Stage 4 cancer stomach cancer
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Advances in Treatment and Prognosis of Stage 4 Stomach Cancer
Introduction to Stage 4 Stomach Cancer
Stage 4 stomach cancer, also known as advanced gastric cancer, is characterized by the spread of cancer beyond the stomach to other parts of the body. This stage is associated with a poor prognosis and presents significant treatment challenges. Recent research has focused on improving survival rates and quality of life for these patients through various therapeutic strategies, including chemotherapy, molecular testing, and surgical interventions.
Chemotherapy and Survival Rates
Impact of Chemotherapy on Prognosis
The introduction of new chemotherapeutic agents has significantly impacted the prognosis of stage 4 gastric cancer. A study analyzing data from a large population-based cancer registry in Japan found that the overall survival rate for stage 4 gastric cancer improved from 11.4% to 13.2% following the approval of several oncologic drugs since 2009. Younger patients, particularly those under 60, showed the most significant improvement in survival rates.
Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy (NAC) has been explored as a treatment option for specific types of advanced gastric cancer. A phase III randomized controlled trial (JCOG0501) investigated the efficacy of NAC with S-1 plus cisplatin followed by D2 gastrectomy. Although NAC led to significant downstaging of tumors, it did not demonstrate a survival benefit over surgery followed by adjuvant chemotherapy alone .
Molecular Testing and Targeted Therapies
HER2/neu and Immunotherapy
Molecular profiling has become a standard practice in the treatment of late-stage gastric cancer. In a study conducted in India, HER2/neu testing was performed on 71.2% of stage 4 gastric cancer patients, with a positivity rate of 16.16%. Patients who tested positive for HER2/neu were treated with trastuzumab, which has been shown to improve survival rates. Additionally, testing for mismatch repair (MMR) status and programmed death ligand 1 (PDL-1) status helps identify patients who may benefit from immunotherapy.
Surgical Interventions
Gastrectomy and Perioperative Outcomes
Surgical resection remains a critical component of treatment for certain patients with advanced gastric cancer. A study examining the impact of cancer stage on perioperative mortality found that stage 4 cancer significantly influences 30-day mortality rates. However, the inclusion of more granular cancer staging in mortality models could improve the accuracy of predicting short-term outcomes.
Neoadjuvant Chemotherapy and Surgery
The safety and efficacy of combining NAC with surgery were evaluated in patients with type 4 or large type 3 gastric cancer. The results indicated that NAC followed by D2 gastrectomy could be performed safely without increasing morbidity or mortality, although it did not provide a survival advantage over surgery alone.
Conclusion
The treatment landscape for stage 4 stomach cancer has evolved with the introduction of new chemotherapeutic agents, molecular testing, and targeted therapies. While chemotherapy has improved survival rates, particularly among younger patients, the role of neoadjuvant chemotherapy remains uncertain. Molecular profiling is essential for identifying patients who may benefit from targeted therapies and immunotherapy. Surgical interventions continue to play a vital role, although the impact of cancer stage on perioperative outcomes must be carefully considered. Ongoing research and clinical trials are crucial for further improving the prognosis and quality of life for patients with advanced gastric cancer.
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