Surgical treatment of stomach cancer: possibilities of predicting survival rate at the present stage

S.I. Kirkilevsky, A.G. Lurin, V.G. Dubinina, O.V. Lukyanchuk, A.A. Mashukov, A.A. Bilenko, A.N. Zgura, S.V. Mеrlich, D.V. Ratsiborsky, V.Е. Maksimovsky, I.V. Shilin, D.N. Osadchy

Abstract


Background. Studying the survival rate of cancer patients is the main task of the clinical and experimental oncologist. Based on the mathematical analysis of many factors at once, it is possible to predict the life expectancy of a patient with stomach cancer. Materials and methods. A total of 221 patients operated for gastric cancer in the period of 2007–2013 were included in the study conducted at the premises of the abdominal oncosurgical department of the Odessa regional oncology center. Patients underwent radical oncosurgical operations, after which the tumor tissue was examined routinely histologically and for the presence of expression of certain molecular markers, which were also prognosis markers, like the degree of differentiation, the depth of invasion to the stomach wall or the number of lymph nodes affected by metastases. Results. The worst prognosis of survival, based on the existing group of patients, was the so-called “triple negative” gastric cancer, by analogy with a similar form of breast cancer. An interesting feature revealed in the process of analyzing marker combinations was the combination of VEGFR-p53-Her2+Ki-67–: such tumors were highly differentiated forms, without invasion into neighboring structures, exophytic growth, without signs of aggressive growth. What is commonly referred to as local forms, promising in terms of long-term survival, even in the loco-regional stage. A group was found where the performance of multiorgan resections affected the survival rate of patients with gastric carcinoma at late observation periods — after 100 months. The main critical feature of the VEGFR-p53+Her2-Ki-67+ group was the absence of metastases in regional lymph nodes, even in the case of Т4 tumor. It is possible to monitor the influence of standard morphological factors and tumor cells expressed on the membranes of oncoproteins on the life expectancy of a particular patient. Survival methods can be used by surgeons and chemotherapists to personalize chemotherapy (Her2/new, VEGFR) and to individualize surgical methods of treatment: invasion into the stomach wall, patient’s age, affected lymph nodes count, tumor size, G grade and p53 bioagressivity. Conclusions. Given the increasing dependence of medical community on the availability of medical data on various topics, there is the need to create more precise gradations in the dependency of survival of cancer patients on various clinical and morphological situations.

Keywords


stomach cancer; immunohistochemistry; oncoproteins

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DOI: https://doi.org/10.22141/1997-2938.2.33.2017.107647

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