Journal of Yeungnam Medical Science

Original article

Diagnostic performance of F-18 FDG PET or PET/CT for detection of recurrent gastric cancer: a systematic review and meta-analysis: Chang In Choi, Jae Kyun Park, Tae Yong Jeon, Dae-Hwan Kim; J Yeungnam Med Sci. 2023;40(Suppl):S37-S46. Published online August 17, 2023; DOI: https://doi.org/10.12701/jyms.2023.00220

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Abstract PDF: Background
This systematic review and meta-analysis investigated the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of disease recurrence after curative resection of gastric cancer.
Methods
The PubMed and Embase databases, from the earliest available date of indexing through November 30, 2019, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT to detect recurrent disease after gastric cancer surgery.
Results
Across 17 studies (1,732 patients), the pooled sensitivity for F-18 FDG PET or PET/CT was 0.82 (95% confidence interval [CI], 0.74–0.88) with heterogeneity of I2=76.5 (p<0.001), and the specificity was 0.86 (95% CI, 0.78–0.91) with heterogeneity of I2=94.2 (p<0.001). Likelihood ratio (LR) tests gave an overall positive LR of 6.0 (95% CI, 3.6–9.7) and negative LR of 0.2 (95% CI, 0.14–0.31). The pooled diagnostic odds ratio was 29 (95% CI, 13–63). The summary receiver operating characteristic curve indicates that the area under the curve was 0.91 (95% CI, 0.88–0.93).
Conclusion
The current meta-analysis showed good sensitivity and specificity of F-18 FDG PET or PET/CT for detecting recurrent disease after curative resection of gastric cancer despite heterogeneity in ethnicity, recurrence rate, histology, and interpretation method.

Case reports

Intraabdominal abscess mimicking gastric cancer recurrence: a case report: Yong-Eun Park; J Yeungnam Med Sci. 2023;40(4):426-429. Published online February 1, 2023; DOI: https://doi.org/10.12701/jyms.2022.00864

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Abstract PDF: Surgical site infection is a common healthcare-associated infection that rarely occurs several months after surgery. Herein, a case is described in which an abdominal mass lesion was found at a 6-month follow-up visit after gastrectomy was performed for early gastric cancer. Positron emission tomography-computed tomography revealed a 2.5 cm-sized mass with a high maximal standard uptake value (8.32), located above a previous anastomosis site. Locoregional recurrence of gastric cancer was diagnosed by multidisciplinary team discussion, and explorative laparotomy was performed. However, surgical and pathologic findings revealed that the mass was an intraabdominal abscess. In conclusion, differential diagnosis of delayed abscess formation should be considered if the possibility of tumor recurrence is low, especially after early gastric cancer surgery.

Adrenal insufficiency development during chemotherapy plus anti-programmed death receptor-1 monoclonal antibody (tislelizumab) therapy in patients with advanced gastric cancer: two case reports: Jin Ho Baek; J Yeungnam Med Sci. 2022;39(1):62-66. Published online April 19, 2021; DOI: https://doi.org/10.12701/yujm.2021.00934

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Abstract PDF

Immune checkpoint inhibitor (ICI)-associated adrenal insufficiency is rare but may become a serious adverse event in patients treated with ICIs. The present case report documents two cases of adrenal insufficiency developed during chemotherapy plus tislelizumab (百泽安, Baize’an; BeiGene Ltd.) therapy in patients with advanced gastric cancer. Adrenal insufficiency developed after 6 and 13 cycles of treatment and was well controlled with hydrocortisone. The patients also developed hypothyroidism, which was managed with levothyroxine. Two patients showed a partial response, and one patient out of two achieved a near-complete response, sustaining over 11 months. Increased awareness of ICI-related adrenal insufficiency is crucial for early detection and prompt management of patients treated with ICIs.

Citations

Citations to this article as recorded by

Immune checkpoint inhibitor-related adrenal hypofunction and Psoriasisby induced by tislelizumab: A case report and review of literature
Yisi Deng, Manling Huang, Runpei Deng, Jun Wang
Medicine.2024; 103(12): e37562. CrossRef
Severe thyrotoxicosis induced by tislelizumab: a case report and literature review
Liman Huo, Chao Wang, Haixia Ding, Xuelian Shi, Bin Shan, Ruoying Zhou, Ping Liang, Juan Hou
Frontiers in Oncology.2023;[Epub] CrossRef
Immune-related adverse events with severe pain and ureteral expansion as the main manifestations: a case report of tislelizumab-induced ureteritis/cystitis and review of the literature
Qihao Zhou, Zhiquan Qin, Peiyuan Yan, Qunjiang Wang, Jing Qu, Yun Chen
Frontiers in Immunology.2023;[Epub] CrossRef
Isolated Renal Calyceal Urothelial Carcinoma Effectively Treated With PD-1 Inhibitor Alone: A Case Report And Literature Review
Shihao Li, Yi Zhu, Zhijian Xu, Jianjun Liu, Hongwei Liu
Frontiers in Oncology.2022;[Epub] CrossRef

Case Reports

Metastatic eyelid cancer from gastric adenocarcinoma.: Ji Yoon Jung, Eun Joo Goo, Jae Chang Lee, Jay Song, Sung Ae Koh, Kyung Hee Lee, Young Kyung Bae; Yeungnam Univ J Med. 2016;33(2):142-145. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.142

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Abstract PDF: Gastric cancer is the most common cancer in Korean males and can easily spread to distant organs such as the liver, lungs, brain, or bones. However, skin metastasis, particularly of the eye, is rare. Metastatic eyelid cancer is extremely rare; metastases from internal organs have not been reported so far. We recently experienced a patient with metastatic eyelid cancer from adenocarcinoma of the stomach. A 62-year-old female was admitted with a right upper eyelid mass and foreign body sensation. She had a history of stomach cancer of 3 years. She was treated by chemotherapy and radiotherapy for pathologic fracture. After receiving supportive care for 2 years, the mass appeared on her right pupil. Punch-biopsy of the mass was performed and histological examination revealed adenocarcinoma, the same as the initial histological result. We report this case with a review of related literature.

Liver abscess and septic complications associated with advanced gastric cancer.: Gun Jung Youn, Young Choi, Min Jae Kim, Jae Sin Lee, Ui Won Ko, Yeon Ho Joo; Yeungnam Univ J Med. 2015;32(1):38-41. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.38

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Abstract PDF

Pyogenic liver abscess with metastatic septic complications is a rare and serious infectious disease if not treated properly. Pyogenic liver abscesses are caused by bacterial, fungal, or parasitic organisms. Escherichia coli used to be the predominant causative agent, but Klebsiella pneumoniae emerged as a major cause in the 1990s. Liver abscesses are caused by hepatic invasion via many routes, such as, the biliary tree, portal vein, hepatic artery, direct extension, or penetrating trauma. Furthermore, diabetes mellitus and malignant conditions are established important risk factors of K. pneumoniae liver abscesses and of septic metastasis, and several recent studies have asserted that K. pneumoniae liver abscess might be a presentation of occult or silent colon cancer. We report a case of K. pneumoniae liver abscess, metastatic septic pulmonary embolism, and endophthalmitis associated with diabetes and advanced gastric cancer.

Citations

Citations to this article as recorded by

Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia
Min Kyu Kang, Hee Jung Kwon, Min Cheol Kim
Yeungnam University Journal of Medicine.2020; 37(3): 246. CrossRef
A Case of Advanced Gastric Cancer Concomitant with Pyogenic Liver Abscess in the Patient with Subtotal Gastrectomy
Dong-Hee Park, Nae-Yun Heo, Heon Sa-Kong, Na-Ri Jeong, Su-Jin Jeong, Sung Jin Oh, Kyung Han Nam
The Korean Journal of Gastroenterology.2017; 69(2): 143. CrossRef

Original Articles

The Clinical Relevance of Distinguishing pT2 Gastric Cancer According to the Depth of Invasion and a Difference of Prognosis: Se Won Kim, Sun Kyo Song, Sang Woon Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S416-423. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S416

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Abstract PDF

Purpose：A difference of a pathologic characteristic in proportion to depth of invasion analyzed in T2 gastric cancer and a difference of depth of invasion examined an influence to lymph node metastasis and prognosis. Materials and Methods：The clinicopathologic outcomes of 432 patients who underwent curative resection for pT2 stage gastric cancers from 1995 to 1999 were reviewed retrospectively. We are compared on lymphatic metastasis, stage distribution, histologic classification, Bormann’s classification, Lauren classification, vessel invasion, lymphatic invasion, neural invasion and 5-year survival rate of pT2 groups(mp vs. ss).
Results
：pT2b(ss) group compare to pT2a(mp) in Lauren classification, ratio of diffused type was higher(p<0.05) and in Bormann classification, infiltration type was higher (p<0.01). Vessel and lymphatic invasion, neural invasion showed significant difference between pT2a(mp) and pT2b(ss) (p<0.01). Difference noted between pT2a(mp) and pT2b(ss) group in a lymph node metastatic rate, degree of a metastasis and stage distribution (p<0.01). On stratifying patients according to depth of invasion, 5-year suvival rate for those with pT2a(mp) group was significantly greater than those with pT2b(ss) group(82.4% vs. 47.4%, respectively: P<0.01). In this study, appeared with the significant prognostic factor in 5-year suvival rate which multivariate analysis, depth of invasion(P<0.05) and lymph node metastasis (P<0.01) that enforced the total gastric cancer patient who had T2 gastric cancer with the object noted, but for patients with accurately staged pN0 group, suvival characteristics were similar for pT2a (mp) and pT2b(ss) gastric cancer (P=0.97).
Conclusion
：The subclassification of pT2 gastric cancer into pT2a(mp) and pT2b(ss) is necessary to demonstrate their different prognosis.

Citations

Citations to this article as recorded by

The Analysis of Clinical Characteristics of pT2a and pT2b Gastric Cancer
Byoung Hyun Choi, Ji Hoon Kim, Jin Ho Kwak, Hyuck Jae Jang, Myung Sik Han
Journal of the Korean Surgical Society.2009; 77(4): 257. CrossRef

Efficacy and Side Effect of Docetaxel Based Chemotherapy as Second-Line Treatment in Recurrent Gastric Cancer: Se Won Kim, Sang Woon Kim, Sun Kyo Song; Yeungnam Univ J Med. 2007;24(2 Suppl):S399-406. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S399

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Abstract PDF: Purpose：To investigate the efficacy and safety of docetaxel based chemotherapy as a secondline treatment in patients with metastatic or recurrent gastric cancer. Materials and Methods：Between January 2001 and March 2007, 28 patients with recurrent or metastatic gastric cancer were enrolled. The administered doses of decetaxel was 75 mg/m² on day 1 and 5, cisplatin 60 mg/m² on day 3, 5-FU 600 mg/m² over 24 hrs on day 1 to day 5, every 4 weeks. The response was assessed every 2 cycles. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institute-common toxicity criteria (NCI-CTC).
Results
：For response rates, 3 (10.7%) partial response, 13 (46.4%) stable disease, and 12 (42.9%) progressive disease, respectively. The overall disease control rate was 57.1%. The median time to progression was 3.0 months (2-8 months). Median overall survival was 8 months (5-11 months). NCI-CTC grade 3 leukocytopenia occurred in 1 cases, grade 3 anemia in 1case and grade 3 nausea/vomiting in 2 cases.
Conclusion
：Docetaxel based chemotherapy has a tolerable efficacy with acceptable toxicities in patients with recurrent gastric cancer as a second-line treatment.

Efficacy of Unresectable or Recurred Gastric Cancer Treated with TS-1 Chemotherapy or TS-1/CDDP Combination Chemotherapy: Se Won Kim, Sang Woon Kim, Sun Kyo Song; Yeungnam Univ J Med. 2007;24(2 Suppl):S391-398. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S391

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Abstract PDF: Purpose：Although several chemotherapy regimens used against advanced and recurred gastric cancer have been studied extensively in an attempt to further improve the prognosis of patients, no standard chemotherapeutic regimens have been established. The aim of this study was to determine the anti-tumor efficacy and safety of TS-1 or TS-1 plus cisplatin (CDDP). Materials and Methods：From December 2004 to June 2007, we treated 43 patients with unresectable or recurred gastric cancer either with 80 mg/m2 of TS-1 for 28 days, which was followed by a 2-week rest, or with 80 mg/m² of TS-1 for 28 days and 60 mg/m² of CDDP on day 3 every 6 weeks.
Results
：Tumor response rates in the primary chemotherapy group and in the recurrent group were 46.7% and 21.4%, respectively. The median survival rates in the primary and the recurrent group were 14 months and 8 months, and it was not significantly different. But the one-year survival rates according to the kinds of regimens (TS-1 or TS-1/CDDP group) were significantly different (P=0.0014). The incidences of grade 3 or 4 adverse effects were 18%, respectively.
Conclusion
：The anti-tumor efficacy and safety of TS-1 and TS-1 plus CDDP in unresectable or recurred gastric cancer patients seemed to be high with modest adverse effects, thus suggesting the possible use of this regimen for unresectable or recurred gastric cancer patients.

Review Article

Treatment of Advanced Gastric Cancer: Sun-Kyo Song; Yeungnam Univ J Med. 2007;24(2 Suppl):S125-131. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S125

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Abstract PDF: Curative surgery is the most common and desirable treatment for advanced gastric cancer(AGC), but macroscopically curative resection of AGC dose not always mean a curative outcome. For the tailored management of AGC, accurate preoperative stage are made by using abdominal CT, FDG PET and laparoscopy is necessary. In case of T₃/T₄ lesion, neoadjuvant chemotherapy(NAC) and neoadjuvant chemoradiotherapy(NACR) are effective therapeutic approaches with acceptable toxicity without increasing surgical morbidity and mortality. I recommend the use of a multidisciplinary therapeutic strategy for treatment of AGC. Future applications of newer cytotoxic drugs such as oxaliplatin, capecitabine, irinotecan, and docetaxel or targeted therapies may help to improve the management of AGC.

Original Articles

The Comparison of Survival Rates of Postoperative Adjuvant Chemotherapies in The Stage III Gastric Cancer Patients.: Eun Mi Kim, Se Won Kim, Sang Woon Kim, Sun Kyo Song; Yeungnam Univ J Med. 2006;23(2):193-204. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.193

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Abstract PDF: PURPOSE: Various postoperative adjuvant chemotherapy regimens have been proposed for the patients with advanced gastric cancer. The majority of clinical trials have shown no significant difference in the survival benefit. The aim of this study was to compare the survival rates of postoperative adjuvant chemotherapies used in stage III gastric cancer patients who received curative gastrectomy. MATERIALS AND METHODS: Between 1990 and 1999, a survival analysis was performed in 260 patients who received curative gastric resection and postoperative adjuvant chemotherapy. The patients were divided into four groups according to the chemotherapeutic regimens received. The groups were: the F group: furtulon alone, FM group: furtulon and mitomycin, FAM group: 5-FU, adriamycin and mitomycin, FLEP group: 5-FU, leucovorin, etoposide and cisplatin. The survival rates were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: There were no differences among the groups of patients with regard to tumor characteristics except for lymph node metastasis and the ratio of metastasis to lymph nodes. In the FLEP group, the ratio of metastasis to lymph nodes was higher than in the other groups. The five and ten year survival rates of F, FM, FAM and FLEP were 51.9%, 28.9%, 59.5%, 49.8%, 66.1%, 57.4% and 30.0%, 27.5%, respectively. The univariate analysis showed that age, Borrmann type, lymph node metastasis, ratio of metastasis to lymph nodes, postoperative adjuvant chemotherapy and recurrence were significant factors for survival. For the multivariate analysis, recurrence, age, Borrmann type, ratio of lymph node metastasis and lymph node dissection were independent prognostic factors; however, the postoperative adjuvant chemotherapy was not an independent prognostic factor. CONCLUSION: The FAM regimen was the most beneficial postoperative adjuvant chemotherapy for improved survival rates; the FM regimen was the second and the FLEP regimen was the last. In order to determine the effectiveness of postoperative adjuvant chemotherapy in stage III gastric cancer, well designed prospective studies including a surgery only group will be needed.

The clinical relevance of nm23 protein expression in resected gastric cancer patient.: Sun Kyo Song, Hong Jin Kim, Sang Woon Kim; Yeungnam Univ J Med. 1999;16(1):43-51. Published online June 30, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.1.43

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Abstract PDF: The aim of present study was to elucidate whether the expression of nm23 protein might be of clinical value as prognostic factor in gastric cancer. The expression of nm23 protein was analyzed using immunohistochemical method in formalin-fixed and paraffin-embedded tissue samples of 76 gastric carcinoma patients. The cytoplasmic immunoreactivity of nm23 protein were detected in 53.9%(41/76). When the immunoreactivity of nm23 protein with TNM status and other histopathologic findings were compared by using Chi-Square test, nm23 was found to have correlations with the lymph node metastasis(p=0.04), the number of metastatic lymph node, and the invasion of lymphatic vessels(p=0.007). But, it has no correlation with TNM status. The conventional prognostic factors such as the depth of invasion, lymph node metastasis, distant metastasis, Borrmann type, size of tumor, and the curability of operation was found to have strong correlation with the survival time(p<0.003). But, the expression of nm23 protein was not significantly correlated with that in survival analysis. These results showed that the expression of nm23 protein is not a useful prognostic indicator in gastric cancer.

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