Surgical management of gastric cancer improves survival.However,for some time,surgeons have had diverse opinions about the extent of gastrectomy.Researchers have conducted many clinical studies,making slow but steady ...Surgical management of gastric cancer improves survival.However,for some time,surgeons have had diverse opinions about the extent of gastrectomy.Researchers have conducted many clinical studies,making slow but steady progress in determining the optimal surgical approach.The extent of lymph node dissection has been one of the major issues in surgery for gastric cancer.Many trials demonstrated that D2 dissection resulted in greater morbidity and mortality than D1 dissection.However,long-term outcomes demonstrated that D2 dissection resulted in longer survival than D1 dissection.In 2004,the Japan Clinical Oncology Group reported a pivotal trial which was performed to determine whether para-aortic lymph node dissection combined with D2 dissection was superior to D2 dissection alone and found no benefit of the additional surgery.Gastrectomy with pancreatectomy,splenectomy,and bursectomy was initially recommended as part of the D2 dissection.Now,pancreas-preserving total gastrectomy with D2 dissection is standard,and ongoing trials are addressing the role of splenectomy.Furthermore,the feasibility and safety of laparoscopic gastrectomy are well established.Survival and quality of life are increasingly recognized as the most important endpoints.In this review,we present perspectives on surgical techniques and important trials of these techniques in gastric cancer patients.展开更多
Gastroesophageal adenocarcinomas (GEACs) remain a global health problem. These are most often diagnosed at advanced stage and the estimated 5-year relative survival rate is about 5％. Although cure is not possible for...Gastroesophageal adenocarcinomas (GEACs) remain a global health problem. These are most often diagnosed at advanced stage and the estimated 5-year relative survival rate is about 5％. Although cure is not possible for patients with advanced GEAC, systemic therapy (chemotherapy or biochemotherapy) can palliate symptoms, improve survival and provide a better quality of life. One of the most promising options for some patients with advanced stage GEAC is immunotherapy, which can result in durable responses. Numerous phase Ⅲ trials evaluating targeted therapies in different lines are ongoing and it is hoped that better bio-markers will emerge to identify patients who can benefit from targeted agents and immunotherapy in the future. Surgery remains as the corner stone for localized GEAC and adjunctive therapies can increase the survival rates by about 10％. The high toxicity and low completion rates of adjuvant therapy led to the strategies of preoperative treatment. With the results of ongoing pre-operative therapy trials we will be able to determine the optimal adjunctive approach for resectable GEAC.展开更多
Epigenetic alterations,including DNA methylation,histone modification,loss of genome imprinting,chromatin remodeling and non-coding RNAs,are associated with human carcinogenesis.Among them,DNA methylation is a fundame...Epigenetic alterations,including DNA methylation,histone modification,loss of genome imprinting,chromatin remodeling and non-coding RNAs,are associated with human carcinogenesis.Among them,DNA methylation is a fundamental epigenetic process to modulate gene expression.In cancer cells,altered DNA methylation includes hypermethylation of site-specific CpG island promoter and global DNA hypo-methylation.Detection of aberrant gene promoter methylation has been applied to the clinic to stratify risk in cancer development,detect early cancer and predict clinical outcomes.Environmental factors associated with carcinogenesis are also significantly related to aberrant DNA methylation.Importantly,epigenetic changes,including altered DNA methylation,are reversible and thus,used as targets for cancer therapy or chemoprevention.An increasing number of recent studies reported DNA methylation level to be a useful biomarker for diagnosis,risk assessment and prognosis prediction for gastrointestinal(GI)cancers.This review summarized the accumulated evidence for clinical application to use aberrant DNA methylation levels in GI cancers,including colorectal,gastric and esophageal cancer.展开更多
Gastric adenocarcinoma(GAC)is estimated as the fifteenth most common cancer in the USA.Incidence rate has been gradually decreasing,but prognosis remains dismal.For patients with locally advanced GAC(stage>T1B and&...Gastric adenocarcinoma(GAC)is estimated as the fifteenth most common cancer in the USA.Incidence rate has been gradually decreasing,but prognosis remains dismal.For patients with locally advanced GAC(stage>T1B and<T4B),multimodality therapies,such as surgery,chemotherapy,and radiation therapy,are needed.Perioperative chemotherapy or postoperative chemoradiation/chemotherapy is recommended.For metastatic GAC patients,combination of two cytotoxics(platinum compound and fluoropyrimidine)has become a common place in the USA,and when HER2 is positive,trastuzumab is added.When GAC progresses after the first line therapy,additional biomarkers(microsatellite instability and programmed death ligand 1)should be tested so that checkpoint inhibitors can be used.Overall,the options for advanced GAC patients are limited and more research is needed.展开更多
基金supported by multidisciplinary grants from The University of Texas MD Anderson Cancer Centersupported in part by the National Cancer Institute,National Institutes of Health(No.CAl 38671, CAl72741,and CAl50334 to JAA)the Biostatistics Resource Group(No. P30CA016672)
文摘Surgical management of gastric cancer improves survival.However,for some time,surgeons have had diverse opinions about the extent of gastrectomy.Researchers have conducted many clinical studies,making slow but steady progress in determining the optimal surgical approach.The extent of lymph node dissection has been one of the major issues in surgery for gastric cancer.Many trials demonstrated that D2 dissection resulted in greater morbidity and mortality than D1 dissection.However,long-term outcomes demonstrated that D2 dissection resulted in longer survival than D1 dissection.In 2004,the Japan Clinical Oncology Group reported a pivotal trial which was performed to determine whether para-aortic lymph node dissection combined with D2 dissection was superior to D2 dissection alone and found no benefit of the additional surgery.Gastrectomy with pancreatectomy,splenectomy,and bursectomy was initially recommended as part of the D2 dissection.Now,pancreas-preserving total gastrectomy with D2 dissection is standard,and ongoing trials are addressing the role of splenectomy.Furthermore,the feasibility and safety of laparoscopic gastrectomy are well established.Survival and quality of life are increasingly recognized as the most important endpoints.In this review,we present perspectives on surgical techniques and important trials of these techniques in gastric cancer patients.
文摘Gastroesophageal adenocarcinomas (GEACs) remain a global health problem. These are most often diagnosed at advanced stage and the estimated 5-year relative survival rate is about 5％. Although cure is not possible for patients with advanced GEAC, systemic therapy (chemotherapy or biochemotherapy) can palliate symptoms, improve survival and provide a better quality of life. One of the most promising options for some patients with advanced stage GEAC is immunotherapy, which can result in durable responses. Numerous phase Ⅲ trials evaluating targeted therapies in different lines are ongoing and it is hoped that better bio-markers will emerge to identify patients who can benefit from targeted agents and immunotherapy in the future. Surgery remains as the corner stone for localized GEAC and adjunctive therapies can increase the survival rates by about 10％. The high toxicity and low completion rates of adjuvant therapy led to the strategies of preoperative treatment. With the results of ongoing pre-operative therapy trials we will be able to determine the optimal adjunctive approach for resectable GEAC.
文摘Epigenetic alterations,including DNA methylation,histone modification,loss of genome imprinting,chromatin remodeling and non-coding RNAs,are associated with human carcinogenesis.Among them,DNA methylation is a fundamental epigenetic process to modulate gene expression.In cancer cells,altered DNA methylation includes hypermethylation of site-specific CpG island promoter and global DNA hypo-methylation.Detection of aberrant gene promoter methylation has been applied to the clinic to stratify risk in cancer development,detect early cancer and predict clinical outcomes.Environmental factors associated with carcinogenesis are also significantly related to aberrant DNA methylation.Importantly,epigenetic changes,including altered DNA methylation,are reversible and thus,used as targets for cancer therapy or chemoprevention.An increasing number of recent studies reported DNA methylation level to be a useful biomarker for diagnosis,risk assessment and prognosis prediction for gastrointestinal(GI)cancers.This review summarized the accumulated evidence for clinical application to use aberrant DNA methylation levels in GI cancers,including colorectal,gastric and esophageal cancer.
文摘Gastric adenocarcinoma(GAC)is estimated as the fifteenth most common cancer in the USA.Incidence rate has been gradually decreasing,but prognosis remains dismal.For patients with locally advanced GAC(stage>T1B and<T4B),multimodality therapies,such as surgery,chemotherapy,and radiation therapy,are needed.Perioperative chemotherapy or postoperative chemoradiation/chemotherapy is recommended.For metastatic GAC patients,combination of two cytotoxics(platinum compound and fluoropyrimidine)has become a common place in the USA,and when HER2 is positive,trastuzumab is added.When GAC progresses after the first line therapy,additional biomarkers(microsatellite instability and programmed death ligand 1)should be tested so that checkpoint inhibitors can be used.Overall,the options for advanced GAC patients are limited and more research is needed.
