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LOCAL ADVANCED GASTRIC CANCER:
OPTIMIZATION OF MANAGEMENT
OBJECTIVE: Search of best treatment plan for local advanced gastric
cancer (GC) patients (GCP) (T4bN0-2M0) was realized.
METHODS: We analyzed data of 144 consecutive GCP (age=55.7±9.5
years; tumor size=8±3 cm) radically operated (R0) and monitored in 1975-
2015 (m=95, f=49; total gastrectomy=41, distal gastrectomy=70, proximal
gastrectomy=33, combined gastrectomy with resection of 1-6 adjacent
organs (pancreas, liver, diaphragm, colon transversum, splenectomy,
small intestine, kidney, adrenal gland, etc.)=144; T4b=144; M1=0; N0=47,
N1=10, N2=87; G1=37, G2=25, G3=82; only surgery-S=97, adjuvant
treatment-AT=47 (chemoimmunotherapy: 5-FU + thymalin/taktivin).
Survival curves were estimated by the Kaplan-Meier method. Differences
in curves between groups of GCP were evaluated using a log-rank test.
Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap simulation and
neural networks computing were used to determine any significant
dependence.
RESULTS: For total of 144 GCP overall life span (LS) was 1685.3±2100.3
days, (median=728 days) and cumulative 5-year survival (5YS) reached
43.9%, 10 years – 36.5%, 20 years – 30.4%. 40 GCP lived more than 5 years
without GC progressing. 72 GCP died because of GC during the first 5
years after surgery. 5YS was superior significantly after AT (69.3%)
compared with S (35.1%) (P=0.001 by log-rank test). Cox modeling
displayed that 5YS significantly depended on: phase transition (PT) N0-
N12 in term of synergetics, tumor growth, histology, localization, age, AT,
ESS, color index, blood chlorides, hemorrhage time (P=0.000-0.049).
Neural networks computing, genetic algorithm selection and bootstrap
simulation revealed relationships between 5YS and PT N0-N12 (rank=1),
color index (rank=2), eosinophils (3), ESS (4), age (5),
thrombocytes/cancer cells – CC (6), eosinophils/CC (7), healthy cells/CC
(8), AT (9). Correct prediction of 5YS was 100% by neural networks
computing.
CONCLUSIONS: Optimal management strategies for local advanced
GCP are: 1) availability of experienced surgeons because of complexity of
radical procedures; 2) aggressive en block surgery and adequate lymph
node dissection for completeness; 3) high-precision prediction;
4) adjuvant treatment for GCP with unfavorable prognosis.
Oleg Kshivets, MD, PhD Surgery Department, Kaluga Cancer Center, Kaluga, Russia
P-098

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Kshivets Oleg Local Advanced Gastric Cancer: Optimization of Management

  • 1. LOCAL ADVANCED GASTRIC CANCER: OPTIMIZATION OF MANAGEMENT OBJECTIVE: Search of best treatment plan for local advanced gastric cancer (GC) patients (GCP) (T4bN0-2M0) was realized. METHODS: We analyzed data of 144 consecutive GCP (age=55.7±9.5 years; tumor size=8±3 cm) radically operated (R0) and monitored in 1975- 2015 (m=95, f=49; total gastrectomy=41, distal gastrectomy=70, proximal gastrectomy=33, combined gastrectomy with resection of 1-6 adjacent organs (pancreas, liver, diaphragm, colon transversum, splenectomy, small intestine, kidney, adrenal gland, etc.)=144; T4b=144; M1=0; N0=47, N1=10, N2=87; G1=37, G2=25, G3=82; only surgery-S=97, adjuvant treatment-AT=47 (chemoimmunotherapy: 5-FU + thymalin/taktivin). Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence. RESULTS: For total of 144 GCP overall life span (LS) was 1685.3±2100.3 days, (median=728 days) and cumulative 5-year survival (5YS) reached 43.9%, 10 years – 36.5%, 20 years – 30.4%. 40 GCP lived more than 5 years without GC progressing. 72 GCP died because of GC during the first 5 years after surgery. 5YS was superior significantly after AT (69.3%) compared with S (35.1%) (P=0.001 by log-rank test). Cox modeling displayed that 5YS significantly depended on: phase transition (PT) N0- N12 in term of synergetics, tumor growth, histology, localization, age, AT, ESS, color index, blood chlorides, hemorrhage time (P=0.000-0.049). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT N0-N12 (rank=1), color index (rank=2), eosinophils (3), ESS (4), age (5), thrombocytes/cancer cells – CC (6), eosinophils/CC (7), healthy cells/CC (8), AT (9). Correct prediction of 5YS was 100% by neural networks computing. CONCLUSIONS: Optimal management strategies for local advanced GCP are: 1) availability of experienced surgeons because of complexity of radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) high-precision prediction; 4) adjuvant treatment for GCP with unfavorable prognosis. Oleg Kshivets, MD, PhD Surgery Department, Kaluga Cancer Center, Kaluga, Russia P-098