Tóm Tắt Luận Án Lê Thành Trung (Tiếng Anh).Pdf

MINISTRY OF EDUCATION MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY LE THANH TRUNG EVALUATION OF THE RESULTS OF GASTRIC CANCER TREATMENT IN THE ENDERLY WITH COMBINED SURGERY WITH EOX REGIMENT Specializa[.]

MINISTRY OF EDUCATION MINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY

LE THANH TRUNG

EVALUATION OF THE RESULTS OF GASTRIC CANCER TREATMENT IN THE ENDERLY WITH COMBINED SURGERY WITH EOX REGIMENT

Specialization : Oncology

SUMMARY OF MEDICAL DOCTORAL THESIS

HA NOI – 2023

THE STUDY WAS COMPLETED AT

HANOI MEDICAL UNIVERSITY

The scientific instructor:

Assoc Prof Dr DOAN HUU NGHI

Reviewer 1: PGS.TS Nghiem Thi Minh Chau

Reviewer 2: PGS.TS Tran Bao Long

Reviewer 3: PGS.TS Pham Cam Phuong

The dissertation will be defended in front of the University Thesis Evaluation CouncilMeeting at: Hanoi Medical University at: day 2023

Thesis can be learned at library

1 The National Library

2 Library of Hanoi Medical University

LIST OF PUBLISHED ARTICLES RELATED TO THE STUDY

1 Le Thanh Trung, Doan Huu Nghi (2021), Evaluation of early results of gastric cancer surgery in the elderly, Journal of Medicine and Pharmacy, April 18, 2021, 186-191

2 Le Thanh Trung, Doan Huu Nghi (2021), Evaluation of some undesirable effects of EOX regimen in the treatment of stomach cancer in the elderly, Vietnam Medical Journal, May 2/ 2021, 65-69

3 Le Thanh Trung, Doan Huu Nghi (2021), Evaluation of gastric cancer survival time in the elderly after surgery in combination with EOX regimen, Vietnam Medical Journal, June 1st/ 2021, 78-82

INTRODUCTION

1 Urgency of the topic

Gastric cancer is a common malignancy According to the statistics

of Globocan 2020, breast cancer is the 5th disease among 10 cancers, one of the 3 main causes of death related to malignancies (after only common cancer and liver cancer) In Vietnam, colorectal cancer ranks 4th out of 10 common cancers (in both sexes), with 17906 new cases,

14615 deaths with an incidence rate of 24.64 per 100 000 population Along with the advancement of Medicine and the improvement of living conditions, the average life expectancy of people increases, increasing the number of elderly people In 2017, the elderly in Vietnam reached the threshold of 11% of the population, accounting for about 10.6 million people and is expected to reach 17.5% in 2030 (about 18.6 million people) and 28% in 2050 (about 32 million people), Vietnamese life expectancy in 2021 is 73.7 years old Therefore, the number of people aged 60 and older with gastric cancer has also increased

In Vietnam so far, there have been many studies on the treatment

of gastric cancer, but no in-depth research on the treatment of gastric cancer in the elderly Therefore, we conducted the topic "Evaluating the results of gastric cancer treatment in the elderly by surgery with combination chemotherapy with EOX protocol"

3 New contributions of the thesis

The study helps to determine the clinical and subclinical characteristics of elderly patients with gastric cancer At the same time, it is assessed that surgery in the elderly is safe, there are no complications during surgery The operative time was shorter than many authors, an average of 152.2 ± 39.8 minutes There was no difference in the survival time of the group that used 6 full courses of chemotherapy and the group that did not use 6 cycles

of EOX chemotherapy with p=0.8194

Adjuvant chemotherapy with EOX regimen 71.3% of chemotherapy cycles were reduced in dose, so there were few grade 3, 4 side effects Overall survival time of 3 years, 4 years, 5 years of the first study group are 85.6%, 59.7% and 46.7% respectively

The mean overall survival was 49.7±1.8 months Cumulative disease-free survival time of 3, 4, and 5 years was 63.5%, respectively; 45.8%; 35.6% The mean disease-free survival time was 44.4±2.1 months Patients with anemia had a mean survival time of 35.76±2.5 months, which was statistically significantly lower than that

of the non-anemic group, which was 53.8±1.6 months with p=0.001 Patients with concomitant cardiovascular disease had a mean survival time of 37.45±3.5 months, which was lower than the mean survival time of the group without comorbid cardiovascular disease (51.8±1,8 months), (p= 0.03)

4 Thesis structure

The thesis is presented in 128 pages (excluding references and appendices)

Thesis is divided into:

- Chapter 1: Overview of the document 49 pages

- Chapter 2: Research subjects and methods 14 pages

- Chapter 3: Research results 32 pages

The thesis includes 46 tables, 13 charts, and 132 references

Appendices include research works, references, some illustrations, research sheets, list of patients

CHAPTER 1 OVERVIEW 1.1 Epidemiology, risk factors for gastric cancer

Stomach cancer is a common disease in the world as well as in Vietnam According to Globocal 2020, gastric cancer is the 5th most common cancer in the world with an incidence rate of 23.17 per 100 000 population, making it one of the three most common causes of cancer-related death worldwide world, after lung cancer and liver cancer

Our country is located in an area with a high incidence, according to Globocan 2020, gastric cancer ranks fourth after liver and lung cancer

in both sexes with 17906 new cases, 14615 deaths, the incidence rate is 24.64 per 100 000 people

1.2 Diagnosing stomach cancer

Definitive diagnosis: based on clinical and paraclinical tests such as contrast X-ray, abdominal ultrasound, endoscopic ultrasound, endoscopic biopsy for pathology, CT Scan, PET/CT In which, endoscopy and biopsies for pathology have decisive diagnostic value

Diagnosis of staging according to AJCC 2017

1.3 Stomach cancer treatment

Multimodal treatment includes surgery, chemotherapy, radiotherapy and immunotherapy When the disease is in the regional stage, surgery is the main treatment method, chemotherapy is an adjuvant treatment

1.4 Some factors affect treatment in the elderly

Elderly people have aging and functional decline in many organs and have many comorbidities

The elderly group has a higher risk of complications and perioperative mortality than younger people This rate can be reduced with good preoperative preparation, limited emergency surgery, application of minimally invasive surgical techniques, close monitoring during and after surgery for timely adjustment

CHAPTER 2 MATERIALS AND METHODS 2.1 Subjects

Including 57 patients diagnosed with gastric cancer stage IIA-IIIC Surgical treatment combined with EOX regimen At hospital K and hospital E from January 2009 to December 2019

2.1.1 Inclusion criteria

Histopathology type of carcinoma Age 60 was treated with radical gastrectomy, D2 lymphadenectomy Received chemotherapy with EOX regimen Full record keeping

2.1.2 Exclusion criteria

Patients with co-morbid systemic diseases such as diabetes mellitus, uncontrolled hypertension Had chemoradiotherapy before surgery Surgery does not guarantee cure The case had another cancer

d: allowable error, estimated d=0.15

The result of sample size calculation is n = 42 patients In this study, 57 patients met the inclusion criteria for the study

CHAPTER 3 RESULTS

During the period from January 2009 to December 2019, there were

57 gastric cancer patients treated with EOX chemotherapy combined surgery at Hospital K and E hospital The results were as follows:

3.1 Clinical and paraclinical features

3.1.1 Age and sex characteristics

Most of the patients in the study were male, accounting for 75.4%, female was 24.6%, the ratio was approximately 3/1 The mean age of men was 63.7±3.1 years, of women was 62.8±2.8, the overall mean of the study was 63.7±3.4 The highest is 72 years old for men and 69 years old for women

- Musculoskeletal diseases: arthritis 7%; osteoporosis 7%; disc disease 8.8%

- Cataract 14%

- Diabetes 10.5%

- Kidney or urinary tract disease 12.3%

- Digestive diseases 12.3%

- Hepatobiliary disease 5.26%

- Respiratory disease 5.26%

- There are 7 patients with high blood pressure and 4 patients with abnormalities in the electrocardiogram: atrioventricular dysfunction

- In the study, there were no patients with angina pectoris,

myocardial infarction; cerebrovascular disease and tuberculosis

Self palpation of abdominal tumor 04 07

- Symptoms of abdominal pain

Most patients present with abdominal pain with the rate of 96.5% The main characteristic of dull pain is 98.2%

Pain in the epigastrium 98.2%

- The most common systemic symptom is weight loss 45.6%

- Anemia syndrome 28.1%

- There were 5 patients presenting with gastrointestinal bleeding, accounting for 8.8%

3.1.4 Preoperative blood test

- The rate of anemia (Hemoglobin < 10g/dL) is 21.1%

- There were 7 patients with hypoproteinemia (12.3%) and 15 patients with hypoalbuminemia (26.3%)

3.1.5 Tumor markers before surgery

- There were 13 patients (22.8%) with increased CEA concentration > 5ng/ml

- CA 19-9 and CA 72-4 increased slightly, only 5 patients increased CA 19-9 (8.8%) and 11 patients increased CA 72-4 (19.3%)

- The results of the macroscopic description on endoscopy showed that the ulcer type accounted for the highest rate (77.19%), the wart form and the infiltrated form were less common

3.1.7 Preoperative ultrasound

The detection rate of lesions in the stomach and/or regional lymph nodes on ultrasound was 52.6% There were 2 patients with signs of wall thickening with abdominal lymph nodes (7%) There were 27 patients (47.4%) with no lesions detected on preoperative ultrasound

3.1.8 Preoperative computed tomography scan

- Most tumors were detected in antrum (59.6%) and small curvature (22.8%)

- Signs of gastric wall thickening on CT scan were noted in all patients (100%) and signs of loss of layer structure were common (93%)

- CT scan detected abdominal lymph nodes in 26/57 cases (1.8%)

- CT scan detected invasive tumor in 5/57 cases (8.8%)

3.2 Results of surgical treatment

3.2.1 Surgery time

- The average surgery time was 152.4±39.8 (minutes), the lowest

100 minutes, the highest 360 minutes

- Surgery time from 2h-2.5h accounted for 43.9%

3.2.2 Surgical method

Patients are mainly used 2 methods of gastric bypass surgery

- Partial gastrectomy 91.2%

- Removal of the entire stomach 8.8%

3.2.3 Complications and complications after surgery

There are 100% cases without complications during surgery Only

1 case (1.8%) had complications of intestinal obstruction after surgery

3.2.4 Number of days in hospital after surgery

- Most of the patients were hospitalized for more than 07 days with the rate of 91.2%

- Patients were hospitalized for less than 07 days with the rate of 8.8%

3.2.5 Pathological results after surgery

- Most patients have tumor size T3 and T4a with the rate of 42.1%

- No lymph nodes account for 29.8%; N1 lymph nodes account for 49.1%; N2 accounts for 10.5%; N3 accounts for 10.6%

- Patients are mainly stage IIB with 33.3%, IIIA with 31.6%

- Histopathological results showed

Mainly adenocarcinomas with low differentiation accounted for

36.8%, moderately differentiated accounted for 35.1% and poorly differentiated 1.8%

Ring cell carcinoma accounted for 26.3%

3.3 Results of chemotherapy after surgery

3.3.1 Dosage of drugs in treatment

All patients were treated at 85-100% for all 6 cycles

- Treatment 85%-<100% of the dose accounts for 71.3%

- Treatment of 100% of the dose accounts for 28.7%

3.3.2 General adverse effects on hematology over 6 cycles

Table 3.3 General hematological toxicity over 6 cycles

3.3.3 General undesirable effects on liver - kidney function

General toxicity on liver-renal function over 6 cycles

Table 3.4 General toxicity on liver-renal function

substances that are not toxic to the body Therefore, it is only calculated through 6 treatment cycles

3.3.4 General clinical side effects over 6 cycles

Table 3.5 General clinical side effects over 6 cycles

- General clinical toxicity is mainly grade 1 and 2, little influence

on the treatment course

- A few cases of toxicity grade 3 and 4, greatly affecting the treatment course, specifically with anorexia 2.6%; nausea, vomiting 3.2%; diarrhea 1.5%; hand-foot syndrome 1.8% and peripheral neuropathy 0%

3.3.5 Patient switched to chemotherapy regimen

There were 05 poorly tolerated patients who had to be switched to Xelox regimen, in which one patient had right atrioventricular block, one had sinus tachycardia, one had grade 4 thrombocytopenia, two had grade 4 fatigue and anorexia No disease who must stop the chemical

3.4 Results of surgery combined with EOX regimen

3.4.1 Extra life time

Chart 3.1 Kaplan - Meier diagram depicting overall survival time

- The cumulative survival time of 3 years is 85.6%, 4 years is 59.7%, 5 years is 46.7%

- The mean overall survival time was 49.7 ± 1.8 months

- Cumulative disease-free survival time of 3 years is 63.5%, 4 years is 45.8%, 5 years is 35.6%

- The mean disease-free survival time was 44.4 ± 2.1 months

using enough and not enough 6 cycles of chemotherapy was not

statistically significant with p = 0.8194

3.4.2 Some factors related to survival time

 Relation of survival time with anemia

p=0.001 Chart 3.2 The Kaplan-Meier diagram depicts the relationship

between survival time and anemia

Patients with anemia had a median survival time of 35.76 ± 2.5 months, which was lower than that of the non-anemic group of 53.8 ± 1.6 months The difference was statistically significant with p<0.05

 Association of survival time with comorbid heart disease

p=0.003 Chart 3.3 Kaplan–Meier diagram depicting the association of

survival time with comorbid heart disease

Patients with comorbid cardiovascular disease had a mean survival time of 37.45±3.5 months, which was lower than the mean survival time of group without comorbid cardiovascular disease of 51.8±1 8 months The difference was statistically significant with p<0.05

 The relationship of survival time with age and sex, with weight loss, with tumor size, with size of primary tumor, with disease stage, with disease stage is not statistically significant With

Song them lien quan den benh tim mach kem theo

CHAPTER 4 DISCUSSION 4.1 Clinical and paraclinical characteristics of the study subjects

4.1.1 Age and sex characteristics

During the study period, 57 gastric cancer patients underwent radical surgery combined with EOX regimen chemotherapy The mean age was 63.7±3.4 years old, the lowest was 60 years old, the highest was 72 years old The number of male patients was 43, 3 times that of 14 female patients, the ratio was approximately 3/1 The male/female ratio is higher than that of domestic authors such as Trinh Hong Son, the average age is 54.6 ± 24.5; The male/female ratio is 1.75 Do Trong Quyet is 2.5 To Nhu Hanh (2012) average age is 52.7, male/female ratio is 1.72/1

The male/female ratio is similar to studies in developed countries with a higher average life expectancy such as Sasako (2008) in a study

in Japan with a higher mean age at about 60 years old, male also accounted for the same proportion majority, about 70% Cunningham

in the MAGIC study (2006) had a mean age of 62, a male/female ratio

of 3.7/1 In the REAL-2 study (2009), the mean age was 63, the male/female ratio was 4.1/1

The longer the exposure to the risk factors, the higher the incidence The prevalence of the disease by sex in the world as well as in Vietnam has the same characteristics higher than in men There are different gender differences depending on the study This may be because men are more likely to be exposed to high risk factors for gastric cancer than women, so the longer life expectancy, the higher the risk of gastric cancer

in men compared to women This is consistent with the results of this study because the study subjects were patients aged 60 years and older

4.1.2 Comorbidities

In this study, there were musculoskeletal diseases: arthritis 7%; osteoporosis 7%; disc disease 8.8%, cataract 14%; diabetes 10.5%; kidney or urinary tract disease 12.3%; digestive diseases 12.3%; hepatobiliary disease 5.26%; respiratory disease 5.26% and 11 patients with cardiovascular disease accounted for 19.2% There were no patients in the myocardial infarction group; cerebrovascular disease and tuberculosis Compared with the author Vu Cong Nguyen and his colleagues, the community had a lower rate of comorbidities such as arthritis (45.8%), chronic back pain (30.3%), digestive diseases (18.6%), respiratory diseases (7.2%), high blood pressure (40.9%) The