year survival rate for group 1 (1~3 positive nodes) was 50.9%; for group 2 (4~6 positive nodes), 56.7%; and for group 3 (more than 6 positive nodes), 12.0% (p<0.0001). According to the frequency of lymph node metastases, the five year survival rate for those with up to 25 per cent frequency of metastases was 47.5%; for those with up to 50 per cent frequency of metastases, 15.6%; and for those with greater than 50 per cent metastases, 6.3% (p<0.0001). According to the frequency of the regional lymph nodes (which include perigastric nodes along the lesser and greater curvatures, nodes located along the left gastric, common hepatic, splenic, and celiac arteries) metastasis, we categorized them as group 0 (N0: no metastasis), 1 (N1: metastasis in up to 25%), and 2 (N2: metastasis in greater than 25%).
CONCLUSION
This subdivision could be successfully applied to the clinical evaluation of gastric carcinoma (five year survival rate for N0, 86.9%; for N1, 49.0%; and for N2, 10.7% (p<0.0001)) without difficulty in dividing certain lymph nodes into the correct location.

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