Stage four stomach cancer
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Stage Four Stomach Cancer: Insights and Treatment Approaches
Prevalence and Molecular Profiling in Stage 4 Stomach Cancer
Stage four stomach cancer, also known as advanced gastric cancer, is characterized by its poor prognosis and high mortality rate. Molecular profiling has become a critical component in the treatment of this disease, particularly in identifying candidates for targeted therapies and immunotherapies. A study conducted in India highlighted the importance of testing for molecular markers such as HER2/neu, mismatch repair (MMR)/microsatellite instability (MSI), and programmed death ligand 1 (PDL-1) in stage 4 gastric/gastroesophageal junction (GEJ) adenocarcinoma patients. The study found that 16.16% of patients tested positive for HER2/neu, and these patients showed improved survival rates when treated with trastuzumab. Additionally, 8.8% of patients exhibited deficient MMR/MSI high status, and 32.7% had a PDL-1 tumor proportion score greater than 1%, making them potential candidates for immune checkpoint inhibitors.
Neoadjuvant Chemotherapy and Surgical Outcomes
The efficacy of neoadjuvant chemotherapy (NAC) in improving surgical outcomes for patients with advanced gastric cancer has been a subject of research. A phase III trial in Japan evaluated the safety and effectiveness of NAC with S-1 plus cisplatin followed by gastrectomy. The study found that NAC could be safely administered without increasing morbidity or mortality rates. Patients who received NAC had a shorter operation time compared to those who did not, suggesting that NAC may facilitate more efficient surgical procedures. However, the overall survival benefits of NAC in this context require further investigation.
Late Diagnosis and Socioeconomic Factors
Late-stage diagnosis of stomach cancer significantly impacts patient outcomes and survival rates. A systematic review of stomach cancer cases in East African countries revealed that most patients are diagnosed at advanced stages (stage III and IV), which adversely affects their clinical outcomes. The review emphasized the need for early diagnosis, improved health facilities, and enhanced diagnostic capabilities to improve survival rates in these regions.
Similarly, socioeconomic status (SES) plays a crucial role in the stage at which stomach cancer is diagnosed. A study in Korea found that patients with lower SES were more likely to be diagnosed at a later stage compared to those with higher SES. This disparity underscores the importance of accessible cancer screening programs and targeted interventions to ensure early detection and treatment, particularly for economically disadvantaged populations.
Conclusion
Stage four stomach cancer remains a challenging condition with a poor prognosis. Molecular profiling is essential for identifying patients who may benefit from targeted therapies and immunotherapies. Neoadjuvant chemotherapy shows promise in improving surgical outcomes, although its impact on overall survival needs further exploration. Early diagnosis and addressing socioeconomic disparities are critical to improving patient outcomes. Enhanced screening programs and healthcare infrastructure are necessary to detect and treat stomach cancer at earlier stages, ultimately improving survival rates.
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