Resectable gastric signet ring cell carcinoma: clinicopathological characteristics and survival outcomes

Background:Gastric signet ring cell carcinoma (SRCC) appears to have clinical features and survival rates particularly different from other histological types. The aim of this study was to investigate clinicopathological features and survival outcomes of SRCC and to compare them with non-signet ring cell carcinoma (NSRCC).Methods:We retrospectively studied 145 patients with non-metastatic gastric carcinoma who underwent gastrectomy in our institute from 2005 to 2015. Among them, 36 patients (9.4%) with SRCC were compared to 109 patients (90.6%) with NSRCC.Results:Patients with SRCC presented at a younger age (p=0.001) with more advanced stage III-IV disease (p=0.005) and advanced N stages with a higher rate of pN3 (p=0.0001), a higher number of invaded lymph nodes (p=0.002) and a higher rate of patients with a lymph node ratio exceeding 25% (63.9% vs 36.7, p=0.004). After a median follow up of 35.30 months, there was no significant difference in the 5 years overall (OS) survival between SRCC and NSRCC ((36.7% vs 45.7%, p=0.206).However, the 5 years progressive free survival (PFS) was significantly decreased in case of SRCC (38.7% vs 50.9%, p=0.038) with a higher rate of metastasis in (52.9% vs 29.5%, p=0.013) and peritoneal recurrence (35.3% vs 9.5%, p<0.0001). The main prognostic factors of PFS and OS in SRCC were tumoral stenosis, hypoprotidemia, tumor size, depth of invasion (p=0.001), perineural and lymphovascular invasion, the UICC stage and complete surgical resection.Conclusion:Gastric SRCC have a particular clinicopathological behavior compared to NSRCC suggesting its more aggressive character

Determinants of surgical morbidity in gastric cancer: experience of a single center and literature review

Background:This study aimed to evaluate the severity of intraoperative and post-operative complications of gastric cancer surgery and to investigate the predictive factors correlated to surgical morbidity.Methods:We included 145 patients operated for gastric cancer. We investigated the risk factors associated with complications, length of hospital stay, operative time, and intraoperative blood transfusion (BT). Significant risk factors were analyzed by multiple logistic regression analysis.Results:Postoperative complications occurred in 32 patients (22.1 %) and the rate of major complications was 7.6%. The rate of anastomotic fistula was 6.9% and was correlated to diabetes, tumor size, operative time, surgical margin, and extended lymphadenectomy. The mean risk factors for postoperative morbidity were the presence of comorbidities and ASA score (p = 0.021), intraoperative BT (p = 0.045) and prolonged operative time (p = 0.055).Conclusion:Surgical morbidity of gastric cancer is correlated to the extent of resection as well as the clinical and histological characteristics

Chemoradiotherapy or chemotherapy as adjuvant treatment for resected gastric cancer: should we use selection criteria?

Background: The management of gastric adenocarcinoma is essentially based on surgery followed by adjuvant treatment. Adjuvant chemotherapy (CT) as well as chemoradiotherapy (CTRT) have proven their effectiveness in survival outcomes compared to surgery alone. However, there is little data comparing the two adjuvant approaches. This study aimed to compare the prognosis and survival outcomes of patients with gastric adenocarcinoma operated and treated by adjuvant radio-chemotherapy or chemotherapy Materials and methods: We retrospectively evaluated 80 patients with locally advanced gastric cancer (LGC) who received adjuvant treatment. We compared survival outcomes and patterns of recurrence of 53 patients treated by CTRT and those of 27 patients treated by CT.  Results: After a median follow-up of 38.48 months, CTRT resulted in a significant improvement of the 5-year PFS (60.9% vs. 36%, p = 0.03) and the 5-year OS (55.9% vs. 33%, p = 0.015) compared to adjuvant CT. The 5-year OS was significantly increased by adjuvant CTRT (p = 0.046) in patients with lymph node metastasis, and particularly those with advanced pN stage (p = 0.0078) and high lymph node ratio (LNR) exceeding 25% (p = 0.012). Also, there was a significant improvement of the PFS of patients classified pN2–N3 (p = 0.022) with a high LNR (p = 0.018). CTRT was also associated with improved OS and PFS in patients with lymphovascular and perineural invasion (LVI and PNI) compared to chemotherapy. Conclusion: There is a particular survival benefit of adding radiotherapy to chemotherapy in patients with selected criteria such as lymph node involvement, high LNR LVI, and PNI

Cancers primitifs de la verge: à propos de 11 cas et revue de la littérature

Le cancer de la verge est une pathologie rare en Tunisie ou la circoncision est de pratique courante. Il s'agit dans 95% des cas d'un carcinome épidermoïde. Le traitement repose essentiellement sur la chirurgie. Nous rapportons rétrospectivement les caractères épidémiologique, clinique, thérapeutique et évolutif de 11 cas de cancers primitifs de la verge

Survival and prognosis factors of lymphadenectomy in vulvar carcinoma: A tunisian single center study about 150 cases

Objective: Lymph node metastases represent the major prognostic factor in squamous cell carcinoma of the vulva. However, the therapeutic value is still controversial. The purpose of our work was to identify histopronostic risk factors for lymph node involvement and assess the impact of lymphadenectomy on overall survival (OS) and recurrence free survival (RFS). Method: This was a retrospective study about 150 cases of squamous cell carcinoma of the vulva over a period of 21 years (1994–2014). Clinical, anatomaphatological and evolutionary data were reported. OS and RFS curves for different parameters were established. Results: Lymph node invasion was significantly correlated with age 2 cm, TNM T-stage, vascular emboli and perinerval invasion. 5-years OS and RFS was 50.3% and 63.8% respectively. The 5-year OS and RFS rate decreased from 61.8% and 81.8% in the absence of lymph node involvement to 31.3% and 70.7% in cases of lymph node involvement respectively. The OS and the RFS at 5 years went from 53.1% and 63.8% to 18.2% and 42.7% respectively, in case of capsular break-up. Bilateral lymph node involvement caused the decrease of the 5-years OS from 52.5% to 34.1%. The lymph node ratio was inversely proportional to the OS. 5-years OS was 39% in case of a ratio <10% and 13% for a ratio between 20% and 30%. The 5-year RFS, decreased from 46% for a ratio <10%, to 24% for a ratio between 20% and 30%. Superficial inguinal lymph node dissection exposed to a high risk of inguinal recurrence. Conclusion: The lymphadenectomy has an incontestable diagnostic and prognostic value. The aim is to optimize the groin management in order to limit the morbidity of lymph node dissection while guaranteeing a carcinological safety. Keywords: Vulvar tumor, Squamous cell carcinoma, Surgery, Lymph node excision, Surviva