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Remnant gastric cancer: a neglected group with high potential for immunotherapy

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

The importance of targeted therapy and interest in the study of predictive markers in gastric cancer (GC) have increased in recent years with the use of anti-HER2 therapy and immunotherapy with anti-PD1/PD-L1 for microsatellite instability (MSI) and PD-L1 + tumors. However, the behavior of remnant GC (RGC) in this scenario is poorly reported. Thus, this study aims to evaluate the clinicopathological characteristics and prognosis of RGC and its association with the expression of current markers for targeted therapy.

Methods

All RGC resections performed in a single center from 2009 to 2019 were retrospectively reviewed. As a comparison group, 53 primary proximal GC (PGC) who underwent total D2-gastrectomy were selected. HER2, MSI status and PD-L1 expression were analyzed by immunohistochemistry. Combined Positive Score (CPS) was used to determine PD-L1 positivity.

Results

A total of 40 RGC were included. RGC patients were older (p = 0.001), had lower BMI (p = 0.001) and number of resected lymph nodes (p < 0.001) compared to the PGC. Regarding markers expression, MSI was higher in RGC than PGC (27.5% vs 9.4%, p = 0.022). The frequency of CPS-positive was 32.5% and 26.4% in RGC and PGC, respectively (p = 0.522). HER2 positivity was 17.5% and 22.6% for RGC and PGC, respectively (p = 0.543). In survival analysis, DFS was better for RGC CPS-positive than RGC CPS-negative (p = 0.039) patients. There was no difference in survival considering MSI status.

Conclusion

RGC had higher incidence of MSI than PGC, and CPS-positive RGC was associated with better survival. The immunological profile of RGC patients suggests that they would be good candidates for immunotherapy.

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Data availability

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

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Funding

This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP agency)—Grant number 2016/25524-0. Role of funding source: acquisition of material and reagents for pathological analysis.

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  1. Instituto do Cancer, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, Sao Paulo, SP, 01249000, Brazil

    Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, Tiago Biachi de Castria, Renan Ribeiro e Ribeiro, Leonardo Cardili, Evandro Sobroza de Mello, Bruno Zilberstein, Ulysses Ribeiro-Júnior & Ivan Cecconello

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  1. Marcus Fernando Kodama Pertille Ramos
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  2. Marina Alessandra Pereira
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Contributions

MFKPR: study design, data retrieval, critical analysis, draft of the manuscript. MAP, TBC: data retrieval, statistical analysis, critical analysis, draft of the manuscript. RRR, LC, ESM: pathological analysis. BZ, UR-J, IC: critical analysis, review of the manuscript.

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Correspondence to Marcus Fernando Kodama Pertille Ramos.

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The study was approved by the hospital ethics committee (NP1586/19) and registered online (www.plataformabrasil.com; CAAE: 2915516.2.0000.0065).

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Informed consent was waived by the local ethics committee in view of the retrospective nature of the study.

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Ramos, M.F.K.P., Pereira, M.A., de Castria, T.B. et al. Remnant gastric cancer: a neglected group with high potential for immunotherapy. J Cancer Res Clin Oncol 146, 3373–3383 (2020). https://doi.org/10.1007/s00432-020-03322-7

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