Purpose: There is no consensus regarding whether metastasectomy in gastric cancer patients with Krukenberg tumors (KTs) is associated with survival benefits. The aim of this study was to evaluate the treatment of KTs of gastric origin in a large series of patients and to identify prognostic factors affecting survival. Patients and Methods: All patients who were diagnosed with gastric cancer and ovarian metastases in a single medical center between January 2006 and December 2016 were identified and included. The patients were divided into two groups according to treatment modality: a metastasectomy group and a nonmetastasectomy group. Clinicopathological features and overall survival (OS) were compared between the groups. Results: In total, 182 patients were identified; 94 patients presented with synchronous KTs, and 88 developed metachronous KTs during follow-up. OS was significantly longer in the metastasectomy group than in the nonmetastasectomy group among those with synchronous (14.0 months vs 8.0 months; p = 0.001) and metachronous (14 months vs 8 months; p = 0.018) KTs. Multivariate analysis indicated that metastasectomy (hazard ratio [HR] 0.537; 95% confidence interval [CI] 0.344–0.839; p = 0.006), ascites (HR 1.523; 95% CI 1.058–2.193; p = 0.024), linitis plastica (HR 1.995; 95% CI 1.115–3.571; p = 0.020), and systemic chemotherapy (HR 0.456; 95% CI 0.280–0.742; p = 0.002) were independent predictors of OS. Conclusion: Metastasectomy combined with systemic chemotherapy should be performed in gastric cancer patients with synchronous or metachronous KTs. Metastasectomy, systemic therapy, linitis plastica, and ascites are prognostic factors for OS. Further prospective randomized studies are needed.

We designed the present work to explore the connection between sarcopenia and interleukin-16 (IL-16) expression and their integrated relation with gastric cancer (GC) survival. We deemed the sex-specific third lumbar vertebra skeletal muscle index cutoffs for sarcopenia to be ≤40.8 and ≤34.9 cm²/m² in male and female patients, respectively. Immunohistochemistry was carried out to detect IL-16 levels among GC tissues of the patients. We determined overall survival (OS) and relapse-free survival (RFS) by univariate and multivariate analyses. This study included 225 GC cases, with an average age of 62.7 years. There were 41 (18.2%) female patients, and 107 (47.5%) patients had sarcopenia. Sarcopenia and high IL-16 expression were identified as independent factors to predict OS (hazard ratios [HR] = 1.64 and 1.79, 95% confidence interval [CI] = 1.25–2.23 and 1.16–2.78, respectively) and RFS (HR = 1.43 and 1.60, 95% CI = 1.15–2.95 and 1.10–2.37, respectively). There were more cases showing high IL-16 expression detected in the sarcopenia group (55.7% vs. 37.3%, p = 0.003). Later, we grouped the patients with sarcopenia and IL-16 expression and discovered that the patients with sarcopenia and IL-16 upregulation displayed the poorest OS (HR = 3.02; 95% CI = 1.64–5.91) and RFS (HR = 2.34; 95% CI = 1.47–4.69). In conclusion, more IL-16 upregulation was noted in GC patients with sarcopenia. Sarcopenia accompanied by high IL-16 expression remarkably indicates a dismal prognosis in GC patients. This suggests that these biomarkers may be able to identify patients with GC with poor prognosis and enhance prognostication.

The postoperative survival rates of patients with gastric cancer at different stages treated at the National Cancer Center (NCC) of China have not been reported. Therefore, we evaluated the survival of patients with gastric cancer who underwent surgery at the NCC from 2011 to 2018 to provide baseline information for further studies. We identified 7,301 patients with primary gastric carcinoma who underwent surgery at the NCC between January 2011 and May 2018; among these, 5,008 patients were enrolled in this study. Follow up was completed on April 30, 2020. We analyzed the 5-year survival according to the stage, sex, age, and other clinicopathological features. Five-year survival rates of patients with pTNM stages IA, IB, IIA, IIB, IIIA, IIIB, IIIC, and IV treated at the NCC were 94.9%, 91.8%, 86.5%, 76.1%, 61.1%, 44.2%, 29.7%, and 8.1%, respectively, which were similar to those reported in Japan during the same period. Five-year survival rates of patients with ypTNM stages I, II, III, and IV were 93.1%, 63.2%, 27.2%, and 0.0%, respectively. In multivariable analysis, age, signet ring cell carcinoma, adjuvant chemotherapy, and degree of differentiation were revealed as important prognostic factors. The survival rates of patients with gastric cancer treated at the NCC have been significantly improved, reaching the levels of Japan in the same period.

A high Mandard score may indicate the tumor is insensitive to chemotherapy. We analyzed tumor regression and lymph node response under different Mandard scores to assess the impact of Mandard score on prognosis. Methods. Mandard scores and ypN stage of postoperative pathological reports were recorded. The results were reviewed by a professional pathologist. The radiologist compared the tumor regression before and after chemotherapy by computed tomography (CT). The survival of all patients was obtained by telephone follow-up. Multivariate Cox regression was used to assess the relationship between overall risk of death and Mandard score, imaging evaluation, and ypN stage. Results. In the Mandard score (4-5) group, the median survival time for PR and ypN0 patients was 68.5 and 76.7 months. While in the Mandard score (1-2) group, the median survival time for PD and ypN3a patients was 15.6 and 14.5 months. Imaging evaluation of tumor regression (PR 68.5 months, SD 27.8 months, and PD 10.2 months) and lymph node remission (ypN0 76.7 months, ypN1 61.6 months, ypN2 18.0 months, ypN3a 18.7 months, and ypN3b 18.3 months) showed improved survival. Mandard score, imaging evaluation, and ypN stage are important prognostic factors affecting prognosis. Conclusion. A high Mandard score does not mean neoadjuvant chemotherapy is ineffective in gastric cancer. Patients with imaging evaluation of tumor regression and ypN stage reduction may benefit from neoadjuvant chemotherapy.

For Siewert type II/III adenocarcinoma of gastroesophageal junction (AGE), the efficacy of adjuvant chemoradiotherapy (CRT) after D2/R0 resection remains uncertain. To determine whether CRT was superior to chemotherapy (CT) alone after D2/R0 resection for locally advanced Siewert type II/III AGE. We identified 316 locally advanced Siewert type II/III AGE patients who were treated with D2/R0 resection at National Cancer Center from 2011 to 2018. 57 patients received adjuvant CRT and 259 patients received adjuvant CT. We followed patients for overall survival (OS), relapse-free survival, and recurrence pattern. Five-year OS rates of the CRT group and the CT group for all patients were 66.7% and 41.9% (P = 0.010). Five-year OS rates of the CRT group and the CT group for Siewert type III AGE patients were 65.7% and 43.9% (P = 0.006). Among the 195 patients whose recurrence information could be obtained, 18 cases (34.6%) and 61 cases (42.7%) were diagnosed as recurrence in the CRT group and CT group, respectively. The local and regional recurrence rates in the CRT group were lower than that in the CT group (22.2% vs 24.6%, 27.8% vs 39.3%). Multivariable cox regression analysis showed that vascular invasion, nerve invasion, and adjuvant CRT were important prognostic factors for Siewert type III AGE. For locally advanced Siewert type III AGE, adjuvant CRT may prolong OS and reduce the regional recurrence rate.