BACKGROUND: Gastric and esophagogastric junction adenocarcinoma are responsible for approximately 13.5% of cancer-related deaths. Given the fact that these tumors are not typically detected until they are already in the advanced stages, neoadjuvancy plays a fundamental role in improving long-term survival. Identification of those with complete pathological response (pCR) after neoadjuvant chemotherapy (NAC) is a major challenge, with effects on organ preservation, extent of resection, and additional surgery. There is little or no information in the literature about which endoscopic signs should be evaluated after NAC, or even when such re-evaluation should occur. AIM: To describe the endoscopic aspects of patients with gastric and esophagogastric junction adenocarcinomas who underwent NAC and achieved pCR, and to determine the accuracy of esophagogastroduodenoscopy (EGD) in predicting the pCR. METHODS: A survey was conducted of the medical records of patients with these tumors who were submitted to gastrectomy after NAC, with anatomopathological result of pCR. RESULTS: Twenty-nine patients were identified who achieved pCR after NAC within the study period. Endoscopic responses were used to classify patients into two groups: G1-endoscopic findings consistent with pCR and G2-endoscopic findings not consistent with pCR. Endoscopic evaluation in G1 was present in an equal percentage (47.4%; p=0.28) in Borrmann classification II and III. In this group, the predominance was in the gastric body (57.9%; p=0.14), intestinal subtype with 42.1% (p=0.75), undifferentiated degree, 62.5% (p=0.78), Herb+ in 73.3% (p=0.68). The most significant finding, however, was that the time interval between NAC and EGD was longer for G1 than G2 (24.4 vs. 10.2 days, p=0.008). CONCLUSION: EGD after NAC seems to be a useful tool for predicting pCR, and it may be possible to use it to create a reliable response classification. In addition, the time interval between NAC and EGD appears to significantly influence the predictive power of endoscopy for pCR.
BACKGROUND: Gastric and esophagogastric junction adenocarcinoma are responsible for approximately 13.5% of cancer-related deaths. Given the fact that these tumors are not typically detected until they are already in the advanced stages, neoadjuvancy plays a fundamental role in improving long-term survival. Identification of those with complete pathological response (pCR) after neoadjuvant chemotherapy (NAC) is a major challenge, with effects on organ preservation, extent of resection, and additional surgery. There is little or no information in the literature about which endoscopic signs should be evaluated after NAC, or even when such re-evaluation should occur. AIM: To describe the endoscopic aspects of patients with gastric and esophagogastric junction adenocarcinomas who underwent NAC and achieved pCR, and to determine the accuracy of esophagogastroduodenoscopy (EGD) in predicting the pCR. METHODS: A survey was conducted of the medical records of patients with these tumors who were submitted to gastrectomy after NAC, with anatomopathological result of pCR. RESULTS: Twenty-nine patients were identified who achieved pCR after NAC within the study period. Endoscopic responses were used to classify patients into two groups: G1-endoscopic findings consistent with pCR and G2-endoscopic findings not consistent with pCR. Endoscopic evaluation in G1 was present in an equal percentage (47.4%; p=0.28) in Borrmann classification II and III. In this group, the predominance was in the gastric body (57.9%; p=0.14), intestinal subtype with 42.1% (p=0.75), undifferentiated degree, 62.5% (p=0.78), Herb+ in 73.3% (p=0.68). The most significant finding, however, was that the time interval between NAC and EGD was longer for G1 than G2 (24.4 vs. 10.2 days, p=0.008). CONCLUSION: EGD after NAC seems to be a useful tool for predicting pCR, and it may be possible to use it to create a reliable response classification. In addition, the time interval between NAC and EGD appears to significantly influence the predictive power of endoscopy for pCR.
Authors: Felipe José Fernández Coimbra; Victor Hugo F de Jesus; Héber S C Ribeiro; Alessandro L Diniz; André Luís de Godoy; Igor Correia de Farias; Tiago Felismino; Celso A L Mello; Maria Fernanda Almeida; Maria Dirlei F S Begnami; Emmanuel Dias-Neto; Rachel S P Riechelmann; Wilson L da Costa Journal: Ann Surg Oncol Date: 2019-06-20 Impact factor: 5.344
Authors: Sook Ryun Park; Jong Seok Lee; Chan Gyoo Kim; Hark Kyun Kim; Myeong-Cherl Kook; Young-Woo Kim; Keun Won Ryu; Jun Ho Lee; Jae-Moon Bae; Il Ju Choi Journal: Cancer Date: 2008-06 Impact factor: 6.860
Authors: Eduardo Redondo-Cerezo; Juan Gabriel Martínez-Cara; Rita Jiménez-Rosales; Francisco Valverde-López; Antonio Caballero-Mateos; Pablo Jérvez-Puente; Jose Luis Ariza-Fernández; Margarita Úbeda-Muñoz; Mercedes López-de-Hierro; Javier de Teresa Journal: United European Gastroenterol J Date: 2016-12-12 Impact factor: 4.623
Authors: Alexander P Stark; Naruhiko Ikoma; Yi-Ju Chiang; Jeannelyn S Estrella; Prajnan Das; Bruce D Minsky; Mariela M Blum; Jaffer A Ajani; Paul Mansfield; Brian D Badgwell Journal: Ann Surg Oncol Date: 2019-07-26 Impact factor: 5.344
Authors: Daniel Lin; Uqba Khan; Thorsten O Goetze; Natalie Reizine; Karyn A Goodman; Manish A Shah; Daniel V Catenacci; Salah-Eddin Al-Batran; James A Posey Journal: Am Soc Clin Oncol Educ Book Date: 2019-05-17
Authors: Naruhiko Ikoma; Mariela Blum; Jeannelyn S Estrella; Prajnan Das; Wayne L Hofstetter; Keith F Fournier; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: Gastric Cancer Date: 2017-06-22 Impact factor: 7.370