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Review
. 2018 Oct 19;3(2):122-129.
doi: 10.1002/ags3.12218. eCollection 2019 Mar.

Re-emerging role of macroscopic appearance in treatment strategy for gastric cancer

Kei Hosoda  1 , Masahiko Watanabe  1 , Keishi Yamashita  1   2
Affiliations
Review

Re-emerging role of macroscopic appearance in treatment strategy for gastric cancer

Kei Hosoda et al. Ann Gastroenterol Surg. .

Abstract

Pathological outcomes are definitely the most important prognostic factors in gastric cancer, but they can be obtained only after surgical resection. Use of preoperative adjuvant chemotherapy is becoming widespread for aggressive human cancer, so clinical factors such as macroscopic features are important as they are highly predictive for patient prognosis. In gastric cancer, the macroscopic type represents a distinct prognosis; Type 0 represents early gastric cancer with excellent prognosis, but, among advanced tumors, giant Type III and Type IV tumors have a dismal prognosis. Japan Clinical Oncology Group (JCOG) Stomach Cancer Study Group adopted macroscopic features as high-risk entities in clinical trials. It makes sense for risk classification to use macroscopic phenotypes because The Cancer Genome Atlas (TCGA) Network has lately subcategorized different histologies associated with specific macroscopic types by the molecular features of the whole genome. Dismal prognosis of Type IV gastric cancer is notorious, but similar prognosis was seen in giant Type III gastric cancer defined as 8 cm or beyond, both of which are unique for their propensity of peritoneal dissemination. In this review, clinical relevance including prognosis of such macroscopic high-risk features will be separately debated in the context of precision medicine and updated prognostic outcomes will be presented under the present standard therapy of curative surgery followed by postoperative S-1 chemotherapy. Moreover, promising emerging novel therapeutic strategies including trimodal potent regimens or intraperitoneal chemotherapy will be described for such aggressive gastric cancer.

Keywords: gastric cancer; macroscopic appearance; precision medicine; therapeutic strategy.

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Conflict of interest statement

Authors declare no conflicts of interest for this article.

Figures

Figure 1
Figure 1
A, Representative gastroendoscopy images of advanced gastric cancer by macroscopic classification. Upper panels include high‐risk macroscopic features of Type IV (left) and giant Type III (right). Lower panels include average‐risk macroscopic features of Type 0, Type I, Type II, small Type III, and Type V (in order from left to right). B, Rate of each macroscopic feature in pathological stage II/III advanced gastric cancer in our own experience. High‐risk macroscopic features (Type IV and giant Type III) are seen in 10.5% as shown in this figure
Figure 2
Figure 2
Overall survival of patients with gastric cancer from (A) nationwide registry of gastric cancer and (B) our experience of 5172 gastric cancer patients according to Borrmann's macroscopic features. (C) Disease‐specific survival of 491 cT1 gastric cancer patients
Figure 3
Figure 3
A, Survival curves for intestinal type were compared with those of diffuse‐type gastric cancer with pStage II/III in the p53 aberration group. B, Survival curves according to macroscopic features for the high‐risk group (Type IV and giant Type III group) and the average‐risk group (otherwise Type 0, Type I, Type II, small Type III, and Type V group). Five‐year survival is shown
See this image and copyright information in PMC

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