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Low metabolic activity in primary gastric adenocarcinoma is associated with resistance to chemoradiation and the presence of signet ring cells

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Abstract

Purposes

Preoperative chemoradiation is a potential treatment option for localized gastric adenocarcinoma (GAC). Currently, the response to chemoradiation cannot be predicted. We analyzed the pretreatment maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) on positron emission tomography/computed tomography as potential predictors of the response to chemoradiation.

Methods

We analyzed the SUVmax and TLG data from 59 GAC patients who received preoperative chemoradiation. We used logistic regression models to predict a pathologic complete response (pCR) and Kaplan–Meier curves to determine overall survival among patients with high and low SUVmax or TLG.

Results

Twenty-nine patients (49%) had Siewert type III adenocarcinoma and 30 (51%) had tumors located in the lower stomach. Forty-one patients had poorly differentiated GAC, and 26 had signet ring cells. The median SUVmax was 7.3 (0–28.2) and the median TLG was 56.6 (0–1881.5). Patients with signet ring cells had a low pCR rate, as well as a low SUVmax and TLG. In the multivariable logistic regression model, high SUVmax was a predictor of pCR (odds ratio = 11.1, 95% confidence interval = 2.12–50.0, p = 0.004). Overall survival was not associated with the SUVmax (log-rank p = 0.69) or TLG (log-rank p = 0.85)

Conclusion

A high SUVmax was associated with sensitivity to chemoradiation and pCR in GAC, and signet ring cells seemed to confer resistance.

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Funding

This research was supported by generous Grants from the Caporella, Dallas, Sultan, Park, Smith, Frazier, Oaks, Vanstekelenberg, Planjery, and Cantu families, as well as from the Schecter Private Foundation, Rivercreek Foundation, Kevin Fund, Myer Fund, Dio Fund, Milrod Fund, and The University of Texas MD Anderson Cancer Center (Houston, Texas, USA) multidisciplinary grant program. This research was also supported in part by National Cancer Institute Grants CA129906, CA127672, CA138671, and CA172741 and by Department of Defense Grants CA150334 and CA162445 (J.A.A.) and by a Grant from the Japan Society for the Promotion of Science Overseas Research Fellowships and Program for Advancing Strategic International Networks to Accelerate the Circulation of Talented Researchers (K.H.).

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Authors and Affiliations

  1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Kazuto Harada, Masaaki Iwatsuki, Mariela A. Blum Murphy, Meina Zhao, Namita Shanbhag & Jaffer A. Ajani

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

    Madhavi Patnana

  3. Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Xuemei Wang

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

    Prajnan Das & Bruce D. Minsky

  5. Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Brian Weston, Jeffrey H. Lee & Manoop S. Bhutani

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

    Jeannelyn S. Estrella

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

    Naruhiko Ikoma & Brian D. Badgwell

  8. Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Kazuto Harada & Masaaki Iwatsuki

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  1. Kazuto Harada
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Correspondence to Jaffer A. Ajani.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions.

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Harada, K., Patnana, M., Wang, X. et al. Low metabolic activity in primary gastric adenocarcinoma is associated with resistance to chemoradiation and the presence of signet ring cells. Surg Today 50, 1223–1231 (2020). https://doi.org/10.1007/s00595-020-02018-2

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  • DOI: https://doi.org/10.1007/s00595-020-02018-2

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