Naruhiko Ikoma1, Jeannelyn S Estrella2, Wayne Hofstetter3, Prajnan Das4, Bruce D Minsky4, Jaffer A Ajani5, Keith F Fournier1, Paul Mansfield1, Brian D Badgwell6. 1. Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. bbadgwell@mdanderson.org.
Abstract
BACKGROUND: The American Joint Committee on Cancer's 8th edition introduced ypStage, a separate staging system for patients with gastric cancer having undergone preoperative therapy. Overall, ypN0 patients have better survival outcomes than ypN+ patients. However, whether patients with cN+/ypN0 disease ("downstaged N0") and those with cN0/ypN0 disease ("natural N0") have similar survival is unknown. METHODS: An institutional database was reviewed to identify gastric adenocarcinoma patients who underwent potentially curative R0 resection after induction chemotherapy or chemoradiation. Patients were categorized into three groups based on nodal status: cN0/ypN0, cN+/ypN0, and ypN+. Univariable and multivariable Cox regression models were used to identify clinicopathologic factors associated with overall survival (OS). RESULTS: We identified 316 patients who met the study criteria. Ninety-four patients (30%) had cN0/ypN0 disease, 93 (29%) had cN+/ypN0 disease, and 129 (41%) had ypN+ disease. The median OS was 7.7 years, and the 5-year OS was 60.3%. In the multivariate analysis, OS did not differ between the cN0/ypN0 and cN+/ypN0 patients (hazard ratio, 0.90 [95% CI 0.54-1.48]; p = 0.666), but it was shorter in ypN+ patients (hazard ratio, 1.82 [95% CI 1.15-2.87]; p = 0.01). CONCLUSIONS: In gastric cancer patients who underwent preoperative therapy, we found similar OS in cN0/ypN0 and cN+/ypN0 patients. Because ypN+ patients had poor OS, achieving ypN0 status is an important hallmark demonstrating the effectiveness of preoperative therapy for gastric cancer.
BACKGROUND: The American Joint Committee on Cancer's 8th edition introduced ypStage, a separate staging system for patients with gastric cancer having undergone preoperative therapy. Overall, ypN0 patients have better survival outcomes than ypN+ patients. However, whether patients with cN+/ypN0 disease ("downstaged N0") and those with cN0/ypN0 disease ("natural N0") have similar survival is unknown. METHODS: An institutional database was reviewed to identify gastric adenocarcinomapatients who underwent potentially curative R0 resection after induction chemotherapy or chemoradiation. Patients were categorized into three groups based on nodal status: cN0/ypN0, cN+/ypN0, and ypN+. Univariable and multivariable Cox regression models were used to identify clinicopathologic factors associated with overall survival (OS). RESULTS: We identified 316 patients who met the study criteria. Ninety-four patients (30%) had cN0/ypN0 disease, 93 (29%) had cN+/ypN0 disease, and 129 (41%) had ypN+ disease. The median OS was 7.7 years, and the 5-year OS was 60.3%. In the multivariate analysis, OS did not differ between the cN0/ypN0 and cN+/ypN0 patients (hazard ratio, 0.90 [95% CI 0.54-1.48]; p = 0.666), but it was shorter in ypN+ patients (hazard ratio, 1.82 [95% CI 1.15-2.87]; p = 0.01). CONCLUSIONS: In gastric cancerpatients who underwent preoperative therapy, we found similar OS in cN0/ypN0 and cN+/ypN0 patients. Because ypN+ patients had poor OS, achieving ypN0 status is an important hallmark demonstrating the effectiveness of preoperative therapy for gastric cancer.
Authors: Alexander P Stark; Mariela M Blum; Yi-Ju Chiang; Prajnan Das; Bruce D Minsky; Jeannelyn S Estrella; Jaffer A Ajani; Brian D Badgwell; Paul Mansfield; Naruhiko Ikoma Journal: J Gastric Cancer Date: 2020-09-17 Impact factor: 3.720
Authors: Naruhiko Ikoma; Jeannelyn S Estrella; Mariela Blum Murphy; Prajnan Das; Bruce D Minsky; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: J Gastrointest Surg Date: 2020-06-15 Impact factor: 3.452
Authors: Gina Kim; Patricia Friedmann; Ian Solsky; Peter Muscarella; John McAuliffe; Haejin In Journal: J Gastric Cancer Date: 2020-12-29 Impact factor: 3.720
Authors: Casey J Allen; Alisa N Blumenthaler; Grace L Smith; Prajnan Das; Bruce D Minsky; Mariela Blum; Jaffer Ajani; Paul F Mansfield; Naruhiko Ikoma; Brian D Badgwell Journal: Ann Surg Oncol Date: 2020-07-21 Impact factor: 5.344
Authors: Casey J Allen; David T Pointer; Alisa N Blumenthaler; Rutika J Mehta; Sarah E Hoffe; Bruce D Minsky; Grace L Smith; Mariela Blum; Paul F Mansfield; Naruhiko Ikoma; Prajnan Das; Jaffer Ajani; Sean P Dineen; Jason B Fleming; Brian D Badgwell; Jose M Pimiento Journal: Ann Surg Date: 2021-10-01 Impact factor: 13.787