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Determinants of Survival for Patients with Neoadjuvant-Treated Node-Negative Gastric Cancer

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

Abstract

Background

This study sought to determine prognostic markers for disease recurrence and survival in a cohort of neoadjuvant-treated, node-negative gastric cancer patients (ypT0-4N0M0).

Methods

Clinicopathologic data from patients treated with neoadjuvant therapy followed by curative-intent gastrectomy at the University of Texas MD Anderson Cancer Center from 1995 to 2017 were evaluated. Patients with AJCC TNM stage ypT0-4N0M0 were considered for analysis.

Results

The inclusion criteria were met by 212 patients with a mean age of 58.3 years. Of these patients, 60 % were male, 53 % were Caucasian, 87 % received chemoradiation, and 13 % received chemotherapy. The findings showed a median overall survival (OS) rate of 11.3 years, a 5-year survival rate of 72 %, and a 10-year survival rate of 57 %. During a median follow-up period of 5.5 years, 38.2 % of the patients died. In the multivariable analysis, ypT4-stage and nodal yield fewer than 16 were significantly associated with reduced OS. Cancer classified as ypT4 had more aggressive biologic traits, including lymphovascular and perineural invasion, and was treated more aggressively with total gastrectomy and additional organ resection despite frequent positive margins. Depth of invasion remained significantly associated with worse outcome after the analysis controlled for nodal yield and possible stage migration. Compared with ypT0-3 tumors, ypT4 cancers were associated with significantly more recurrences (13 % vs. 45 %; p < 0.05), and the primary modes of failure for ypT4 lesions were local recurrence and peritoneal metastases (88 % of recurrences).

Conclusions

Depth of primary tumor invasion and nodal yield were significantly associated with OS among the patients with ypT0-4N0M0 gastric cancer. Serosal invasion (ypT4) was associated with a high rate of peritoneal recurrence, and trials of intraperitoneal therapy targeting these patients should be considered.

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Acknowledgement

Editorial support was provided by Bryan Tutt, Scientific Editor, Research Medical Library.

Author information

Authors and Affiliations

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

    Derek J. Erstad MD, Paul F. Mansfield MD, Brian D. Badgwell MD & Naruhiko Ikoma MD

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

    Mariela Blum MD & Jaffer A. Ajani MD

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

    Jeannelyn S. Estrella MD

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

    Prajnan Das MD & Bruce D. Minsky MD

Authors
  1. Derek J. Erstad MD
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  2. Mariela Blum MD
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  3. Jeannelyn S. Estrella MD
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  4. Prajnan Das MD
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  5. Bruce D. Minsky MD
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  6. Jaffer A. Ajani MD
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  8. Brian D. Badgwell MD
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  9. Naruhiko Ikoma MD
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Contributions

DJE performed data acquisition, data analysis and interpretation, and manuscript construction. MB, JSE, PD, BDM, JAA, PFM, BDB, and NI contributed to data acquisition and analysis, provided expert clinical opinion, and contributed to manuscript creation.

Corresponding author

Correspondence to Naruhiko Ikoma MD.

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PD: Honorarium- Adlai Nortye, Honorarium - ASTRO, Honorarium - Leidos/ NCI.

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Erstad, D.J., Blum, M., Estrella, J.S. et al. Determinants of Survival for Patients with Neoadjuvant-Treated Node-Negative Gastric Cancer. Ann Surg Oncol 28, 6638–6648 (2021). https://doi.org/10.1245/s10434-021-09625-4

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  • DOI: https://doi.org/10.1245/s10434-021-09625-4

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