Alina Desiree Sandø1,2, Reidun Fougner3, Jon Erik Grønbech4,5, Erling Audun Bringeland4,5. 1. Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway. alina.desiree.sando.klemmetvoll@stolav.no. 2. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. alina.desiree.sando.klemmetvoll@stolav.no. 3. Department of Radiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 4. Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway. 5. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Abstract
BACKGROUND: Response evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC. METHODS: Retrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment. RESULTS: Of 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004-0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode. CONCLUSIONS: Routine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.
BACKGROUND: Response evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC. METHODS: Retrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment. RESULTS: Of 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004-0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode. CONCLUSIONS: Routine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.
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Authors: David Cunningham; William H Allum; Sally P Stenning; Jeremy N Thompson; Cornelis J H Van de Velde; Marianne Nicolson; J Howard Scarffe; Fiona J Lofts; Stephen J Falk; Timothy J Iveson; David B Smith; Ruth E Langley; Monica Verma; Simon Weeden; Yu Jo Chua Journal: N Engl J Med Date: 2006-07-06 Impact factor: 91.245
Authors: Paula Jiménez Fonseca; Alberto Carmona-Bayonas; Raquel Hernández; Ana Custodio; Juana Maria Cano; Alejandra Lacalle; Isabel Echavarria; Ismael Macias; Monserrat Mangas; Laura Visa; Elvira Buxo; Felipe Álvarez Manceñido; Antonio Viudez; Carles Pericay; Aitor Azkarate; Avinash Ramchandani; Carlos López; Eva Martinez de Castro; Ana Fernández Montes; Federico Longo; Rodrigo Sánchez Bayona; Maria Luisa Limón; Asun Diaz-Serrano; Alfonso Martin Carnicero; David Arias; Paula Cerdà; Fernando Rivera; Jose Maria Vieitez; Manuel Sánchez Cánovas; M Garrido; J Gallego Journal: Br J Cancer Date: 2017-08-01 Impact factor: 7.640