Impact of ypT, ypN, and Adjuvant Therapy on Survival in Gastric Cancer Patients Treated with Perioperative Chemotherapy and Radical Surgery

Coimbra, Felipe José Fernández; Jesus, Victor Hugo Fonseca de; Ribeiro, Héber S. C.; Diniz, Alessandro Landskron; Godoy, A.; Farias, Igor Correia de; Felismino, Tiago; Mello, Celso Abdon Lopes de; Almeida, Maria Fernanda Arruda; Begnami, María Dirlei; Dias‐Neto, Emmanuel; Riechelmann, Rachel; Costa, Wilson Luiz da

doi:10.1245/s10434-019-07454-0

Cited by 33 publications

(32 citation statements)

References 27 publications

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“…However, in locally advanced GC patients, operation could not always lead to a satisfactory consequence, even with postoperative therapy [2]. Neoadjuvant chemotherapy (NCT) improves R0 resection rate and prognosis when compared with surgery alone or surgery with postoperative therapy [3], but the outcomes are sometimes unpredictable due to the differences in many factors such as tumor differentiation and Lauren classification. More indicators to assess the survival are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

CA724 predicts overall survival in locally advanced gastric cancer patients with neoadjuvant chemotherapy

Tong

Zhao

Shan

et al. 2020

Preprint

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Background: Serum tumor markers are of great importance in diagnosis, prognostic predicting and recurrence monitoring in gastrointestinal malignancy, including AFU, AFP, CEA, CA199, CA125 and CA724. However, their significances in gastric cancer (GC) patients with neoadjuvant therapy (NCT) are still uncertain. The aim of this study is to evaluate the predictive value of these six tumor markers in locally advanced GC patients with NCT and curative surgery. Methods: 290 locally advanced GC patients with NCT and D2 radical gastrectomy were retrospectively analyzed. Their tumor markers before (pre-) and after (post-) NCT and pathological characters were exacted from the database in our hospital. The optimal cutoff values of six tumor markers were calculated by ROC and Youden index. Their predictive significances were analyzed and survival curves on overall survival (OS) were obtained by Kaplan-Meier method. Associations between categorical variables were explored by Chi-square test or Fisher's exact method. Multivariate analyses were performed by Cox regression model. Results: Not only the pre- and post- CA199, CA125 and CA724 could predict the OS respectively, but also the changes (diff-) between post- and pre- groups were related to the prognosis (P < 0.05). In multivariable analysis, only pre- (P = 0.016) and post-CA724 (P = 0.033) remained significant, and the significance of diff-CA724 was on borderline (P = 0.085). Besides, pre- and post-CA199, CA125 and CA724 were associated with the metastasis of lymph node (N- vs N+) and pathological stage (Ⅰ-Ⅱ vs Ⅲ) (P < 0.05). Post-CA724 was related to the invasion of vascular or lymphatic vessels (P = 0.019), and pre-CA724 was nearly remarkable (P = 0.082). However, AFU, AFP and CEA showed no association with survival (P > 0.05). Conclusions: CA724 is an independent factor to prognosis, and could be used to predict the ypN and ypTNM stage in locally advanced GC patients undergone NCT and curative resection.

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Section: Introductionmentioning

confidence: 99%

CA724 predicts overall survival in locally advanced gastric cancer patients with neoadjuvant chemotherapy

Tong

Zhao

Shan

et al. 2020

Preprint

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“…Concerning the extent of LAD, a more aggressive (D 1-3 or D 1-2 instead of D1 alone) surgical procedure might be associated with an increase in postoperative morbidity [21,22]. On the other hand, a more radical lymph node dissection (D 1-2 vs. D1 alone) has been shown to prolong OS [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…While pN stages were documented from the inception of the database, for over more than four decades, the extent of LAD and the number of harvested lymph nodes were not documented until 1998. However, when the 214 cases where the number of harvested lymph nodes was available were analyzed, the median number of harvested lymph nodes was 21 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), indicating an adequate extent of LAD. Of the 136 patients where D1-3 LAD was documented, the vast majority underwent D2 LAD (n = 120, 86.9%) while D1 LAD and D3 LAD was performed in 10 (7.3%) and 8 (5.8%) patients, respectively.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Role of Postoperative Complications in Overall Survival after Radical Resection for Gastric Cancer: A Retrospective Single-Center Analysis of 1107 Patients

Galata

Blank

Weiß

et al. 2019

Cancers

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Background: The aim of this study was to investigate the impact of postoperative complications on overall survival (OS) after radical resection for gastric cancer. Methods: A retrospective analysis of our institutional database for surgical patients with gastroesophageal malignancies was performed. All consecutive patients who underwent R0 resection for M0 gastric cancer between October 1972 and February 2014 were included. The impact of postoperative complications on OS was evaluated in the entire cohort and in a subgroup after exclusion of 30 day and in-hospital mortality. Results: A total of 1107 patients were included. In the entire cohort, both overall complications (p < 0.001) and major surgical complications (p = 0.003) were significant risk factors for decreased OS in univariable analysis. In multivariable analysis, overall complications were an independent risk factor for decreased OS (p < 0.001). After exclusion of patients with complication-related 30 day and in-hospital mortality, neither major surgical (p = 0.832) nor overall complications (p = 0.198) were significantly associated with decreased OS. Conclusion: In this study, postoperative complications influenced OS due to complication-related early postoperative deaths. In patients successfully rescued from early postoperative complications, neither overall complications nor major surgical complications were risk factors for decreased survival.

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“…5 A stage III ToGA clinical study showed that the efficacy of trastuzumab combined with an XP/FP regimen in patients with HER-2-positive advanced esophagogastric junction or gastric cancer was significantly better than that of patients receiving only chemotherapy. Median OS was 13.8 months (95% confidence interval [CI] [12][13][14][15][16] for patients assigned to the trastuzumab plus chemotherapy arm compared with 11.1 months (95% CI [10][11][12][13] in the chemotherapy group (hazard ratio [HR] 0.74; 95% CI 0.60--0.91; p = 0.0046). Especially in the patients with HER-2 immunohistochemistry 2 + and FISH positive or the patients with HER-2 immunohistochemistry 3 +, the survival improvement was more obvious, with the median OS better in the experimental arm (16.8 vs 11.8 months, HR: 0.65).…”

Section: Introductionmentioning

confidence: 99%

<p>Trastuzumab with FLOT Regimen for the Perioperative Treatment of Resectable HER2 + Advanced Gastric Cancer: A Retrospective Study</p>

Tong¹,

Li²,

Lin³

et al. 2020

CMAR

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These authors contributed equally to this workBackground: The aim of this study was to evaluate the efficacy and safety of trastuzumab, combined with the FLOT regimen, in the perioperative treatment of resectable HER-2-positive advanced gastric cancer. Methods: Overall, 45 patients were divided into two groups; 29 patients in the experimental group were treated with trastuzumab combined with FLOT and 16 patients in the control group were treated with FLOT alone. The primary endpoint was objective response rate (ORR), and the secondary endpoints were disease control rate (DCR), tumor regression grade (TRG), surgical margin, side effects, and overall survival. Results: In the experimental and control groups, ORR was 72.4% and 43.8% (p=0.226), DCR was 89.7% and 87.5%, R0 resection rate was 96.5% and 93.7%, total/subtotal tumor regression grade was 17.2% and 6.3%, partial tumor regression grade was 27.6% and 18.7% (p=0.468), and 2-year survival rate was 78.1% and 73.9% (p=0.932), respectively. The common side effects were agranulocytosis and vomiting. There was no significant difference between the two groups. Conclusion: Trastuzumab combined with FLOT has a good curative effect and safety profile in the perioperative treatment of patients with resectable HER-2-positive advanced gastric cancer. In addition, trastuzumab + FLOT had the same result as FLOT alone, as there was no significant benefit with the addition of T in the group studied.

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Impact of ypT, ypN, and Adjuvant Therapy on Survival in Gastric Cancer Patients Treated with Perioperative Chemotherapy and Radical Surgery

Cited by 33 publications

References 27 publications

CA724 predicts overall survival in locally advanced gastric cancer patients with neoadjuvant chemotherapy

CA724 predicts overall survival in locally advanced gastric cancer patients with neoadjuvant chemotherapy

Role of Postoperative Complications in Overall Survival after Radical Resection for Gastric Cancer: A Retrospective Single-Center Analysis of 1107 Patients

<p>Trastuzumab with FLOT Regimen for the Perioperative Treatment of Resectable HER2 + Advanced Gastric Cancer: A Retrospective Study</p>

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