Reply to “Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?” : Journal of the Chinese Medical Association

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Reply to “Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?”

Chen, Meng-Chaoa,b; Su, Hsuan-Yuc,d; Su, Yen-Haoe,f,g,h; Huang, Kuo-Hungc,d,i,*; Fang, Wen-Liangc,d,i; Lin, Chii-Wanna; Chen, Ming-Huangd,j; Chao, Yeed,j; Lo, Su-Shund,k; Fen-Yau Li, Annad,l; Wu, Chew-Wunc,d

Author Information

aDepartment of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, ROC

bDepartment of Neurosurgery, China Medical University Hospital, Taipei Branch, Taipei, Taiwan, ROC

cDivision of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

dSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC

eDepartment of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC

fDivision of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC

gDivision of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC

hTMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan, ROC

iGastric Cancer Medical Center, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

jCenter of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

kNational Yang Ming Chiao Tung University Hospital, Yilan, Taiwan, ROC

lDepartment of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

Received December 26, 2022; accepted December 30, 2022.

Author contributions: Dr Meng-Chao Chen and Dr Hsuan-Yu Su contributed equally to the article.

Conflicts of interest: Dr Yee Chao, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

*Address Correspondence. Dr. Kuo-Hung Huang, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: [email protected] (K.-H. Huang).

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Journal of the Chinese Medical Association 86(3):p 350, March 2023. | DOI: 10.1097/JCMA.0000000000000875
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DEAR EDITOR,

Thank you for your comments1 for our article.2 With regard to lymph node metastasis, gastric cancer with lymph node metastasis, which is limited to N1 or N2 (NCCN guideline), is classified as regional lymph node metastasis. It has been proved that gastric cancer with D2 lymph node dissection is a standard procedure for gastric cancer surgery.3 These regional lymph nodes could be completely resected by lymph node dissection. If the lymph nodes metastasize to N3 region, it could be classified as distant lymph node metastasis. Lymph node dissection for N3 lymph nodes might have limited benefit for gastric cancer treatment. Unlike the GYN disease, we did not consider gastric cancer with regional lymph node metastasis as “systemic disease.” However, adjuvant chemotherapy for gastric cancer with lymph node metastasis after curative resection is beneficial for these patients. We agreed that GC patients with pT3-4 and/or the presence of lymphadenopathy was at a higher risk of recurrence and should be applied with adjuvant treatment as NCCN guideline’s recommendation. With regard to postoperative adjuvant chemotherapy, there was less effective chemotherapy for gastric cancer after curative resection with D2 lymph node dissection. Since 2008, S-1 has been used as adjuvant chemotherapy for stage II or III disease after curative surgery at our institute based on its proven survival benefit. We had described in the “Method” section.

With regard to ARID1A mutations in gastric cancer, it has been proven that ARID1A mutations are associated with increased immune activity in gastrointestinal cancer.4 We agreed any systemic treatment may have toxicity for human body. As we mentioned above, we use S-1 as adjuvant chemotherapy for stage II or stage III gastric cancer after curative surgery. In gastric cancer, the immunotherapy was considered for patients with stage IV gastric cancer or recurrence after gastric surgery if the gastric cancer patient has therapeutic failure by first- or second-line chemotherapy. Our study provided a therapeutic consideration for targeted therapy and immunotherapy for patient with recurrence after curative surgery.

REFERENCES

1. Li YT, Chang WH. Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone? J Chin Med Assoc 2023;86:348–9.
2. Chen MC, Su HY, Su YH, Huang KH, Fang WL, Lin CW, et al. The clinicopathological and genetic differences among gastric cancer patients with no recurrence, early recurrence, and late recurrence after curative surgery. J Chin Med Assoc 2023;86:55–62.
3. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, Whang-Peng J. Nodal dissection for patients with gastric cancer: a randomized controlled trial. Lancet Oncol 2006;7:309–15.
4. Li L, Li M, Jiang Z, Wang X. ARID1A mutations are associated with increased immune activity in gastrointestinal cancer. Cells 2019;8:678.
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