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Advances in Gastric Cancer and Peritoneal Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (25 September 2025) | Viewed by 4436

Special Issue Editor

Department of Surgery, Jichi Medical University, Tochigi 329-0498, Japan
Interests: gastric cancer; peritoneal disease; conversion surgery; intraperitoneal chemotherapy; potential biomarker

Special Issue Information

Dear Colleagues,

Peritoneal disease can be the most frequent type of metastasis and site of recurrence in patients with advanced gastric cancer. This being the case, treatments of peritoneal disease should be the key for the improvement of prognoses for these patients. For years, we have focused on Stage IV gastric cancer with peritoneal disease. The intraperitoneal administration of paclitaxel (IP-PTX) has a great medical advantage in controlling peritoneal lesions and can be combined with various systemic chemotherapies.

Hyperthermic intraperitoneal chemotherapy (HIPEC), combined with cytoreductive surgery, has been tried for patients with PM of GC mainly in Western countries. These aggressive treatments have not resulted in significant survival benefits in GC patients with PM. Since the intraperitoneal administration of anticancer drugs can induce an extremely high concentration of drugs in the peritoneal cavity, intraperitoneal chemotherapy would appear to be a reasonable and promising strategy with which to control peritoneal dissemination.

This Special Issue aims to highlight the current knowledge on gastric cancer and peritoneal diseases and underline possible diagnostic as well as therapeutic repercussions in gastric cancer and peritoneal diseases.

Dr. Shin Saito
Guest Editor

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Keywords

  • gastric cancer
  • peritoneal disease
  • conversion surgery
  • intraperitoneal chemotherapy
  • potential biomarker

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Published Papers (3 papers)

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Research

17 pages, 2050 KB  
Article
Bidirectional Neoadjuvant Chemotherapy for Patients with Gastric Cancer and Synchronous Peritoneal Metastases (GCPMs): Results of a Western Phase II Study
by Daniele Biacchi, Marco Angrisani, Vincenzo Picone, Daniele Scuto, Maria Gloria Gallotti, Fabio Accarpio, Franco Iafrate, Giorgio Masci, Immacolata Iannone, Alessandra Spagnoli and Paolo Sammartino
J. Clin. Med. 2025, 14(18), 6518; https://doi.org/10.3390/jcm14186518 - 16 Sep 2025
Viewed by 619
Abstract
Background: The outcomes of patients with peritoneal metastases from gastric cancer (GCPMs) remain dismal, with an overall survival (OS) of less than 1 year. Approaches reported from East Asia include normothermic intraperitoneal systemic chemotherapy, aimed at downstaging the disease, allowing an R0 resection. [...] Read more.
Background: The outcomes of patients with peritoneal metastases from gastric cancer (GCPMs) remain dismal, with an overall survival (OS) of less than 1 year. Approaches reported from East Asia include normothermic intraperitoneal systemic chemotherapy, aimed at downstaging the disease, allowing an R0 resection. This is the first Western study evaluating a bidirectional regimen in a neoadjuvant setting of GCPMs. This phase II study evaluates the tolerability, efficacy and conversion surgery rate. Methods: Patients with PCI < 13 without ascites or HER2 overexpression and no extraperitoneal spread were enrolled starting in January 2018. After staging laparoscopy combined with PIPAC (cisplatin + doxorubicin), NIPS began following Yonemura’s schedule: cisplatin (30 mg/m2) + docetaxel (30 mg/m2), intraperitoneally (day 1); capecitabine 1000 mg/m2, orally (days 2–15); and cisplatin (30 mg/m2) + docetaxel (30 mg/m2), intravenous (day 8). After three cycles, patients with no progressive disease and negative peritoneal cytology underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Three additional NIPS cycles were reserved for patients who underwent surgery. Results: Among the 25 treated patients with 17.3-month (95%CI: 10.4; NA) OS, no adverse events (CTCAE) ≥ G3 arose. With a 52% conversion surgery rate, 13 patients underwent CRS combined with HIPEC (cisplatin 100 mg/m2), 10 with CC0 status 3 with CC experienced no operative mortality, and major complications rated Clavien–Dindo IIIB occurred in 2 patients (15.4%). The median OS for patients undergoing surgery was 26 (95%CI: 23.1; NA) months, with progression-free survival of 20 (95%CI: 16.7–NA) months. Conclusions: NIPS is safe and effective. The conversion rate in our Western patients is comparable to that reported in Eastern Asian countries. Full article
(This article belongs to the Special Issue Advances in Gastric Cancer and Peritoneal Diseases)
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12 pages, 1658 KB  
Article
Advances in Intraperitoneal Chemotherapy for Gastric Cancer Patients with Peritoneal Metastases: Current Status of Treatment and Institutional Insights
by Shin Saito, Hironori Yamaguchi, Akira Saito, Yuki Kaneko, Hideyuki Ohzawa, Shinichiro Yokota and Joji Kitayama
J. Clin. Med. 2025, 14(10), 3521; https://doi.org/10.3390/jcm14103521 - 17 May 2025
Viewed by 1941
Abstract
Introduction: Peritoneal metastasis (PM) is the most common site of recurrence following curative resection for advanced gastric cancer (GC). Along with disease progression, it can lead to complications such as intestinal obstruction, hydronephrosis, obstructive jaundice, and ascites, significantly impairing the patient’s quality of [...] Read more.
Introduction: Peritoneal metastasis (PM) is the most common site of recurrence following curative resection for advanced gastric cancer (GC). Along with disease progression, it can lead to complications such as intestinal obstruction, hydronephrosis, obstructive jaundice, and ascites, significantly impairing the patient’s quality of life. Therefore, peritoneal metastasis is considered a critical target for treatment. In general, these patients are treated with systemic chemotherapy; however, the therapeutic effect is often limited due to the anticancer agents’ poor penetration into the peritoneal cavity. We aim to identify factors associated with the best overall survival (OS) in GC patients with peritoneal metastasis. Methods: Patients with advanced GC who were diagnosed as having macroscopic PM or positive peritoneal cytology by staging laparoscopy were enrolled. We introduced intraperitoneal Paclitaxel (IP-PTX) combined with S-1 plus oxaliplatin (SOX). Gastrectomy with lymph node dissection was performed as conversion surgery when the PM showed an excellent response. Results: Ninety-six patients received IP-PTX + SOX, with a median of 16 courses. The 1- and 5-year OS rates were 70.2% and 24.5%, respectively, with a mean survival time (MST) of 20.0 months. No chemotherapy-related mortality was observed. Conversion surgery was performed in 44 patients (45.8%), with a 1-year OS rate of 100%. Conclusions: Combination chemotherapy using the IP-PTX + SOX regimen is highly effective and is recommended as induction chemotherapy for patients with PM from GC. Conversion gastrectomy should be considered following an excellent response, particularly in patients with peritoneal cancer index (PCI) scores below 20. Full article
(This article belongs to the Special Issue Advances in Gastric Cancer and Peritoneal Diseases)
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22 pages, 2249 KB  
Article
Gastric Adenocarcinomas with CDX2 Induction Show Higher Frequency of TP53 and KMT2B Mutations and MYC Amplifications but Similar Survival Compared with Cancers with No CDX2 Induction
by Ioannis A. Voutsadakis
J. Clin. Med. 2024, 13(24), 7635; https://doi.org/10.3390/jcm13247635 - 15 Dec 2024
Cited by 4 | Viewed by 1251
Abstract
Background: Gastric cancer is one of the most prevalent gastrointestinal cancers. Mortality is high, and improved treatments are needed. A better understanding of the pathophysiology of the disease and discovery of biomarkers for targeted therapies are paramount for therapeutic progress. CDX2, a [...] Read more.
Background: Gastric cancer is one of the most prevalent gastrointestinal cancers. Mortality is high, and improved treatments are needed. A better understanding of the pathophysiology of the disease and discovery of biomarkers for targeted therapies are paramount for therapeutic progress. CDX2, a transcription factor of hindgut specification, is induced in several gastric cancers, especially with intestinal differentiation, and could be helpful for defining sub-types with particular characteristics. Methods: Gastric cancers with induced CDX2 mRNA expression were identified from the gastric cohort of The Cancer Genome Atlas (TCGA) and were compared with cancers that had no CDX2 mRNA induction. Induced CDX2 mRNA expression was defined as mRNA expression z-score relative to all samples above 0, and non-induced CDX2 mRNA expression was defined as mRNA expression z-score relative to all samples below −1. Results: Patients with gastric cancers with CDX2 mRNA induction were older, had less frequently diffuse histology, and more often had mutations in TP53 and KMT2B and amplifications in MYC. CDX2 induction was correlated with HNF4α induction and was reversely correlated with SOX2. Gastric cancers with CDX2 mRNA induction showed lower PD-L1 expression than cancers with lower CDX2 expression but did not differ in CLDN18 mRNA expression. Progression-free and overall survival of the two groups was also not significantly different. Conclusion: Gastric cancers with CDX2 mRNA induction displayed specific characteristics that differentiate them from cancers with no CDX2 induction and could be of interest for optimizing current and future therapies. Full article
(This article belongs to the Special Issue Advances in Gastric Cancer and Peritoneal Diseases)
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