Jaffer A Ajani

Szent László Hospital, Budapest, Budapeŝto, Budapest, Hungary

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Publications (640)2728.32 Total impact

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    ABSTRACT: Background: Peritoneal metastases (PM) in patients with gastric adenocarcinoma (GAC) may be identified by diagnostic laparoscopy (DL) or imaging (I). Although prognosis is poor, some patients have excellent outcome. We compared the overall survival (OS) of patients in 3 groups: those with positive cytology (CY+) by DL (DL-CY+), those with gross PM (GPM) by DL (DL-GPM+) and with GPM obvious on I (I-GPM+). Methods: 146 GAC patients were identified. The Kaplan-Meier analysis, univariate, and multivariate Cox proportional hazards regression models were employed. Results: Patients were primarily men (67%), with good ECOG scores (0-1; 89%), had DL (84%), had poorly differentiated GAC (92%), and had received chemotherapy (89%). The median OS for all patients was 15 months (5%CI, 12.9-18.2 months). The DL-CY+ group had median OS of 22.5 months (95%CI, 15-29.3 months). Patients with I-GPM+ had four times the risk of death than those with DL-CY+ (P < 0.001) and patients with DL-GPM+ had two times the risk of death than those with DL-CY+ (P = 0.001). At 36 months, all DL-GPM+ and I-GPM+ had died but 8 patients with DL-CY+ remained alive. Conclusions: Some GAC patients with DL-CY+ have long OS; therefore, novel strategies to further prolong their OS are needed. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 11/2015; DOI:10.1002/jso.24087 · 3.24 Impact Factor
  • M A Blum Murphy · Elena Elimova · Jaffer A Ajani ·
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    ABSTRACT: Many trials have evaluated preoperative chemotherapy for the treatment of locally advanced esophageal cancer (LAEC). Most studies were small with conflicting results and no clear evidence of survival advantage. However, two large trials that included squamous cell carcinomas and adenocarcinomas of the esophagus produced opposite outcomes with one showing limited benefit and the other showing none. Recent meta-analyses suggests only a modest benefit from induction chemotherapy in the treatment of LAEC. Two factors associated with prolonged survival are: (1) an R0 resection and (2) pathological complete remission. Preoperative chemotherapy is preferred in Europe for adenocarcinomas; however chemoradiation has been the treatment of choice in the US. The individualization and optimization of therapy for esophageal cancer patients may come from an in-depth understanding of molecular biology and the development of predictive biomarkers. The use of targeted and immunotherapy agents in the preoperative setting are also promising and warrant further evaluation.
    Expert review of gastroenterology & hepatology 11/2015; DOI:10.1586/17474124.2016.1116936 · 2.42 Impact Factor
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    ABSTRACT: Background: The optimal surgical approach for gastroesophageal junction (GEJ) cancer treated with preoperative therapy remains controversial. We compared the outcomes of patients who underwent either esophagectomy or gastrectomy and identified variables associated with overall survival (OS). Methods: We reviewed records of patients with Siewert types II and III GEJ adenocarcinoma who were treated with preoperative therapy followed by resection from 1995 to 2013. OS was assessed using Kaplan-Meier curves and associated variables were analyzed using Cox proportional hazards models. Results: Of 143 patients, 110 (76.9 %) had type II and 33 (23.1 %) had type III tumors. Most (86 %) patients had stage T3 or T4 disease, and more than half had N+ (62 %) disease. The majority (93 %) received neoadjuvant chemoradiation; 7 % received chemotherapy alone. Patients with type II tumors underwent either esophagectomy (75 %) or gastrectomy (25 %). Patients with type III tumors primarily underwent gastrectomy (88 %). Eighty-six (60 %) patients underwent extended (D1+/D2) abdominal lymphadenectomy. We saw no differences between esophagectomy and gastrectomy patients in R0 resection rate (94 vs. 95 %; p = 0.9), number of nodes removed (mean, 18.3 vs. 19.3; p = 0.6), or 60-day mortality rate (4 vs. 4 %; p = 1.0). The median follow-up period for survivors was 65 months. Esophagectomy and gastrectomy showed similar 5-year OS rates (49 vs. 53 %; p = 0.8). Surgical approach was not associated with OS [hazard ratio (HR) 1.30; 95 % confidence interval (CI) 0.68-2.45; p = 0.43]. The strongest predictor of OS was extended lymphadenectomy (HR 0.55; 95 % CI, 0.32-0.94; p = 0.03). Conclusions: R0 resection and OS rates were similar in patients undergoing esophagectomy or gastrectomy after neoadjuvant therapy; however, extended abdominal lymphadenectomy may improve OS rates.
    Annals of Surgical Oncology 11/2015; DOI:10.1245/s10434-015-4898-0 · 3.93 Impact Factor

  • International journal of radiation oncology, biology, physics 11/2015; 93(3):S12-S13. DOI:10.1016/j.ijrobp.2015.07.036 · 4.26 Impact Factor
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    ABSTRACT: Purpose: This phase I study (EudraCT No. 2006-001177-25) investigated aflibercept, a vascular endothelial growth factor decoy receptor protein (VEGF Trap), in combination with docetaxel, cisplatin, and 5-fluorouracil in patients with advanced solid tumors. Patients and methods: Patients received 2, 4, or 6 mg/kg of intravenous aflibercept with docetaxel 75 mg/m2, cisplatin 75 mg/m2, and 5-fluorouracil 750 mg/m2 in 3-week cycles until disease progression or unacceptable toxicity. Primary objectives were to evaluate dose-limiting toxicities (DLTs) during cycle 1 and to determine the recommended phase II dose. Pharmacokinetics, tolerability, and antitumor activity were also investigated. Results: Forty-four patients were enrolled and treated (29 patients in a dose-escalation phase and 15 patients in an expansion cohort). Following three cases of febrile neutropenia in patients receiving aflibercept at 4 mg/kg, the protocol was amended to allow earlier granulocyte colony-stimulating factor support (from day 6) and prophylactic use of ciprofloxacin. Subsequently, there were two DLTs: febrile neutropenia (2 mg/kg) and grade 4 pulmonary embolism (6 mg/kg). An excess of free over VEGF-bound aflibercept was observed at 6 mg/kg. The most frequent grade 3/4 adverse events (AEs) were neutropenia (54.5%), lymphopenia (47.7%), and stomatitis (38.6%). AEs associated with VEGF blockade (any grade) included epistaxis (61.4%), dysphonia (40.9%), hypertension (38.6%), and proteinuria (11.4%). There were 15 partial responses, including 9 in patients with gastroesophageal cancers. Thirteen patients had stable disease. Conclusion: Aflibercept 6 mg/kg administered every 3 weeks in combination with docetaxel, cisplatin, and 5- fluorouracil is the recommended dose for further clinical development based on tolerability, pharmacokinetics, and antitumor activity.
    Oncology 10/2015; DOI:10.1159/000440958 · 2.42 Impact Factor
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    ABSTRACT: Objective: The purpose of this study was to identify clinical and geriatric assessment variables associated with outcome in patients with gastric adenocarcinoma who have undergone gastrectomy. Methods: We reviewed demographic, clinical, and geriatric assessment variables, including recent falls, pain, performance status, American Society of Anesthesiologists score, assistive device use, comorbidity, polypharmacy, and weight change, for patients undergoing gastrectomy between 2005 and 2014. Outcome variables included morbidity, mortality, hospital length of stay, and readmission. Results: Of 279 patients, 133 (48%) underwent total gastrectomy. The 90-day major morbidity rate was 24% and the mortality rate was 1%. Length of hospital stay ≥14 days occurred in 38%, with readmission within 30 days in 13%. On multivariate analysis, gastroesophageal junction involvement, (odds ratio [OR] 2.5, 95% confidence interval [1.1-5.8]), additional organ resection, (OR 3.2, [1.6-6.3]), pain score >0 (OR 3.8, [1.6-8.7]), Eastern Cooperative Oncology Group performance status >0, (OR 2.3, [1.2-4.6]), and polypharmacy (OR 2.4, [1.1-5.2]) were associated with major morbidity. Hospital stay ≥14 days was associated with age ≥75 years (OR 3.9, [1.7-9.2]), total gastrectomy (OR 3.5, [2.0-6.3]), performance status >0 (OR 1.8, [1.0-3.2]), and preoperative chemotherapy (OR 0.3, [0.2-0.7]). Conclusions: Future studies are needed to identify methods to improve performance status, as this may improve postoperative complications and resource utilization. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 10/2015; DOI:10.1002/jso.24077 · 3.24 Impact Factor
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    ABSTRACT: Background: In patients with localized gastric adenocarcinoma (LGAC) who receive preoperative therapy, tools to predict response or prognosticate outcome before therapy are lacking. We used initial standardized uptake value (iSUV) of positron emission tomography (PET) to evaluate its association with overall survival (OS). Methods: We identified 60 patients with confirmed LGAC who were treated with preoperative chemoradiation and had a baseline PET in addition to other routine staging. Fisher's exact test and Wilcoxon's rank sum test were used to determine the association between iSUV and other variables, and the log-rank test and Cox proportional hazards model were used for survival analysis. Results: The median iSUV was 6 (range, 0-28). The presence of signet ring cells in pretreatment biopsies correlated highly with low iSUV (≤6; p = 0.0017). Patients with a high iSUV (>6) had a longer OS compared to those with a low iSUV (≤6; p = 0.0344). iSUV was not an independent predictor (p = 0.12); however, the risk of death was reduced for patients with an iSUV >6 (hazard ratio = 0.26). Conclusion: Our novel findings show that among LGAC patients treated with preoperative chemoradiation and surgery, those with a high iSUV have longer OS than patients with a low iSUV. iSUV appears to have a predictive role in patients with LGAC when treated with preoperative chemoradiation.
    Oncology 09/2015; 89(6). DOI:10.1159/000436972 · 2.42 Impact Factor
  • Elena Elimova · Jaffer A Ajani ·
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    ABSTRACT: The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
    Journal of Clinical Oncology 08/2015; 33(28). DOI:10.1200/JCO.2014.60.1765 · 18.43 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate if a baseline, an interim or a post-chemoradiation (CTRT) 18-fluorodeoxy-glucose positron emission computed tomography (18F-FDG PET/CT) studies could provide information on pathologic response to CTRT and overall survival (OS). Thirty-one patients with histologically proven adenocarcinoma or squamous cell carcinoma of the oesophagus, fit for trimodality therapy were prospectively enrolled. Most were men (93.5%), and had a stage III cancer (74.2%). Chemotherapy consisted of oxaliplatin/5-fluorouracil (45.2%) and taxane/5-fluorouracil (54.8%). All patients underwent a baseline, an interim (performed 12±2days after the onset of CTRT) and a post-CTRT 18F-FDG PET/CT study. The 18F-FDG PET/CT variables evaluated were at baseline, interim and post-CTRT studies maximum standardised uptake value (SUVmax) and total lesion glycolysis (TLG). Clinical and 18F-FDG PET/CT parameters were correlated with pathologic complete response (pathCR) and OS. Among the 31 patients studied, 61.3% achieved a clinical complete response (cCR) and 87.1% had surgery. The median OS was 35.1months (95% confidence interval (CI): 19.9-NA). PathCR rate was 22.2%. There was only a marginal association between cCR and pathCR (p=0.06). None of the other variables was predictive of pathCR. There was association between OS and baseline TLG (p=0.03) at the optimal cutoff TLG value of 75.15. Additionally, TLG and ΔTLG post-CTRT were also associated with OS (p=0.01 and 0.03, respectively). None of the PET parameters is predictive of pathCR but TLG at baseline and post-CTRT are prognostic of OS. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of cancer (Oxford, England: 1990) 08/2015; DOI:10.1016/j.ejca.2015.07.044 · 5.42 Impact Factor
  • Xia Pu · Jaffer A. Ajani · Jian Gu · Xiangjun Gu · Yuanqing Ye · Xifeng Wu ·

    Cancer Research 08/2015; 75(15 Supplement):5587-5587. DOI:10.1158/1538-7445.AM2015-5587 · 9.33 Impact Factor
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    ABSTRACT: Activation of cancer stem cell signaling is central to acquired resistance to therapy in esophageal cancer (EC). ABT-263, a potent Bcl-2 family inhibitor, is active against many tumor types. However, effect of ABT-263 on EC cells and their resistant counterparts are unknown. Here we report that ABT-263 inhibited cell proliferation and induced apoptosis in human EC cells and their chemo-resistant counterparts. The combination of ABT-263 with 5-FU had synergistic lethal effects and amplified apoptosis that does not depend fully on its inhibition of BCL-2 family proteins in EC cells. To further explore the novel mechanisms of ABT-263, proteomic array (RPPAs) were performed and gene set enriched analysis demonstrated that ABT-263 suppresses the expression of many oncogenes including genes that govern stemness pathways. Immunoblotting and immunofluorescence further confirmed reduction in protein expression and transcription in Wnt/β-catenin and YAP/SOX9 axes. Furthermore, ABT263 strongly suppresses cancer stem cell properties in EC cells and the combination of ABT-263 and 5-FU significantly reduced tumor growth in vivo and suppresses the expression of stemness genes. Thus, our findings demonstrated a novel mechanism of ABT-263 antitumor effect in EC and indicating that combination of ABT-263 with cytotoxic drugs is worthy of pursuit in patients with EC.
    Oncotarget 07/2015; 6(28). DOI:10.18632/oncotarget.4540 · 6.36 Impact Factor
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    ABSTRACT: Nearly 50% of gastric cancer patients are diagnosed with advanced gastric cancer (AGC). Therapy is palliative but results in ill effects. The median overall survival (OS) of AGC patients is often <12 months. It is unclear if the early initiation of therapy in all AGC patients is beneficial. A retrospective analysis of AGC patients in our database was carried out. The patients were divided into two groups: asymptomatic or symptomatic. We sought to assess whether the delay of systemic therapy was harmful in asymptomatic patients. A total of 135 patients were analyzed. Most patients were symptomatic (68%), males (67%), and had low ECOG scores (0-1; 85%). In univariate analyses, ECOG performance status 0 (p = 0.005), delayed initiation of therapy (p = 0.03), and lack of symptoms (p = 0.03) were associated with a longer OS. The multivariate model for OS identified only ECOG performance status as an independent prognosticator of longer OS (p = 0.02). Asymptomatic patients who had delayed (≥4 weeks) systemic therapy had an OS rate of 77% at 1 year compared to 58% for patients treated within 4 weeks (p = 0.47). Symptomatic AGC patients had a poor outcome compared to asymptomatic AGC patients. Treatment delay in asymptomatic patients had no detrimental effect on OS, suggesting that the timing of therapy can be based on patient selection. © 2015 S. Karger AG, Basel.
    Oncology 07/2015; 89. DOI:10.1159/000434647 · 2.42 Impact Factor
  • Source
    Elena Elimova · Jaffer A Ajani ·

    Journal of Clinical Oncology 06/2015; 33(21). DOI:10.1200/JCO.2014.59.8847 · 18.43 Impact Factor
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    ABSTRACT: This study aimed to determine whether postoperative morbidity and mortality rates increased after preoperative chemoradiation in patients who underwent gastrectomy. The medical records of 7404 patients with gastric or gastroesophageal cancer seen from January 1995 to August 2012 were reviewed to identify patients who underwent gastrectomy. χ (2) and logistic regression analysis were used to determine differences in the 90-day postoperative morbidity and mortality rates of patients who underwent upfront surgery (SURG), preoperative chemotherapy (CHEMO), or preoperative chemoradiation (CHEMOXRT). Of the 500 patients included in this study, 200 underwent SURG, 65 had CHEMO, and 235 had CHEMOXRT. Respectively, 33, 43, and 58 % of these patients underwent total gastrectomy (p < 0.01). Resection of other organs was performed respectively in 19, 26, and 23 % of the patients (p = 0.37). Minor complications within 90 days (Clavien-Dindo 1 or 2) occurred for 41 % of the SURG patients, 43 % of the CHEMO patients, and 45 % of the CHEMOXRT patients (p = 0.68). Major complications or death within 90 days (Clavien-Dindo 3, 4, or 5) occurred for 21, 28, and 29 % of the patients, respectively (p = 0.15). The 90-day mortality (Clavien-Dindo 5) rates were 2 % for the SURG patients, 6 % for the CHEMO patients, and 3 % for the CHEMOXRT patients (p = 0.25). The median hospital stays were respectively 12, 12, and 13 days (p = 0.09). In the multivariate analysis, male sex, gastroesophageal junction cancer, total gastrectomy, and resection of other organs were associated with increased major morbidity and mortality rates, whereas preoperative therapy was not. The CHEMOXRT patients had postoperative morbidity and mortality rates similar to those for the SURG and CHEMO patients.
    Annals of Surgical Oncology 06/2015; DOI:10.1245/s10434-015-4643-8 · 3.93 Impact Factor
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    ABSTRACT: Introduction: In 2014, the US FDA-approved ramucirumab for use in the second-line setting of advanced or metastatic, gastric or gastroesophageal adenocarcinoma (GEAC) based on the result of Phase III clinical trials; REGARD and RAINBOW.Areas covered: We briefly review the mechanisms of angiogenesis, antiangiogenic therapy and current status of advanced GEAC treatment then highlight the challenges and future prospects of novel molecular-targeted agents.Expert opinion: Although both the REGARD and RAINBOW trials met their primary end points of significantly prolonged overall survival and progression-free survival, the magnitude of the difference is still relatively modest. Given that ramucirumab alone has a marginal effect, a combination of paclitaxel and ramucirumab is strongly preferred as a second-line therapy. To maximize the impact of ramucirumab in patients with GEAC, we can leverage the recent pharmacokinetics data of ramucirumab from the REGARD and RAINBOW trials. In addition, the quest for identifying biomarkers to select patients who are likely to benefit the most should continue. It is our firm belief that taxanes should no longer be added to the frontline regimens in most cases, given the success of the taxane/ramucirumab in the second-line setting.
    Expert Opinion on Orphan Drugs 05/2015; 3(6). DOI:10.1517/21678707.2015.1040390 · 0.53 Impact Factor
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    ABSTRACT: We aimed to identify new serum biomarkers of esophageal adenocarcinoma (EAC). We performed metabolomic analyses of serum samples from 30 patients with histologically confirmed EAC (cases) from The University of Texas MD Anderson Cancer Center and 30 patients without EAC (controls). We identified metabolites whose levels differed significantly between cases and controls and validated those with the greatest difference in an analysis of 321 EAC cases and 331 controls. We generated a metabolite risk score (MRS) for the metabolites. The levels of 64 metabolites differed significantly between EAC cases and controls. The metabolites with the greatest difference were: amino acid L-proline (LP), ketone body 3-hydroxybutyrate (BHBA), and carbohydrate D-mannose (DM) different; these differences were confirmed in the validation set. Cases had lower mean levels of LP that controls (22.78±6.79 ug/ml vs 28.24±8.64 ug/ml; P<.001) and higher levels of BHBA (18.06±17.84 ug/ml vs 7.73±9.92 ug/ml; P<.001) and DM (9.87±4.28 ug/ml vs 6.28 ±3.61 ug/ml; P<.001). Levels of DM were significant higher in patients with late-stage EAC than early-stage EAC (10.61±4.79 ug/ml vs 8.97±3.36 ug/mL; P=.005). Higher levels of LP were associated with a significant decreased in risk of EAC (odds ratio [OR] =0.26; 95% confidence interval [CI], 0.18-0.38). A significant increase in risk of EAC was associated with higher levels of BHBA (OR=4.05; 95% CI, 2.84-5.78) and DM (OR=7.04; 95% CI, 4.79-10.34). Levels of all 3 metabolites associated with EAC risk in quartile analyses; the level of risk conferred by the metabolites increased with smoking status and body mass index. Individuals with a high MRS had a significant (7.76-fold) increase in risk of EAC vs those with low a MRS. Smokers with a high MRS had the greatest risk of EAC (OR=20.26; 95% CI,11.19-36.68), compared with never smokers with a low MRS. Based On A Case Vs Control Metabolic Profile analysis, levels of LP, BHBA and DM are associated with risk of EAC. These markers might be used as prognostic factors for patients with EAC. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2015; 13(10). DOI:10.1016/j.cgh.2015.05.023 · 7.90 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the overall survival (OS) of patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. The medical records of patients with gastric adenocarcinoma presenting to our institution (January 1995 to August 2012) were reviewed to identify patients who underwent diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy. Associations between various clinicopathologic factors and OS were examined with Cox proportional hazards models. Of 192 patients who met inclusion criteria, 103 (54%) required total gastrectomy. One hundred sixty-eight patients (88%) had an extended lymph node dissection, 26 (14%) had resection of adjacent organs, and 178 (93%) had an R0 resection. Median follow-up time for surviving patients was 4.2 years. Median OS for all patients was 5.8 years, and 5-year OS rate was 56%. Multivariable Cox regression model results identified variables associated with diminished OS including age ≥ 65 years (hazard ratio [HR] 1.62; 95% CI 1.05 to 2.51), male sex (HR 1.76; 95% CI 1.13 to 2.74), adjacent organ resection (HR 1.97; 95% CI 1.16 to 3.35), R1 status (HR 2.29; 95% CI 1.17 to 4.48), pathologic N1 stage (HR 1.92; 95% CI 1.24 to 2.98), N2 stage (HR 2.58; 95% CI 1.01 to 6.58), and N3 stage (HR 6.54; 95% CI 2.69 to 15.93). Five-year OS rates for patients with pathologic N0, N1, N2, and N3 disease were 67%, 42%, 43%, and 0%, respectively. Patients with gastric cancer who undergo diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy have a high frequency of obtaining an R0 resection and excellent OS rates. Nodal status after surgery remains an important determinant of OS. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Surgeons 04/2015; 221(1). DOI:10.1016/j.jamcollsurg.2015.04.004 · 5.12 Impact Factor
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    ABSTRACT: Gastric cancer (GC) continues to be a significant problem worldwide and is the third leading cause of cancer death. Armamentarium to treat GC whether it is potentially curable or metastatic (incurable) has changed little over the last decades with only two new agents being approved (trastuzumab and ramucirumab). Many relatively healthy patients after second-line therapy have limited and generally ineffective options. The recent The Cancer Genome Atlas analysis has uncovered four genotypes of GC; however, it is not sufficient to change our treatment strategies and more work needs to be done. The popular front-line regimen containing a platinum compound and a fluoropyrimidine is widely used for drug development and has worked well globally. Thus, this combination appears suitable for adding a biologic agent. The search for new classes of cytotoxics has almost stopped, but it is clear that cytotoxic therapy continues to contribute and it is here to stay. Biologic agents that modulate the immune system of the host appear promising along with many other biologics that can potentially inhibit signaling pathways that are often employed by GC cells. We will briefly describe the efforts that have targeted EGFR, mTOR, angiogenesis and MET pathways.
    Expert Opinion on Pharmacotherapy 04/2015; 16(7):1-6. DOI:10.1517/14656566.2015.1025750 · 3.53 Impact Factor
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    ABSTRACT: Background The purpose of this study was to determine the survival of patients with metastatic gastric cancer treated with surgery.Methods We reviewed the medical records of 7,404 patients with gastric or gastroesophageal cancer seen from January 1995 to August 2012 at MD Anderson Cancer Center and identified patients with stage IV disease treated with surgery. Kaplan–Meier curves were created to compare overall survival (OS) between groups.ResultsOf the 82 patients who met inclusion criteria, sites of metastatic disease included peritoneum (N = 34, 42%), positive cytology only (N = 17, 21%), distant lymph nodes (N = 12, 15%), and distant organs (N = 19, 23%). The median time from initial cancer diagnosis to surgery for metastatic disease was 10 months (range, 0–70). Surgery included exploratory surgery only (N = 16, 20%), primary tumor resection with or without resection of distant disease (N = 50, 61%), and distant disease resection only (N = 16, 20%). Median follow-up for living patients was 3 years (range, 0.1–14). Median survival for all patients was 1.5 years (range, 0.1–14). Five year OS for patients with peritoneal metastases, positive cytology only, distant lymph nodes, and distant organ involvement was 13, 42, 20, and 34%, respectively.Conclusions Surgery in the setting of metastatic disease is an uncommon clinical scenario and has a considerable risk of exploration without resection, although long-term survival is possible. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 04/2015; 111(7). DOI:10.1002/jso.23907 · 3.24 Impact Factor
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    ABSTRACT: Gastric cancer (GC) represents a serious health problem on a global scale. Despite some recent advances in the field, the prognosis in metastatic GC remains poor. Even in localized disease the adjunctive therapies improve overall survival (OS) by only approximately 10%. A better understanding of molecular biology, which would lead to improved treatment options, is needed and is the basis for this review. Many potential biomarkers of prognostic significance have been identified, including ALDH, SHH, Sox9, HER2, EGFR, VEGF, Hippo/YAP, and MET. However, inhibition of only HER2 protein has led to a modest survival benefit. A new approach to GC treatment, which is a disease influenced by inflammation, is the exploitation of the immune system to fight disease. Two interesting targets/prognostic markers that bear further investigation in GC are PD1 and PDL, particularly given their success in the treatment of other inflammation/immune-associated malignancies.
    Journal of the National Comprehensive Cancer Network: JNCCN 04/2015; 13(4):e19-29. · 4.18 Impact Factor

Publication Stats

21k Citations
2,728.32 Total Impact Points


  • 2015
    • Szent László Hospital, Budapest
      Budapeŝto, Budapest, Hungary
  • 1984-2015
    • University of Texas MD Anderson Cancer Center
      • • Department of Epidemiology
      • • Department of Medical Oncology
      • • Division of Radiation Oncology
      • • Department of Thoracic Cardiovascular Surgery
      • • Department of NeuroSurgery
      • • Department of Gastrointestinal Medical Oncology and Digestive Diseases
      • • Department of Surgical Oncology
      • • Department of Radiotherapy
      • • Department of General Surgery
      • • Department of Surgery
      Houston, Texas, United States
  • 1986-2014
    • University of Houston
      Houston, Texas, United States
  • 2013
    • Moffitt Cancer Center
      • Department of Cancer Epidemiology
      Tampa, Florida, United States
  • 2009
    • Krankenhaus Nordwest
      Frankfurt, Hesse, Germany
  • 1998-2008
    • Memorial Sloan-Kettering Cancer Center
      • Department of Medicine
      New York, New York, United States
  • 2007
    • Georgetown University
      Washington, Washington, D.C., United States
    • Shanghai Punan Hospital
      Shanghai, Shanghai Shi, China
  • 2006-2007
    • Duke University
      Durham, North Carolina, United States
    • N.N. Blokhin Cancer Research Center
      Moskva, Moscow, Russia
  • 2005-2007
    • University of Santiago, Chile
      CiudadSantiago, Santiago Metropolitan, Chile
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2004
    • Mayo Clinic - Scottsdale
      Scottsdale, Arizona, United States
  • 1990
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
  • 1987
    • Houston Zoo
      Houston, Texas, United States