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Comparison of the predictive value of pathological response at primary tumor and lymph node status after neoadjuvant chemotherapy in locally advanced gastric cancer

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Abstract

Background

Preoperative chemotherapy has been increasingly used in locally advanced gastric cancer (LAGC). However, the prognostic factors are still insufficient. This study aimed to investigate the prognostic significance of pathological response of the primary tumor to neoadjuvant chemotherapy (NACT) and the lymph node status after NACT.

Methods

Data from 160 patients with LAGC treated with NACT followed by gastrectomy and met the inclusion criteria between March 2016 and December 2019 were retrospectively reviewed. Pathological evaluation after NACT was based on the grade of pathological response of the primary tumor and the status of lymph node. Survival curves for overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and the log-rank test was used to compare survival difference. Univariate and multivariate analyses for prognostic factors were based on the Cox regression.

Results

Among 160 selected cases, 90 had pathological response (PR), while 70 had no pathological response (nPR) to NACT. Smaller tumor size was presented in PR group, which also had lower level of signet ring cell features, compared to nPR group (all p < 0.05). Based on the status of lymph nodes, nodal status (−) group showed smaller tumor size, lower depth of tumor invasion, better differentiated degree, lower level of signet ring cell features, lower rate of lymphatic and venous invasion and less advanced ypTNM stage (all p < 0.05). Survival was equivalent between PR and nPR group (all p > 0.05), while patients with no lymph node metastasis had better DFS than that with lymph node metastasis (HR 0.301, 95% CI 0.194–0.468, p = 0.002). Multivariable Cox regression analysis identified that lymph node status after NACT was an independent prognostic factor associated with survival (OS: hazard ratio 1.756, 95% CI 1.114–3.278, p = 0.029; DFS: hazard ratio 1.901, 95% CI 1.331–3.093, p = 0.012).

Conclusion

Lymph node status is a potential independent prognostic factor for LAGC patients treated with NACT and may be more efficient than pathological response in primary tumor.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This research was supported by National High Level Hospital Clinical Research Funding (High-level Hospital Construction Project of Guangdong Provincial People's Hospital) (grant no. 2022-PUMCH-B-005).

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Authors and Affiliations

  1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Pengfei Su, Yingjing Zhang, Tian Yu, Lin Jiang, Weiming Kang & Jianchun Yu

  2. Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China

    Pengfei Su, Yingjing Zhang, Tian Yu & Lin Jiang

  3. Department of Pathology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China

    Yuqin Liu

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  1. Pengfei Su
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Contributions

Su PF, Jiang L, Yu JC conceived and designed the analysis; Su PF, Jiang L, Zhang YJ, Yu T collected the data; Su PF, Kang WM, Liu YQ, Yu JC performed the analysis; Su PF wrote the paper: all authors reviewed and revised the manuscript.

Corresponding author

Correspondence to Jianchun Yu.

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Conflict of interest relevant to this article was not reported.

Ethical approval

Clinical samples were gathered with written informed consent of patients according to a protocol reviewed and approved by the Institutional Review Board of Peking Union Medical College Hospital (IRB number: JS-2587).

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Informed consent was obtained from all individual participants included in the study.

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Su, P., Zhang, Y., Yu, T. et al. Comparison of the predictive value of pathological response at primary tumor and lymph node status after neoadjuvant chemotherapy in locally advanced gastric cancer. Clin Transl Oncol 25, 2462–2471 (2023). https://doi.org/10.1007/s12094-023-03130-8

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  • DOI: https://doi.org/10.1007/s12094-023-03130-8

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