Impact of ypT, ypN, and Adjuvant Therapy on Survival in Gastric Cancer Patients Treated with Perioperative Chemotherapy and Radical Surgery
- 146 Downloads
Perioperative chemotherapy and surgery is the standard of care in advanced gastroesophageal cancer patients, but its impact among those treated with radical surgery still needs further assessment. We present the results of this multimodality treatment approach in a gastric cancer patients cohort treated with D2 lymphadenectomy. We aimed to identify prognostic factors associated with improved survival.
Patients and Methods
This retrospective cohort study enrolled patients treated with perioperative chemotherapy and resection in a single cancer center in Brazil between 2006 and 2016. Subjects presenting tumors of the gastric stump, esophageal tumors, or treated with intraperitoneal chemotherapy were excluded. Intention-to-treat survival analysis was performed for all subjects who started neoadjuvant chemotherapy, and prognostic factors were determined among those who had R0 resection.
This study included 239 patients, of whom 198 had R0 resection. The mean age was 59.9 years, and most had clinical stage IIB or III disease (88%). Among the 239 patients who started neoadjuvant chemotherapy, 207 (86.6%) completed all neoadjuvant treatment cycles, and surgical resection was performed in 225 subjects (94.1%). Overall 60-day morbidity and mortality rates were 35.6% and 4.4%, respectively. For the entire cohort, median survival was 78 months and the 5-year survival rate was 55.3%. Factors associated with worse survival were ypT3–4 stage, ypN + stage, extended resection, and no adjuvant chemotherapy.
Perioperative chemotherapy resulted in very good outcomes for patients treated with radical surgery, and downstaging after chemotherapy was shown to be a major determinant of prognosis.
The authors acknowledge the financial support given by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Project 2014/26897-0.
All the authors in this study report no disclosures.
- 3.Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol. 2010;28(35):5210–8.CrossRefGoogle Scholar
- 9.Zhong X, Lim EA, Hershman DL, Moinpour CM, Unger J, Lee SM. Identifying severe adverse event clusters using the National Cancer Institute’s common terminology criteria for adverse events. J Oncol Pract. 2016;12(3):e270–80, 45–46.Google Scholar
- 10.Doyle DJ, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). Treasure Island: StatPearls; 2018.Google Scholar
- 12.Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th edn. Hoboken: Wiley; 2017.Google Scholar
- 13.Cats A, Jansen EPM, van Grieken NCT, Sikorska K, Lind P, Nordsmark M, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. Lancet Oncol. 2018;19(5):616–28.CrossRefGoogle Scholar
- 14.Al-Batran S-E, Hofheinz RD, Pauligk C, Kopp H-G, Haag GM, Luley KB, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol. 2016;17(12):1697–708.CrossRefGoogle Scholar
- 16.Claassen YHM, van Amelsfoort RM, Hartgrink HH, Dikken JL, de Steur WO, van Sandick JW, et al. Effect of hospital volume with respect to performing gastric cancer resection on recurrence and survival: results from the CRITICS trial. Ann Surg. 2018. https://doi.org/10.1097/sla.0000000000002940.Google Scholar
- 24.da Costa WL Jr, Coimbra FJ, Ribeiro HS, Diniz AL, de Godoy AL, de Farias IC, et al. Total gastrectomy for gastric cancer: an analysis of postoperative and long-term outcomes through time: results of 413 consecutive cases in a single cancer center. Ann Surg Oncol. 2015;22(3):750–7.CrossRefGoogle Scholar