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Characteristics and Survival of Gastric Cancer Patients with Pathologic Complete Response to Preoperative Therapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pathologic complete response of a primary tumor (ypT0) after preoperative therapy is associated with improved overall survival (OS). However, whether other variables are associated with outcome for gastric cancer patients with ypT0 status is unknown.

Methods

This study reviewed an institutional database of patients who underwent resection of gastric or gastroesophageal adenocarcinoma after preoperative therapy and identified patients with ypT0 status. Cox regression models were used to identify clinicopathologic predictors of OS.

Results

Of 77 patients with ypT0 status identified in this study, 36 (47%) had gastroesophageal junction tumors. At presentation, 62 patients (81%) had clinical T3 disease, and 7 (9%) had clinical T4 disease. The clinical nodal status was positive (cN+) for 45 patients (58%). Preoperative chemoradiation was administered to 75 patients (97%). The median follow-up duration was 3.54 years. The median OS was 10 years, and the 5-year OS rate was 61%. Univariable analysis identified age of 65 years or older at the time of diagnosis, histologic grade, and ypN status as significant predictors of OS. Multivariable analysis confirmed age of 65 years or older [hazard ratio (HR), 4.26; p < 0.001] and persistent nodal disease (ypN+ status; HR, 5.12; p < 0.001) to be independently associated with OS. Clinical stage was not associated with survival. In the subset of ypT0N0 patients, no clinicopathologic feature was predictive of survival.

Conclusion

For gastric or gastroesophageal adenocarcinoma patients with ypT0 status after preoperative therapy, ypN+ status substantially reduced survival. Pretreatment clinical stage had no impact on OS for patients with a pathologic complete response.

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References

  1. Amin MB, Edge SB, Greene FL. AJCC cancer staging manual. 8th ed. Springer, New York, 2017.

    Book  Google Scholar 

  2. Network NCC. Gastric cancer. Version 2.2018. Retrieved 20 Dec 2018 at https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf.

  3. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Article  PubMed  Google Scholar 

  4. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.

    Article  CAS  PubMed  Google Scholar 

  5. Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev. 2013(5):CD008107.

  6. Ikoma N, Blum M, Estrella JS, et al. Evaluation of the American Joint Committee on Cancer 8th edition staging system for gastric cancer patients after preoperative therapy. Gastric Cancer. 2018;21:74–83.

  7. Lowy AM, Mansfield PF, Leach SD, Pazdur R, Dumas P, Ajani JA. Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann Surg. 1999;229:303–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ajani JA, Winter K, Okawara GS, et al. Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904): quality of combined modality therapy and pathologic response. J Clin Oncol. 2006;24:3953–8.

    Article  CAS  PubMed  Google Scholar 

  9. Fields RC, Strong VE, Gonen M, et al. Recurrence and survival after pathologic complete response to preoperative therapy followed by surgery for gastric or gastrooesophageal adenocarcinoma. Br J Cancer. 2011;104:1840–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Aoyama T, Nishikawa K, Fujitani K, et al. Early results of a randomized two-by-two factorial phase II trial comparing neoadjuvant chemotherapy with two and four courses of cisplatin/S-1 and docetaxel/cisplatin/S-1 as neoadjuvant chemotherapy for locally advanced gastric cancer. Ann Oncol. 2017;28:1876–81.

    Article  CAS  PubMed  Google Scholar 

  11. Yoshikawa T, Tanabe K, Nishikawa K, et al. Induction of a pathological complete response by four courses of neoadjuvant chemotherapy for gastric cancer: early results of the randomized phase II COMPASS trial. Ann Surg Oncol. 2014;21:213–9.

    Article  PubMed  Google Scholar 

  12. Badgwell B, Blum M, Estrella J, et al. Predictors of survival in patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. J Am Coll Surg. 2015;221:83–90.

    Article  PubMed  Google Scholar 

  13. Cho H, Nakamura J, Asaumi Y, et al. Long-term survival outcomes of advanced gastric cancer patients who achieved a pathological complete response with neoadjuvant chemotherapy: a systematic review of the literature. Ann Surg Oncol. 2015;22:787–92.

    Article  PubMed  Google Scholar 

  14. Badgwell B, Ajani J, Blum M, et al. Postoperative morbidity and mortality rates are not increased for patients with gastric and gastroesophageal cancer who undergo preoperative chemoradiation therapy. Ann Surg Oncol. 2016;23:156–62.

    Article  PubMed  Google Scholar 

  15. Ikoma N, Hofstetter WL, Estrella JS, et al. The ypT category does not impact overall survival in node negative gastric cancer. J Surg Oncol. 2018;117:1721–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ikoma N, Estrella JS, Hofstetter W, et al. Nodal downstaging in gastric cancer patients: promising survival if ypN0 is achieved. Ann Surg Oncol. 2018;25:2012–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smyth EC, Fassan M, Cunningham D, et al. Effect of pathologic tumor response and nodal status on survival in the Medical Research Council adjuvant gastric infusional chemotherapy trial. J Clin Oncol. 2016;34:2721–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Fitzgerald TL, Efird JT, Bellamy N, et al. Perioperative chemotherapy versus postoperative chemoradiotherapy in patients with resectable gastric/gastroesophageal junction adenocarcinomas: a survival analysis of 5058 patients. Cancer. 2017;123:2909–17.

    Article  PubMed  Google Scholar 

  19. Mokdad AA, Yopp AC, Polanco PM, et al. Adjuvant chemotherapy vs. postoperative observation following preoperative chemoradiotherapy and resection in gastroesophageal cancer: a propensity score-matched analysis. JAMA Oncol. 2018;4:31–8.

    Article  PubMed  Google Scholar 

  20. Jiang Y, Zhang Q, Hu Y, et al. ImmunoScore Signature: a prognostic and predictive tool in gastric cancer. Ann Surg. 2018;267:504–13.

    Article  PubMed  Google Scholar 

  21. Jiang Y, Li T, Liang X, et al. Association of adjuvant chemotherapy with survival in patients with stage II or III gastric cancer. JAMA Surg. 2017;152:e171087.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ikoma N, Das P, Blum M, et al. Preoperative chemoradiation therapy does not increase risk of anastomotic leak in patients with gastric cancer. Int J Radiat Oncol Biol Phys. 2017;99:660–6.

    Article  PubMed  Google Scholar 

  23. Vicente D, Ikoma N, Chiang YJ, et al. Preoperative therapy for gastric adenocarcinoma is protective for poor oncologic outcomes in patients with complications after gastrectomy. Ann Surg Oncol. 2018;25:2720–30.

    Article  PubMed  Google Scholar 

  24. Ikoma N, Das P, Hofstetter W, et al. Preoperative chemoradiation therapy induces primary-tumor complete response more frequently than chemotherapy alone in gastric cancer: analyses of the National Cancer Database 2006–2014 using propensity score matching. Gastric Cancer. 2018;21:1004–13.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

This study was supported in part by the NIH/NCI under Award Number P30CA016672 and used the Clinical Trials Support Resource. Prajnan Das has received consulting fees from Adlai Nortye for serving on an Independent Advisory Panel.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Alexander P. Stark MD, Naruhiko Ikoma MD, MS, Yi-Ju Chiang MSPH, Paul Mansfield MD & Brian D. Badgwell MD, MS

  2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella MD

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das MD, MPH & Bruce D. Minsky MD

  4. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela M. Blum MD & Jaffer A. Ajani MD

Authors
  1. Alexander P. Stark MD
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  2. Naruhiko Ikoma MD, MS
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  3. Yi-Ju Chiang MSPH
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  4. Jeannelyn S. Estrella MD
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  5. Prajnan Das MD, MPH
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  6. Bruce D. Minsky MD
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  7. Mariela M. Blum MD
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  8. Jaffer A. Ajani MD
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  9. Paul Mansfield MD
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  10. Brian D. Badgwell MD, MS
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Contributions

AS (design, analysis, drafting, editing), NI (design, acquisition, analysis, drafting, editing, final approval), YC (analysis, interpretation, editing, final approval), JE (acquisition, editing, final approval), PD (acquisition, editing, final approval), BM (acquisition, editing, final approval), MB (acquisition, editing, final approval), JA (acquisition, editing, final approval), PM (acquisition, editing, final approval), BB (design, acquisition, analysis, drafting, editing, final approval).

Corresponding author

Correspondence to Naruhiko Ikoma MD, MS.

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Stark, A.P., Ikoma, N., Chiang, YJ. et al. Characteristics and Survival of Gastric Cancer Patients with Pathologic Complete Response to Preoperative Therapy. Ann Surg Oncol 26, 3602–3610 (2019). https://doi.org/10.1245/s10434-019-07638-8

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  • DOI: https://doi.org/10.1245/s10434-019-07638-8

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