Characteristics and Survival of Gastric Cancer Patients with Pathologic Complete Response to Preoperative Therapy
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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.
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.
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.
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.
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.
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).
There are no conflicts of interest.
- 2.Network NCC. Gastric cancer. Version 2.2018. Retrieved 20 Dec 2018 at https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf.
- 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.Google Scholar
- 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.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.CrossRefPubMedGoogle 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.CrossRefPubMedPubMedCentralGoogle Scholar