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  • American Society of Clinical Oncology (ASCO)  (7)
  • Pawlik, Timothy M.  (7)
  • 1
    Online Resource
    Online Resource
    The prognostic value of preoperative helicobacter pylori infection in resected gastric cancer.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 137-137
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 137-137
    Abstract: 137 Background: Limited data exist on the prognostic implication of pre-operative Helicobacter pylori (H. pylori) infection in gastric adenocarcinoma (GAC). Our aim was to assess the association of H. pyloriwith recurrence and survival in patients undergoing resection of GAC. Methods: All patients who underwent curative intent resection for GAC from 2000 to 2012 at seven academic institutions comprising the US Gastric Cancer Collaborative were included. 30-day mortalities were excluded. Survival analyses were conducted with Kaplan Meier log rank and multivariate Cox regression. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS). Results: Of 965 patients, 559 met inclusion criteria and had documented pre-operative H. pylori testing. 18.6% (n=104) of patients tested positive for H. pylori pre-operatively. Data regarding treatment of H. pylori was not available. H. pylori infection was associated with younger age (62.1 vs 65.1 years; p=0.041), distal tumor location (82.7% vs 71.9%; p=0.033), and receipt of adjuvant radiation therapy (47.0% vs 34.9%; p=0.032). There were no significant differences in ASA class, margin status, Grade, PNI, LVI, or nodal metastases. The distribution of TNM stage I-III was similar between the two groups. H. pylori status was not associated with tumor recurrence. However, pre-operative H. pylori infection was associated with longer OS (84.3 mo vs 44.2 mo; p=0.008). When accounting for differences in age, tumor location, and delivery of radiation therapy, H. pylori infection persisted as a positive prognostic factor for OS (HR 0.60; CI 0.40-0.91; p = 0.016). Conclusions: Patients with and without preoperative H. pylori infection had no significant differences in adverse pathologic factors including positive margin, high grade, lymph node metastases, or advanced TNM stage. Despite similar disease presentation, pre-operative H. pylori infection was independently associated with improved overall survival. Further studies examining the interaction between H. pylori and tumor immunology and genetics are needed to better understand the relationship between H. pylori and survival in gastric cancer.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.137
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 2
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    The prognostic value of signet ring cell histology in resected gastric cancer.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 128-128
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 128-128
    Abstract: 128 Background: Conflicting data exist on the prognostic implication of signet ring cell (SRC) histology in gastric adenocarcinoma (GAC). Our aim was to assess the association of SRC with recurrence and survival in patients undergoing resection of GAC. Methods: All pts who underwent curative intent resection for GAC from 2000 to 2012 at 7 academic institutions comprising the US Gastric Cancer Collaborative were included. 30-day mortalities were excluded. Survival analyses included Kaplan Meier log rank and multivariate Cox regression. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS). Stage-specific analysis was performed. Results: Of 965 pts, 768 met inclusion criteria. SRC was present in 39.5% and was associated with female gender (52.9% vs 38.6%; p 〈 0.001), younger age (61 vs 67 yrs; p 〈 0.001), poor differentiation (94.8% vs 50.3%; p 〈 0.001), perineural invasion (PNI: 41.4% vs 23%; p 〈 0.001), distal location (82.2% vs 70.1%; p 〈 0.001), receipt of adjuvant therapy (63% vs 51.2%; p=0.002), and more advanced stage (Stage 3: 55.2% vs 36.5%; p 〈 0.001). SRC was associated with earlier recurrence (56.7mo vs median not reached (MNR); p=0.009) and decreased OS (33.7mo vs 46.6mo; p=0.011). When accounting for other adverse pathologic features, PNI (HR 1.57; p=0.016) and higher TNM stage (HR 2.63; p 〈 0.001) were associated with decreased RFS, but SRC was not. PNI (HR 1.53; p=0.006), higher TNM Stage (HR 2.10; p 〈 0.001), greater size (HR 1.05; p=0.014), and adjuvant therapy (HR 0.50; p 〈 0.001) were associated with OS. SRC was not an independent predictor of OS. Stage-specific analysis showed no association between SRC and RFS or OS in Stage 1 or 3. In Stage 2, SRC was associated with earlier recurrence (38.1mo vs MNR; p=0.005) but not OS. The negative association of SRC with decreased RFS persisted in multivariate analysis (HR 3.11; p=0.015). Conclusions: Signet ring histology is associated with other adverse pathologic features including higher grade and higher TNM stage but is not independently associated with reduced RFS or OS. Identification of signet ring histology during preoperative evaluation should not, in isolation, dictate treatment strategy.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.128
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 3
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    The optimal length of the proximal resection margin in patients with proximal gastric adenocarcinoma: A multi-institutional study of the U.S. Gastric Cancer Collaborative.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 108-108
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 108-108
    Abstract: 108 Background: A 5cm margin is advocated for distal gastric cancers. The optimal length of the proximal resection margin (PM) for proximal (GEJ Siewert II and III, cardia, and fundus) gastric adenocarcinoma (GAC) is not established. Methods: Patients who underwent curative intent abdominal-approach resection for proximal GAC from 2000-2012 at 7 academic US institutions were included. Patients with positive distal margins were excluded. PM length was analyzed by 0.5cm increments and was also dichotomized at the mean and median value. Primary endpoints were local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS). Results: Out of 965 patients, 211 had proximal GAC, and 162 had data available on PM length. 151 patients had negative microscopic margins with a mean value of 2.6cm and a median of 1.7cm (range 0.1-15cm). When PM length was sequentially dichotomized and analyzed at 0.5cm increments (0.5-6.5cm), a greater margin distance for each analysis was not associated with LR, RFS, or OS. Similarly, a PM distance greater than the mean or median value was not associated with LR, RFS, or OS. 11 patients had a positive PM (R1), which was associated with higher N-stage (N3: 73% vs 26%; p=0.007) and increased LR (HR6.1; p=0.009). When accounting for other adverse prognostic factors (grade, lymphovascular invasion, tumor size, T-stage, and N-stage), a positive PM was not independently associated with LR. A positive PM was also not associated with decreased RFS or OS. Conclusions: For an abdominal-approach resection of proximal gastric adenocarcinoma, the length of the proximal margin is not associated with local recurrence, recurrence-free survival, or overall survival. A positive microscopic margin is associated with advanced N-stage but is not independently associated with recurrence or survival. When performing an abdominal-approach resection of proximal gastric adenocarcinoma, a grossly negative proximal margin is sufficient. Efforts to achieve a specific margin distance, especially if it necessitates an esophagectomy, should be abandoned.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.108
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 4
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    Value of peritoneal drain placement after total gastrectomy for gastric adenocarcinoma: A multi-institutional analysis from the U.S. Gastric Cancer Collaborative.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 131-131
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 131-131
    Abstract: 131 Background: A recent randomized trial of peritoneal drain (PD) placement after pancreaticoduodenectomy concluded that placement of PDs decreased the frequency and severity of complications. The role of PD placement after total gastrectomy for gastric adenocarcinoma (GAC) is not well-established. Methods: Patients who underwent total gastrectomy for GAC at 7 institutions from the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Univariate and multivariate analyses were performed to evaluate the association of PD placement with postoperative outcomes. Results: 344 patients were identified and anastomotic leak rate was 9%.253 (74%) patients received a PD. Those with PD placed had similar ASA class, tumor size, TNM stage, and need for additional organ resection when compared to their counterparts with no PD. No difference was observed in the rate of any complication (54% vs. 48%;p=0.45), major complication (25% vs. 24%;p=0.90), or 30-day mortality (7% vs. 4%;p=0.51) between the two groups. In addition, no difference in anastomotic leak (9% vs. 10%;p=0.90), need for secondary drainage (10% vs. 9%;p=0.92), or reoperation (13% vs. 8%;p=0.28) was identified. On multivariate analysis, PD placement was not associated with a decrease in frequency or severity of postoperative complications. Subset analysis of patients stratified by whether they underwent concomitant pancreatectomy similarly demonstrated no association of PD placement with reduced complications or mortality. In patients who experienced an anastomotic leak (n=31), placement of PD was similarly not associated with a decrease in complications, need for secondary drainage, or mortality. Conclusions: Peritoneal drain placement after total gastrectomy for adenocarcinoma, regardless of concomitant pancreatectomy, is not associated with a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, or decrease in the need for secondary drainage procedures or reoperation. Routine use of peritoneal drains is not warranted.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.131
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 5
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    The effect of perioperative transfusion on recurrence and survival following gastric cancer resection: A seven-institution analysis of 765 patients from the U.S. Gastric Cancer Collaborative.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 3_suppl ( 2014-01-20), p. 100-100
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 3_suppl ( 2014-01-20), p. 100-100
    Abstract: 100 Background: Whether perioperative blood transfusion has a negative prognostic effect on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) is unknown. Methods: All patients who underwent resection for GAC from 2000-2012 at 7 institutions were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate (UV) and multivariate (MV) regression analyses. Results: Out of 965 pts, 765 underwent curative intent, R0 resection. Median FU for survivors was 44 mos; 30-day deaths were excluded. Median estimated blood loss (EBL) was 250cc and 166 pts (22%) received perioperative RBC transfusions. 5-yr RFS was 51% in transfused and 61% in non-transfused patients (p=0.01). Median OS was decreased in patients receiving transfusions (19 vs 50 mos, p 〈 0.001). On MV analysis, transfusion remained an independent risk factor for decreased RFS (HR 2.8; 95% CI: 1.2-6.5; p=0.01) and decreased OS (Table), regardless of EBL or need for splenectomy. Timing (intraop vs postop) and volume (# of units) did not alter the effect of transfusion on survival. Non-transfused pts were more likely to receive adjuvant therapy (56% vs 44%; p=0.01). Conclusions: Perioperative blood transfusion is associated with decreased recurrence-free and overall survival following resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.3_suppl.100
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 6
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    An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. Gastric Cancer Collaborative.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 120-120
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 120-120
    Abstract: 120 Background: A recent single institutional study demonstrated that jejunostomy feeding tubes (J-tubes) placed during resection of gastric adenocarcinoma (GAC) are associated with increased complications and no change in receipt of adjuvant therapy. Our aim was to validate these findings in a large multi-institutional cohort. Methods: All patients who underwent resection for GAC at 7 institutions participating in the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Patients with metastatic disease were excluded. Univariate and multivariate logistic regression were performed to assess the association of J-tubes with postoperative complications and receipt of adjuvant therapy. Subset analysis of patients who underwent total vs subtotal gastrectomy was also performed. Results: Of 965 patients, 837 were included for analysis, of whom 265 (32%) received a J-tube. Patients receiving J-tubes demonstrated greater incidence of preoperative weight loss, lower BMI, greater extent of resection, and more advanced TNM stage. J-tube placement was associated with increased infectious complications (36% vs 19%;p 〈 0.001), including surgical site infections (14% vs 6%;p 〈 0.001) and deep intra-abdominal infections (11% vs 4%;p 〈 0.001). On multivariate analysis, J-tubes remained independently associated with increased risk of infectious complications (HR=1.93;p=0.001), surgical site infections (HR=2.85;p=0.001), and deep intra-abdominal infections (HR=2.13;p=0.04). J-tubes were not associated with increased receipt of adjuvant therapy (HR=0.82;p=0.34). Subset analysis of patients undergoing total and subtotal gastrectomy similarly demonstrated an association of J-tubes with increased risk of infectious outcomes andno association with increased receipt of adjuvant therapy. Conclusions: J-tubes placed during resection of gastric adenocarcinoma are independently associated with increased postoperative infections and are not associated with increased receipt of adjuvant therapy, despite being placed in patients with advanced TNM stage tumors. Selective use of J-tubes is recommended.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.120
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 7
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    Utility of the proximal margin frozen section for resection of gastric adenocarcinoma: A 7-institution study of the U.S. gastric cancer collaborative.
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 3_suppl ( 2014-01-20), p. 103-103
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 3_suppl ( 2014-01-20), p. 103-103
    Abstract: 103 Background: The proximal gastric margin dictates the extent of resection for gastric adenocarcinoma (GAC). The value of achieving negative margins by additional gastric resection after a positive proximal margin frozen section (FS) is unknown. Methods: The US Gastric Cancer Collaborative includes all patients who had resection of GAC at 7 institutions by oncologic surgeons from 2000-2012. Intraoperative proximal margin FS data were classified as R0 or R1 based on final permanent section (PS); positive distal margins were excluded. Primary aim was to evaluate the impact on local recurrence (LR) of converting a positive proximal margin FS to an R0 final margin by additional resection. Secondary endpoints were recurrence-free (RFS) and overall survival (OS). Results: Of 860 pts, 520 had a proximal margin FS; 67 were positive. Of these 67, 48 were converted to R0 on PS by additional resection. R0 proximal margin was achieved in 447 pts (86%), R1 in 25 (5%), and R1 converted to R0 in 48 (9%). Median FU was 44 mos. Although LR was decreased in the converted R1 to R0 group compared to the R1 group (10% vs 32%, p=0.01), when accounting for other pathologic variables on multivariate (MV) analysis, R1 to R0 conversion was not associated with decreased LR. Median RFS was similar between the R1 to R0 and R1 cohort (37 vs 31 mos; p=0.6) compared to 110 mos for the R0 group. Median OS was similar between the R1 to R0 conversion and R1 groups (36 vs 26 mos; p=0.14) compared to 50 mos for the R0 group. On MV analysis, increasing T-stage and positive lymph nodes were associated with worse OS; R1 to R0 conversion of the proximal margin was not associated with improved OS (p=0.5; Table). Conclusions: Conversion of a positive intraoperative proximal margin frozen section during gastric cancer resection does not decrease local recurrence or improve recurrence-free or overall survival. This may guide decisions regarding the extent of resection. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2014.32.3_suppl.103
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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