Contrast-enhanced ultrasonography assessment of gastric cancer response to neoadjuvant chemotherapy

AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound(DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuvant chemotherapy followed by curative resection between September 2011 and February 2012 were analyzed.Pre-operative chemotherapy regimens of fluorouracil + oxaliplatin or S-1 + oxaliplatin were administered in 2-4 cycles over 6-12 wk periods.All patients underwent contrast-enhanced computed tomography(CT) scan and DCUS before and after two courses of pre-operative chemotherapy.The therapeutic response was assessed by CT using the response evaluation criteria in solid tumors(RECIST 1.1) criteria.Tumor area was assessed by DCUS as enhanced appearance of gastric carcinoma due to tumor vascularity during the contrast phase as compared to the normal gastric wall.Histopathologic analysis was carried out according to the Mandard tumor regression grade criteria and used as the reference standard.Receiver operating characteristic(ROC) analysis was used to evaluate the efficacy of DCUS parameters in differentiating histopathological responders from non-responders.RESULTS:The study population consisted of 32 men and 11 women,with mean age of 59.7 ± 11.4 years.Neither age,sex,histologic type,tumor site,T stage,nor N stage was associated with pathological response.The responders had significantly smaller mean tumor size than the non-responders(15.7 ± 7.4 cm vs 33.3 ± 14.1 cm,P < 0.01).According to Mandard's criteria,27 patients were classified as responders,with 11(40.7%) showing decreased tumor size by DCUS.In contrast,only three(18.8%) of the 16 non-responders showed decreased tumor size by DCUS(P < 0.01).The area under the ROC curve was 0.64,with a 95%CI of 0.46-0.81.The effects of several cut-off points on diagnostic parameters were calculated in the ROC curve analysis.By maximizing Youden's index(sensitivity + specificity-1),the best cut-off point for distinguishing responders from non-responders was determined,which had optimal sensitivity of 62.9% and specificity of 56.3%.Using this cut-off point,the positive and negative predictive values of DCUS for distinguishing responders from non-responders were 70.8% and 47.4%,respectively.The overall accuracy of DCUS for therapeutic response assessment was 60.5%,slightly higher than the 53.5% for CT response assessment with RECIST criteria(P = 0.663).Although the advantage was not statistically significant,likely due to the small number of cases assessed.DCUS was able to identify decreased perfusion in responders who showed no morphological change by CT imaging,which can be occluded by such treatment effects as fibrosis and edema.CONCLUSION:DCUS may represent an innovative tool for more accurately predicting histopathological response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer.

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Objective:The study compared laparoscopy-assisted gastrectomy(LAG) with open gastrectomy(OG) in the management of advanced gastric cancer(AGC).Methods:Literature search was performed in the Medline,Embase,and Cochrane Library databases to identify control studies that compared LAG and OG for AGC.A meta-analysis was conducted to examine the surgical safety and oncologic adequacy,using the random-effect model.Results:Seven eligible studies including 815 patients were analyzed.LAG was associated with less blood loss,less use of analgesics,shorter time of flatus and periods of hospital stay,but longer time of operation.The incidence of most complications was similar between the two groups.However,LAG was associated with a lower rate of pulmonary infection(odds ratio(OR) 0.19;95% confidence interval(CI) 0.05 to 0.68;P<0.05).No significant differences were noted in terms of the number of harvested lymph nodes(weighted mean difference(WMD) 1.165;95% CI-2.000 to 4.311;P>0.05),overall mortality(OR 0.65;95% CI 0.39 to 1.10;P>0.05),cancer-related mortality(OR 0.64;95% CI 0.32 to 1.25;P>0.05),or recurrence(OR 0.62;95% CI 0.33 to 1.16;P>0.05).Conclusions:LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG.No differences were found in long-term outcomes.However,these results should be validated in large randomized controlled studies(RCTs) with sufficient follow-up.

HER-2 overexpression and survival in colorectal cancer: a meta-analysis

Objective： Numerous studies examining the relationship between human epidermal growth factor receptor 2 （HER-2） overexpression and survival in patients with colorectal cancer （CRC） have yielded controversial results. We therefore performed a meta-analysis more precisely to estimate its prognostic value. Methods： Published studies investigating the effect of HER-2 overexpression on CRC survival were identified; the hazard ratios （HRs） and their corresponding 95% confidence intervals （95% Cls） were pooled in terms of disease-specific or overall survival. Results Eleven studies were included in the meta-analysis. The pooled data showed that HER-2 overexpression was negatively related to CRC survival （HR=1.10, 95% CI： 0.77-1.44）. Subgroup analyses regarding test method and study quality also demonstrated little association between HER-2 overexpression and CRC survival （HR=0.89, 95% CI： 0.50-1.29; HR=0.90, 95% Ch 0.43-1.37, respectively）, Conclusions： Regardless of several limitations, our study suggested that HER-2 overexpression probably had little impact on CRC survival.