BACKGROUND: After publication of the MAGIC trial results, preoperative chemotherapy is increasingly used to treat advanced gastric cancer before resection. Tools for measuring response must be assessed. METHODS: We identified all patients with gastric cancer treated with neoadjuvant chemotherapy and R0 resection between 1991 and 2005 from a prospective database. Patients receiving preoperative radiation were excluded. Histologic response to treatment was graded from 0% to 100% by a single pathologist. Kaplan-Meier survival analysis was performed to identify the relationship between response and outcome and to identify factors predictive of disease-specific survival (DSS). Multivariate analysis was performed to identify independent predictors. RESULTS: A total of 168 patients underwent R0 resection after receiving neoadjuvant chemotherapy. Thirty-three percent of tumors were at the gastroesophageal junction. Cisplatin-based therapy was used for 68% of patients. Twenty-two percent of patients had a >50% pathologic response to treatment. Median follow-up after resection for all patients was 25 months. Median DSS for all patients was 33 months. Three-year DSS improved from 44% to 69% with at least a 50% histologic response (P = .01). Factors associated with decreased DSS included positive nodes at resection, pT3 tumor or greater, high grade, perineural or vascular invasion, and <50% response. Multivariate analysis identified nodal status and perineural or vascular invasion as independent predictors of survival. CONCLUSIONS: Posttreatment nodal status and perineural or vascular invasion at resection, but not graded histologic response, independently predict DSS after neoadjuvant chemotherapy and surgical resection of gastric cancer.
BACKGROUND: After publication of the MAGIC trial results, preoperative chemotherapy is increasingly used to treat advanced gastric cancer before resection. Tools for measuring response must be assessed. METHODS: We identified all patients with gastric cancer treated with neoadjuvant chemotherapy and R0 resection between 1991 and 2005 from a prospective database. Patients receiving preoperative radiation were excluded. Histologic response to treatment was graded from 0% to 100% by a single pathologist. Kaplan-Meier survival analysis was performed to identify the relationship between response and outcome and to identify factors predictive of disease-specific survival (DSS). Multivariate analysis was performed to identify independent predictors. RESULTS: A total of 168 patients underwent R0 resection after receiving neoadjuvant chemotherapy. Thirty-three percent of tumors were at the gastroesophageal junction. Cisplatin-based therapy was used for 68% of patients. Twenty-two percent of patients had a >50% pathologic response to treatment. Median follow-up after resection for all patients was 25 months. Median DSS for all patients was 33 months. Three-year DSS improved from 44% to 69% with at least a 50% histologic response (P = .01). Factors associated with decreased DSS included positive nodes at resection, pT3tumor or greater, high grade, perineural or vascular invasion, and <50% response. Multivariate analysis identified nodal status and perineural or vascular invasion as independent predictors of survival. CONCLUSIONS: Posttreatment nodal status and perineural or vascular invasion at resection, but not graded histologic response, independently predict DSS after neoadjuvant chemotherapy and surgical resection of gastric cancer.
Authors: Deyali Chatterjee; Asif Rashid; Hua Wang; Matthew H Katz; Robert A Wolff; Gauri R Varadhachary; Jeffrey E Lee; Peter W Pisters; Henry F Gomez; James L Abbruzzese; Jason B Fleming; Huamin Wang Journal: Am J Surg Pathol Date: 2012-04 Impact factor: 6.394
Authors: Johan L Dikken; Cornelis J H van de Velde; Daniel G Coit; Manish A Shah; Marcel Verheij; Annemieke Cats Journal: Therap Adv Gastroenterol Date: 2012-01 Impact factor: 4.409
Authors: Johan L Dikken; Johanna W van Sandick; H A Maurits Swellengrebel; Pehr A Lind; Hein Putter; Edwin P M Jansen; Henk Boot; Nicole C T van Grieken; Cornelis J H van de Velde; Marcel Verheij; Annemieke Cats Journal: BMC Cancer Date: 2011-08-02 Impact factor: 4.430