A Marchet

Publications (29)65.75 Total impact

• Article: Validation of the new AJCC TNM staging system for gastric cancer in a large cohort of patients (n = 2,155): focus on the T category.

  A Marchet, S Mocellin, A Ambrosi, P Morgagni, G Vittimberga, F Roviello, D Marrelli, G de Manzoni, A Minicozzi, A Coniglio, G Tiberio, F Pacelli, F Rosa, D Nitti
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  ABSTRACT: The prognostic value of T subclassification in patients with gastric carcinoma has been just implemented in the new AJCC TNM staging system, which has reclassified T2a and T2b into T2 and T3 tumors, respectively. The aim of the present study was to validate the prognostic significance of the new T categorization within the frame of the latest TNM staging system. We retrospectively reviewed the records of 686 T2/T3 patients among 2155 subjects who underwent radical resection for gastric carcinoma at six Italian centers from 1988 through 2006. Upon multivariate analysis, the new T categories, extent of lymph node dissection (D) and patient's age were retained by the survival model as independent prognostic factors. In particular, the death risk for patients with T3 tumors was higher than that of patients with T2 tumors (HR: 1.42, P = 0.005). Among the 686 patients previously classified as having T2 tumors, patients with T2 and T3 disease were 270 (39.4%) and 416 (60.6%), respectively. After a median follow-up of 55 months, the 5-year overall survival rates were 67.3% and 52.3% for patients with T2 and T3 tumors, respectively (P < 0.001). The survival advantage for the T2 as compared to T3 category was maintained even when N0 and N+ patients were separately considered (P = 0.0154 and P < 0.001, respectively). Our data confirm the prognostic difference between the newly proposed T2 and T3 categories, which should be implemented in the routine clinical practice to improve risk stratification of patients with gastric cancer.
  European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 09/2011; 37(9):779-85. · 2.56 Impact Factor
• Article: Changing clinical and pathological features of gastric cancer over time.

  D Marrelli, C Pedrazzani, P Morgagni, G de Manzoni, F Pacelli, A Coniglio, A Marchet, L Saragoni, S Giacopuzzi, F Roviello
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  ABSTRACT: The aim of the present multicentre observational study was to evaluate potential changes in clinical and pathological features of patients with gastric cancer (GC) treated in a 15-year interval. A centralized prospective database including clinical, surgical, pathological and follow-up data from 2822 patients who had resection of a primary GC was analysed. The analysis focused on three periods: 1991-1995 (period 1), 1996-2000 (period 2) and 2001-2005 (period 3). Surgical procedure, pathological classification and follow-up were standardized among centres. The number of resections decreased from 1024 in period 1 to 955 and 843 in periods 2 and 3 respectively. More advanced stages and a smaller number of intestinal-type tumours of the distal third were observed over time. Five-year survival rates after R0 resection (2320 patients) did not change over time (overall: 56·6 and 51·2 per cent in periods 1 and 3; disease-free: 66·8 and 61·1 per cent respectively). Decreases in survival in more recent years were related particularly to more advanced stage, distal tumours and tumours in women. Multivariable analysis showed a lower probability of overall and disease-free survival in the most recent interval: hazard ratio 1·22 (95 per cent confidence interval 1·06 to 1·40) and 1·29 (1·06 to 1·58) respectively compared with period 1. Recurrent tumours were more frequently peritoneal rather than locoregional. Overall and disease-free survival rates after R0 resection of GC were unchanged over time.
  British Journal of Surgery 05/2011; 98(9):1273-83. · 4.61 Impact Factor
• Article: Prognostic value of subclassification of T2 tumours in patients with gastric cancer.

  D Nitti, A Marchet, S Mocellin, G M Rossi, A Ambrosi, R Mencarelli
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  ABSTRACT: This study was designed to evaluate the prognostic value of tumour stage T2 subcategorization (T2a and T2b) in patients with gastric carcinoma. Clinicopathological details of a prospective series of patients who had radical resection of gastric adenocarcinoma in a single institution were analysed. Univariable and multivariable survival analyses were performed with the log rank test and Cox's model respectively. Of 373 evaluable patients, 49 (13.1 per cent) had a T2a and 143 (38.3 per cent) a T2b tumour. At a median follow-up of 35.5 months, the 5-year overall survival rate was 73 and 31.1 per cent for patients with T2a and T2b lesions respectively (P < 0.001). On multivariable analysis, T stage remained an independent prognostic factor. Compared with T1a, the mortality risk for patients with T1b (hazard ratio (HR) 1.00; P = 0.992) and T2a (HR 0.97; P = 0.916) tumours was similar; by contrast, the risk of death associated with T2b (HR 1.81; P = 0.031) and T3 (HR 1.89; P = 0.038) lesions was significantly greater than for T1a tumours. Subclassification of T2 tumours should be undertaken routinely in order to stratify patients with gastric cancer more accurately in terms of their mortality risk.
  British Journal of Surgery 04/2009; 96(4):398-404. · 4.61 Impact Factor
• Article: Indexes of surgical quality in gastric cancer surgery: experience of an Italian network.

  G Verlato, F Roviello, A Marchet, S Giacopuzzi, D Marrelli, D Nitti, G de Manzoni
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  ABSTRACT: Short-term results of gastric cancer surgery vary remarkably worldwide, and international surgical quality criteria are urgently needed. To contribute to defining these criteria, we reviewed short-term results of gastrectomy for gastric cancer in three centers of the Italian Research Group for Gastric Cancer, with an average of 24.7, 29.5, and 18 gastrectomies per year. Between 1988 and 2002, 1,032 patients underwent gastrectomy for gastric cancer in Verona, Siena, and Padua. D1, D2, and D3 lymphadenectomy were performed, respectively, in 228, 584, and 220 cases. The median number of retrieved lymph nodes was 14 (interquartile range 9-18.75) after D1, 29 (21-38) after D2, and 46.5 (37-57) after D3. Fewer than 15 nodes were retrieved in 54.5%, 6.2%, and 1.4% of cases undergoing, respectively, D1, D2, and D3. Adjacent organ removal was rare during D1 (splenectomy: 6.1%, splenopancreasectomy: 1.8%), and quite common during D3 (11.4%, 11.4%). Forty patients (3.9%) died postoperatively. Neither postoperative morbidity nor mortality was significantly associated with extension of lymphadenectomy. We conclude that at least D2 lymphadenectomy is necessary to achieve adequate disease staging (>or=15 nodes retrieved). Spleen and pancreas tail are more frequently removed during D3, but this removal is not associated with higher postoperative morbidity or mortality.
  Annals of Surgical Oncology 02/2009; 16(3):594-602. · 4.17 Impact Factor
• Article: Metachronous hepatic metastases from gastric carcinoma: a multicentric survey.

  G A M Tiberio, A Coniglio, A Marchet, D Marrelli, S Giacopuzzi, L Baiocchi, F Roviello, G de Manzoni, D Nitti, S M Giulini
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  ABSTRACT: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease. To survey the clinical approach to the subset of patients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance. Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated. Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001). Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible.
  European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 02/2009; 35(5):486-91. · 2.56 Impact Factor
• Article: Lymph node ratio is a powerful prognostic factor in patients receiving preoperative chemoradiotherapy for rectal cancer

  S. Pucciarelli, C. Capirci, A. Ambrosi, C. Mescoli, P. Toppan, M. L. Friso, S. Lonardi, A. Marchet, A. Ramin, M. Briarava, G. Crepaldi, M. Rugge, D. Nitti
  Annals of Surgical Oncology. 01/2009; 16:82-82.
• Article: Resection line involvement after gastric cancer surgery: clinical outcome in nonsurgically retreated patients.

  P Morgagni, D Garcea, D Marrelli, G De Manzoni, G Natalini, H Kurihara, A Marchet, L Saragoni, E Scarpi, C Pedrazzani, A Di Leo, F De Santis, V Panizzo, D Nitti, F Roviello
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  ABSTRACT: Resection line infiltration (RLI) after surgical treatment represents an unfavorable prognostic factor in advanced gastric cancer. We performed a retrospective analysis of 89 patients with resection line involvement who did not undergo reoperation. On behalf of the Italian Research Group for Gastric Cancer, we present the characteristics and outcome of 89 patients who were submitted to surgical resection for gastric cancer from 1988 to 2001 and did not undergo reoperation because of disease extension or associated pathologies. RLI was significantly higher in patients with T4 tumors and diffuse histological type. Anastomotic leakages were observed in 4.8% of infiltrated esophageal resection margins, whereas 1.9% of infiltrated duodenal resection lines showed duodenal fistulas. Five-year overall survival of patients with RLI was 29%. Prognosis was not affected by RLI in early forms (100% 5-year survival); however, 5-year survival in T2 and T3 stages was significantly lower with respect to the same stages without residual tumor. The influence of RLI on prognosis was confirmed in N0 as well as in N1 and N2 patients. RLI also was an independent prognostic at multivariate analysis (odds ratio = 1.5; 95% confidence interval, 1.08-2.08; P = 0.0144). RLI significantly affects long-term survival of advanced gastric cancer. The impact on prognosis is independent of lymph node involvement. Patients in good general condition for whom radical surgery is possible should be considered for reoperation.
  World Journal of Surgery 10/2008; 32(12):2661-7. · 2.36 Impact Factor
• Article: The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series.

  A Marchet, S Mocellin, A Ambrosi, G de Manzoni, A Di Leo, D Marrelli, F Roviello, P Morgagni, L Saragoni, G Natalini, F De Santis, L Baiocchi, A Coniglio, D Nitti
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  ABSTRACT: The proportion between metastatic and examined lymph nodes (N-ratio) has been proposed as an independent prognostic factor in patients with gastric cancer. In the present work we validated the reliability of N-ratio in a large, multicenter series. We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma. Survival of patients with >15 (Group-1, n=1421) and those with < or =15 (Group-2, n=432) lymph nodes examined was separately analyzed in order to evaluate the influence of lymph node dissection on disease staging. N-ratio categories (N-ratio 0, 0%; N-ratio 1, 1-9%; N-ratio 2, 10-25%; N-ratio 3, >25%) were determined by the best cut-off approach. At multivariate analysis, N-ratio (but not TNM N-category) was retained as an independent prognostic factor both in Group-1 and Group-2 (HR for N-ratio 1, N-ratio 2 and N-ratio 3=1.67, 2.96 and 6.59, and 1.56, 2.68 and 4.28, respectively). After a median follow-up of 45.5 months, the 5-year overall survival rates of TNM N0, N1 and N2 patients were significantly different in Group-1 vs Group-2. This was not the case when adopting the N-ratio classification, suggesting that a low number of excised lymph nodes can lead to patients being understaged using the N-category, but not N-ratio. Moreover, N-ratio identified subsets of patients with significantly different survival rates within TNM N1 and N2 categories in both groups. N-ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer, including those cases with limited lymph node dissection. These data support the rationale to propose the implementation of N-ratio into the current TNM staging system.
  European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 02/2008; 34(2):159-65. · 2.56 Impact Factor
• Article: The prognostic value of N-ratio in patients with gastric cancer: Validation in a large, multicenter series

  A. Marchet, S. Mocellin, A. Ambrosi, G. de Manzoni, A. Di Leo, D. Marrelli, F. Roviello, P. Morgagni, L. Saragoni, G. Natalini, F. De Santis, L. Baiocchi, A. Coniglio, D. Nitti, Italian Res Grp Gastr Canc Study
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  ABSTRACT: Aims: The proportion between metastatic and examined lymph nodes (N-ratio) has been proposed as an independent prognostic factor in patients with gastric cancer. In the present work we validated the reliability of N-ratio in a large, multicenter series. Patients and methods: We retrospectively reviewed the data of 1853 patients who underwent radical resection for gastric carcinoma. Survival of patients with > 15 (Group-1, n = 1421) and those with <= 15 (Group-2, n = 432) lymph nodes examined was separately analyzed in order to evaluate the influence of lymph node dissection on disease staging. N-ratio categories (N-ratio 0, 0%; N-ratio 1, 1-9%; N-ratio 2, 10-25%; N-ratio 3, >25%) were determined by the best cut-off approach. Results: At multivariate analysis, N-ratio (but not TNM N-category) was retained as an independent prognostic factor both in Group-1 and Group-2 (HR for N-ratio 1, N-ratio 2 and N-ratio 3 = 1.67, 2.96 and 6.59, and 1.56, 2.68 and 4.28, respectively). After a median follow-up of 45.5 months, the 5-year overall survival rates of TNM N0, N1 and N2 patients were significantly different in Group-1 vs Group-2. This was not the case when adopting the N-ratio classification, suggesting that a low number of excised lymph nodes can lead to patients being understaged using the N-category, but not N-ratio. Moreover, N-ratio identified subsets of patients with significantly different survival rates within TNM NI and N2 categories in both groups. Conclusions: N-ratio is a simple and reproducible prognostic tool that can stratify patients with gastric cancer, including those cases with limited lymph node dissection. These data support the rationale to propose the implementation of N-ratio into the current TNM staging system. (C) 2007 Elsevier Ltd. All rights reserved.
  Ejso. 01/2008; 34(2):159-165.
• Article: Gene expression profile of primary gastric cancer: Towards the prediction of lymph node status

  A. Marchet, S. Mocellin, C. Belluco, A. Ambrosi, F. DeMarchi, E. Mammano, M. Digito, A. Leon, A. D'Arrigo, M. Lise, D. Nitti
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  ABSTRACT: Background: The identification of gastric tumors associated with a higher risk of lymph node metastasis could help surgeons select patients who may benefit from extended lymph node dissection. The aim of this study was to screen the genome in the search of primary gastric cancer gene expression profiles that might predict lymph node status. Methods: The gene expression profile was evaluated in frozen tumor samples obtained from 32 patients with primary gastric adenocarcinomas. The array consisted of a duplicated spot panel of 5,541 human genes. To classify node-positive (N+) and node-negative (N-) cases, a logistic regression model was fitted optimizing the Akaike Information Criteria after a stepwise gene selection. The accuracy was evaluated by means of leave-one-out cross validation. Results: All patients underwent radical gastrectomy and extended lymphadenectomy. Of all the cases, 21 were N+ and 11 demonstrated no lymph node involvement (N-). After quality filtering, the analysis of variance selected a set of 136 genes potentially correlated with nodal involvement (P value <.05). Of these 136 genes, 5 were differentially expressed (adjusted P value <.05). After a stepwise gene selection, only three genes (Bik, aurora kinase B, eIF5A2) were retained in the logistic model, which could correctly predict lymph node status in 30 of 32 cases. Conclusions: If our findings were confirmed, the identified gene pattern might be used to tailor the extent of lymph node dissection on a single patient basis.
  Annals of Surgical Oncology. 01/2007; 14(3):1058-1064.
• Article: Randomized phase III trials of adjuvant FAMTX or FEMTX compared with surgery alone in resected gastric cancer. A combined analysis of the EORTC GI Group and the ICCG.

  D Nitti, J Wils, J Guimaraes Dos Santos, G Fountzilas, P F Conte, C Sava, A Tres, R C Coombes, D Crivellari, A Marchet, E Sanchez, J M Bliss, J Homewood, M L Couvreur, E Hall, B Baron, E Woods, M Emson, E Van Cutsem, M Lise
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  ABSTRACT: In patients who underwent radical resection for gastric cancer, we investigate the relative efficacy of combined 5-fluorouracil+adriamycin or epirubicin and methotrexate with leucovorin rescue (FAMTX or FEMTX) compared with a control arm. This report is a prospective combined analysis of two randomized clinical trials conducted on patients who underwent radical resection for histologically proven adenocarcinoma of the stomach or esophago-gastric junction. Three hundred and ninety-seven untreated patients, 206 from 23 European Organization for Research and Treatment of Cancer (EORTC) institutions and 191 from 16 International Collaborative Cancer Group (ICCG) institutions, were randomized. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and the treatments were compared for these end-points by means of the log-rank test, retrospectively stratified by trial. In a planned combined analysis of the two trials, no significant differences were found between the treatment and control arms for either DFS (hazards ratio: 0.98, P=0.87) or OS (hazards ratio: 0.98, P=0.86). The 5-year OS was 43% in the treatment arm and 44% in the control arm and the 5-year DFS was 41% and 42%, respectively. Neither FAMTX nor FEMTX can be advocated as adjuvant treatment in patients who undergo resection for gastric cancer.
  Annals of Oncology 03/2006; 17(2):262-9. · 6.43 Impact Factor
• Article: Gene expression profiling of gastric cancer reveals a lymph node metastatic transcriptional fingerprint

  A. Marchet, C. Belluco, A. D'Arrigo, A. Ambrosi, E. Mammano, M. Digito, M. Maino, M. Lise, A. Leon, D. Nitti
  Annals of Surgical Oncology. 01/2006; 13(2):24-24.
• Article: Extended lymphadenectomy (D2) in patients with early gastric cancer.

  D Nitti, A Marchet, E Mammano, A Ambrosi, C Belluco, R Mencarelli, M Maino, G Marconato, F Farinati, M Lise
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  ABSTRACT: To investigate the survival benefit of extended lymphadenectomy (D2) in EGC patients in one European Institution. A review was made of our prospective gastric database from January 1980 to December 2001. Of 527 patients with primary gastric adenocarcinoma, 119 with EGC underwent potentially curative resection (R0) with D2 lymphadenectomy. There were two post-operative deaths. Of the 117 evaluable cases, 96 were classified as N0 and 21 as N+, with metastases in the perigastric lymph nodes (level 1) in 13, and beyond this site (level 2) in eight. Five-year survival was 85.9 and 83.0% in N0 and N+ patients, respectively. During a median follow-up of 90 months, five of the eight patients with level 2 metastases died of recurrent disease and three were alive. The estimated survival benefit for 119 patients with EGC was 2.5% (3/119 cases). In patients with EGC, metastases to level 2 are rare. Our results indicate that D2 lymphadenectomy has a limited survival benefit and that in these cases a less extensive lymphadenectomy (D1) could be performed.
  European Journal of Surgical Oncology 11/2005; 31(8):875-81. · 2.50 Impact Factor
• Article: Axillary sentinel lymph nodes in breast cancer: a single lymphatic pathway drains the entire mammary gland.

  G Zavagno, D Rubello, Z Franchini, F Meggiolaro, A Ballarin, D Casara, V Denetto, A Marchet, L Rampin, C Polico, D Nitti, G Mariani
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  ABSTRACT: To report the pattern of lymphatic mapping following intrasubdermal injections of radiocolloid and of blue dye in different sites of the breast. Prior to surgery 137 breast cancer patients underwent intrasubdermal injection of 30-50 MBq 99mTc-colloidal albumin over the tumour site (ISI group). Ten minutes before surgery, 2 ml patent blue was injected in the subareolar area (SAI group) in 117/137 patients, while 20 patients received intrasubdermal blue-dye in the quadrant opposite the tumour site (OQI group). The different injection routes were considered concordant when the hottest sLN was also blue. In 134/137 patients radiocolloid drained to one or more axillary nodes, while blue nodes were found in 98/117 SAI patients and in 17/20 OQI patients. Multiple hot nodes were found in 63/134 cases and multiple blue nodes in 35/115. In patients in whom both tracers reached the axilla, the hottest node was also blue in 108/115 cases (93/98 SAI and 15/17 OQI patients). In the seven discordant cases, the hottest node was not blue, but in two cases the blue node was also radioactive. Superficial lymphatic drainage from the breast most frequently merges to a single axillary lymph node, irrespective of the site of tracer injection. In a few cases different injection sites identify different, often closely interconnected sLNs.
  European Journal of Surgical Oncology 07/2005; 31(5):479-84. · 2.50 Impact Factor
• Article: Subclassification of the T2 category into T2a and T2b identifies tumors with different biological and clinical outcome in patients with gastric cancer

  D. Nitti, A. Marchet, M. Olivieri, A. Ambrosi, R. Mencarelli, M. Maino, E. Mammano, C. Belluco, M. Lise
  Annals of Surgical Oncology. 01/2005; 12(2):S82-S82.
• Article: Is extended lymphadenectomy (D2) justified in patients with early gastric cancer

  D. Nitti, A. Marchet, C. Belluco, M. Olivieri, A. Ambrosi, R. Mencarelli, M. Lise
  Annals of Surgical Oncology. 01/2004; 11(2):S115-S115.
• Article: The metastatic/examined lymph nodes ratio is an independent prognostic factor after D2 resection for gastric cancer: Analysis of a large European monoinstitutional experience

  D. Nitti, A. Marchet, C. Belluco, M. Olivieri, A. Ambrosi, E. Mammano, M. Lise
  Annals of Surgical Oncology. 01/2003; 10(1):S13-S13.
• Article: Low level of p27((Kip1)) protein expression in gastric adenocarcinoma is associated with disease progression and poor outcome

  D. Nitti, C. Belluco, E. Mammano, A. Marchet, A. Ambrosi, R. Mencarelli, P. Segato, M. Lise
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  ABSTRACT: Background and Objectives: Low tumor expression of the p27(Kip1) protein, which is involved in cell cycle control and apoptosis, is considered a negative prognostic factor in different types of cancer. The aim of this study was to evaluate the clinical and pathological significance of low p27(Kip1) protein expression in patients who had undergone resection for gastric adenocarcinoma. Methods: p27(Kip1) protein was studied by immunohistochemistry in formalin-fixed tumor sections from 95 patients who underwent resection for gastric adenocarcinoma between 1991 and 1996. Based on the median value of protein expression, p27(Kip1) protein expression was classified as low or high. Results: Low p27(Kip1) protein expression was significantly associated with tumor dedifferentiation, increased penetration through the gastric wall, lymph node metastasis, and advanced tumor stage. In the group of 84 patients who underwent curative surgery, 5-year survival was 74% in cases with high p27(Kip1) protein expression and 38% in those with low p27(Kip1) protein expression (P < 0.001). At multivariate analysis, low p27(Kip1) protein expression was an independent negative prognostic factor for survival (RR = 3.671; P = 0.004). Conclusions: In gastric adenocarcinoma, low p27(Kip1) protein expression is associated with poorly differentiated and advanced tumors and is a negative prognostic factor of potential clinical value.
  Journal of Surgical Oncology. 01/2002; 81(4):167-175.
• Article: Resection of pulmonary metastases from colorectal carcinoma.

  A Zanella, A Marchet, P Mainente, D Nitti, M Lise
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  ABSTRACT: A retrospective study was made on 22 patients who underwent surgery (28 operations) for lung metastases of colorectal origin from 1986 to 1995 at the Department of Surgery II, Padova University. The overall 5-year survival (OS) following pulmonary resection was 62% and the 5-year disease-free interval after metastasectomy (DFIM) 45%. The median survival was 23.6 months and the median DFIM 15.3 months. Univariate (Mantel Cox) and multivariate (Cox's model) analyses were used to identify any prognostic factors significant for OS and DFIM. Site and stage of primary colorectal carcinoma, number of pulmonary metastases at presentation, disease-free intervals between treatment of primary tumour and diagnosis of lung metastases (DFIP) appeared to have no influence on OS and DFIM. However, patients who underwent radical resection for metastases had a significantly longer DFIM than those who underwent 'non-radical' resections (P = 0.02), but radical resection had no significant positive effect on OS. A short DFIP, multiple and/or bilateral lesions, lung metastases occurring after liver resection with a curative aim are not contraindications to surgery in patients with pulmonary metastases from colorectal cancer, the main criterion for selection of patients being the possibility of performing 'radical' resection.
  European Journal of Surgical Oncology 11/1997; 23(5):424-7. · 2.50 Impact Factor
• Article: [Complementary treatment to surgery of gastric carcinoma: role of adjuvant and neoadjuvant chemotherapy].

  M Lise, D Nitti, A Marchet, M Tripodi, P Pilati, L Pasetto
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  ABSTRACT: Although there has been a decline in the incidence of gastric cancer worldwide, its mortality rate is still high. In the West, attempts with adjuvant chemotherapy to improve survival have been disappointing. The promising results reported with the FAM (5-FU, Adriamycin, Mitomycin C) regimen in patients with advanced disease, have not been confirmed in an adjuvant setting. Randomized trials on adjuvant chemotherapy in Japan have shown a positive outcome in treated patients only when subgroups with advanced disease are considered. As results with adjuvant chemo-immunotherapy were better than those with chemotherapy alone, immunostimulators have been widely utilized in clinical trials conducted in Japan in recent years. However, chemo-immunotherapy may be more effective in patients with minimal residual disease, due to the combined action of a lower stage at diagnosis and to a diffuse application of standard wide lymphadenectomy. Inadequate lymphadenectomy, like that performed in many western studies, may compromised radicality in patients with "curable" disease and the concept of "minimal residual disease" must therefore be considered in future trials on adjuvant chemotherapy. Future trends for new therapeutic combinations (FAMTX, EAP, 5-FU/Cisplatin, PELF, etc) tested in phase II and III clinical trials are also discussed. Whatever the type of approach used, the high incidence of intra-abdominal recurrences indicates that an improvement in the prognosis of patients with advanced diseases will only come with the development of additional treatment modalities such as neoadjuvant or intraperitoneal chemotherapy.
  Chirurgia italiana 02/1997; 49(3):35-9.