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The authors question classification of advanced disease (e.g., node metastasis, pT3-4) as successfully cured by surgery alone, citing that lymph node involvement is considered systemic disease and larger tumors carry higher failure risk. They also comment on adjuvant therapy underuse versus NCCN recommendations and challenge whether molecular findings (ARID1A vs PIK3CA) clearly translate into improved DFS or OS.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/is-it-possible-that-advanced-stage-gastric-cancer-patients-can-be-cured-by-surgery-alone-letter-to-the-editor/436512/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/is-it-possible-that-advanced-stage-gastric-cancer-patients-can-be-cured-by-surgery-alone-letter-to-the-editor/436512.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1786070896","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why do the authors question curing advanced-stage gastric cancer patients with surgery alone?","Question",{"text":112,"@type":113},"They argue that lymph node metastasis reflects systemic disease and that larger tumors (e.g., pT3-4 and/or N+) have higher therapeutic failure risk when only curative surgery is applied.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do NCCN guidelines factor into the letter’s concerns?",{"text":117,"@type":113},"The letter states that current NCCN guidelines recommend adjuvant treatment rather than surgery alone for patients with pT3-4 and/or N+ gastric cancer, implying a risk of undertreatment.",{"name":119,"@type":110,"acceptedAnswer":120},"What molecular issues does the letter raise regarding ARID1A and PIK3CA?",{"text":121,"@type":113},"The authors note ARID1A mutations may be associated with better prognosis and PIK3CA amplifications with worse prognosis, but question that the original study did not sufficiently separate implications and that targeted therapy/immunotherapy might add limited impact on DFS or OS.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},436512,1790963413,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},549768072016,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","J Chin MedAssoc  \nLETTER TO THE EDITOR  \nIs it possible that advanced-stage gastric cancer patients can be cured by surgery alone?  \nYiu-Tai Lia, Wen-Hsun Changb,c,*  \naDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cFemale Cancer Foundation, Taipei, Taiwan, ROC  \nDEAR EDITOR,  \nWe have read the article entitled “The clinicopathological and genetic differences among gastric cancer patients with no recurrence, early recurrence, and late recurrence after curative surgery”published in the January issue of the Journal ofthe Chinese Medical Association with much interest.1 Dr. Chen’s group tried to integrate the molecular (genetic) difference into the conventional clinicopathological parameter to evaluate the impact on the recurrence pattern in the gastric cancer (GC) patients after curative surgery. Based on their results, the authors concluded that PIK3CA amplifications were frequently detected in diffusetype GC with early recurrence and ARID1A mutations were more common in patients with single-site recurrence, suggesting targeted therapy and immunotherapy might be helpful for the aforementioned patients.1 We congratulated their successful publication. However, we have found some uncertainties of their article.  \nWe are wondering to know why GC patients with positivelymph node metastases could be classified as those who can be successfully by curative surgery (completely or totally resected tumors) . Although we are not familiar with the staging system of GC, in our limited knowledge in the management of patients with gynecologic cancers, the presence of lymph node metastases is always considered the “systemic diseases.”2–4 Additionally, a bigger tumor size classified by tumor node metastasis staging system above pT3-4 may have a higher risk of therapeutic failure when only curative surgery is applied, similar to the cervical cancer,5 suggesting that it is not a better idea to use surgery alone in the management of patients with pT3-4 and/or N+ GC. Infact, the current NCCN guidelines recommend adjuvant treatment rather than surgery alone in patients with pT3-4 and/or N+ GC,6 suggesting that only application of surgery alone for GC patients with pT3-4 and/or the presence of lymphadenopathy was at a higher risk of under treatment. In Dr. Chen’s article, we found the percentage of the adjuvant therapy was very similar without a statistically significant difference among three groups  \n* Address Correspondence. Miss Wen-Hsun Chang, Department of Nursing, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: whchang@vghtpe.gov.tw](ROC. E-mail address: whchang@vghtpe.gov.tw) (W.-H. Chang). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2023) 86: 348-349.  \nReceived December 24, 2022; accepted December 30, 2022.  \ndoi: 10. 1097/JCMA.0000000000000873.  \nCopyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \n(13.6%, 13.4%, and 13.4%, respectively) .1 However, based on the recommendation of NCCN guidelines, many patients who are recommended to have an adjuvant therapy did not receive postoperative adjuvant therapy.  \nAdditionally, as shown by authors, ARID1A mutations were more common in patients with single-site recurrence, suggesting that this molecular biomarker may be an indicator for the better prognosis.1 By contrast, PIK3CA amplifications were more common in diffuse-type GC with early recurrence, suggesting the worse prognosis. However, the authors did not distinguish the difference between both, and the ","cbCaieOdxZPVBAnL","https://ap.wps.com/l/cbCaieOdxZPVBAnL","pdf",286949,"English","# Letter to the Editor\n## Questioning the suitability of surgery-alone for advanced-stage disease\n## Role of adjuvant therapy and alignment with NCCN guidance\n## Interpreting ARID1A and PIK3CA molecular findings and treatment implications\n## Closing remarks on integrating molecular pathology with clinical parameters","[{\"question\":\"Why do the authors question curing advanced-stage gastric cancer patients with surgery alone?\",\"answer\":\"They argue that lymph node metastasis reflects systemic disease and that larger tumors (e.g., pT3-4 and/or N+) have higher therapeutic failure risk when only curative surgery is applied.\"},{\"question\":\"How do NCCN guidelines factor into the letter’s concerns?\",\"answer\":\"The letter states that current NCCN guidelines recommend adjuvant treatment rather than surgery alone for patients with pT3-4 and/or N+ gastric cancer, implying a risk of undertreatment.\"},{\"question\":\"What molecular issues does the letter raise regarding ARID1A and PIK3CA?\",\"answer\":\"The authors note ARID1A mutations may be associated with better prognosis and PIK3CA amplifications with worse prognosis, but question that the original study did not sufficiently separate implications and that targeted therapy/immunotherapy might add limited impact on DFS or OS.\"}]","Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone? - Letter to the Editor | PDF",1790678229]