High Impact of Histopathological Remission for Prognosis after Perioperative Chemotherapy with ECF and ECF-Like Regimens for Gastric and Gastroesophageal Adenocarcinoma

Abstract

Background: Perioperative chemotherapy with epirubicin, cisplatin and 5-fluorouracil (5-FU) (ECF)-like regimens is the European standard for patients with adenocarcinoma of the gastroesophageal junction (GEJ) or gastric body (GaCa) stage UICC II/III (staged according to the Union for International Cancer Control). However, limited data exist on the histopathological response and relevance of prognosis for patients homogeneously treated with ECF(-like) therapies. Methods: All patients with GEJ/GaCa treated from September 2004 to September 2008 by perioperative ECF(-like) chemotherapy were retrospectively analyzed. Cisplatin and 5-FU were substituted with oxaliplatin or capecitabine when indicated. The histopathological response was assessed using the Becker score. Results: Seventy-seven patients were analyzed with a median follow-up of 72.3 months. R0 resection was achieved in 53 of 68 operated patients. Recurrence was observed in 25 (32.5%) of these curatively treated patients, whereas 53/77 patients (68.8%) died, 39 (50.6%) of whom tumor related. The 5-year overall survival (OS) for the intention-to-treat population was 36.3%, and the 5-year tumor-specific survival was 42.2%. Pathological complete response (pCR) was seen in 10 patients (13.0%) and near pCR in 3 patients (3.9%). Patients with pCR had a significantly prolonged 5-year OS of 80.0 versus 29.7% compared to the nonhistopathological complete remission group (p = 0.01). Conclusion: In our retrospective analysis, ECF(-like) pretreatment resulted in a (near) pCR rate of 16.9%. In line with other regimens, our data suggest that histopathological response predicts the OS in patients treated with ECF(-like) regimens.

Which is the optimal management for locally advanced gastric cancer patients with TRG 0 and 1 after R0 resection?

“…Several problems impelled us to carry out similar clinical research on GC. Firstly, GC patients achieving pCR after NAC is uncommon in clinical practice, the pCR rate were respectively 13.0%, 10.0% and 16.0% by using the ECF(like) (38), DCF (39), and FLOT (6) regimen (6). Next, clinical response seems to correlate poorly with pathology in preoperative staging of gastric adenocarcinoma after NAC, Thirdly, pathological response has a higher validity than radiography (36).…”

Prognostic Relevance of Weight and Weight Loss during Multimodal Therapy for Oesophagogastric Tumours

“…The final cohort resulted from me different cohorts (Figure 1). The first cohort ("ECF-cohort", n = 49) was based on pts who receiv treatment between 2005 and 2008 as part of the ECF study [15]. This w study performed at our institution, in which pts with upper-GI tumou The first cohort ("ECF-cohort", n = 49) was based on pts who received their curative treatment between 2005 and 2008 as part of the ECF study [15].…”

“…The first cohort ("ECF-cohort", n = 49) was based on pts who receiv treatment between 2005 and 2008 as part of the ECF study [15]. This w study performed at our institution, in which pts with upper-GI tumou The first cohort ("ECF-cohort", n = 49) was based on pts who received their curative treatment between 2005 and 2008 as part of the ECF study [15]. This was a monocentric study performed at our institution, in which pts with upper-GI tumours received ECF (epirubicin/cisplatin/5-FU) in the context of multimodal therapy.…”

Locally advanced gastric cancer: total iodine uptake to predict the response of primary lesion to neoadjuvant chemotherapy

“…Published data indicated that patients who pathologically respond to neoadjuvant chemotherapy have a better prognosis after surgery than patients who do not respond to chemotherapy (Bichev et al 2015). Because some patients with gastric cancer are insensitive to chemotherapeutics, the evaluative criteria of iconography to predict the effect of neoadjuvant chemotherapy are very important.…”