Tumor regression grade in gastric cancer: Predictors and impact on outcome

Blackham, Aaron U.; Greenleaf, Erin K.; Yamamoto, Maki; Hollenbeak, C.; Gusani, Niraj J.; Coppola, Domenico; Pimiento, José M.; Wong, Joyce Y.

doi:10.1002/jso.24307

Cited by 49 publications

(45 citation statements)

References 27 publications

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“…Differently, in two recent retrospective works regarding predictor factors of survival after perioperative MAGIC-style chemotherapy, TRG1 rates were lower (17%) (17,18). In Becker's analysis TRG was significantly correlated with survival, while in Schmidt's study TRG does not reveal itself as an independent prognostic factor.…”

Section: Discussionmentioning

confidence: 81%

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Achilli¹,

Martini²,

Ceresoli³

et al. 2017

J. Gastrointest. Oncol.

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Background: To verify the prognostic value of the pathologic and radiological tumor response after neoadjuvant chemotherapy in the treatment of locally advanced gastric adenocarcinoma. respectively. The median follow up was 27 months (range, 5.00-68.00 months). Radiological response and TRG were found to be a prognostic factor for OS and DFS, while tumor histology was not significantly related to survival. Conclusions: Both radiological response and TRG have been shown as promising survival markers in patients treated with perioperative chemotherapy for locally advanced gastric cancer. Other predictive markers of response to chemotherapy are strongly required.

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Section: Discussionmentioning

confidence: 81%

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Achilli¹,

Martini²,

Ceresoli³

et al. 2017

J. Gastrointest. Oncol.

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“…In the current study, 12/62 (19.4%) patients had a complete or marked response to neoadjuvant chemotherapy, and only 4/62 (6.5%) exhibited a complete response on final pathology. In other studies, tumor responses were also low, with less than 25% of patients with a significant response while >50% of patients had minimal response (29)(30)(31). Many of these reports also failed to show a statistically significant relationship between response to neoadjuvant therapy and survival.…”

Section: Discussionmentioning

confidence: 93%

Does histology really influence gastric cancer prognosis?

Luu¹,

Thapa²,

Woo³

et al. 2017

J. Gastrointest. Oncol.

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Background: Gastric cancer (GC) is associated with poor survival despite curative-intent surgical resection and systemic therapy. Our objective is to examine the impact of histology on prognosis as well as the impact of linitis plastica (LP) on survival. Methods:The GC database at a single institution was evaluated for patients who underwent resection from 2000 to 2015. Clinicopathologic characteristics were examined and descriptive statistics was used to analyze four groups of patients based on Lauren classification: intestinal (n=93), diffuse (n=20), diffuse with signetring cell features (n=57), and LP (n=40). LP patients had diffuse GC but also presented with circumferential infiltration of the gastric wall for at least a third of the stomach length on endoscopy or imaging. Fisher's exact test was used to compare groups; Cox regression was used for multivariate analysis and Kaplan-Meier method for survival. Results: Of 210 patients who underwent gastric resection, 112 (53%) were male with mean age 65.3 years (SD ±14.6 years). Intestinal GC patients were older at diagnosis but other patient demographics were similar between all groups. LP patients had a higher rate of R1 resection despite higher rates of total gastrectomy (P<0.01). Rates of perineural invasion (PNI) and nodal metastasis were higher in LP (P<0.001). The majority of intestinal GC patients (79%) had stage I/II disease compared to 70% of LP patients with stage III disease.Median overall survival (OS) was 13.7 months for LP, 79 months for intestinal, 97 months for signetring cell, and not reached for diffuse GC (P<0.001). When stratified by stage, there were no significant differences in survival by histology for stage II and stage III patients. However, by Cox regression analysis, factors associated with worse survival included lymphovascular invasion (LVI), nodal disease, and presence of LP. Neutrophil-lymphocyte ratio (NLR), neoadjuvant and adjuvant therapy, and tumor regression grade did not influence survival on multivariate analysis. Conclusions:Intestinal GC is thought to have a better prognosis. Interestingly, this study demonstrates similar outcomes in patients with intestinal, diffuse, and signet-ring cell GC. However, a subset of diffuse GC-LP was associated with an infiltrative pattern of disease characterized by PNI and LVI. Despite controlling for poor prognostic markers, LP was independently associated with a worse prognosis. More research is needed to identify methods of earlier diagnosis and effective systemic therapy to treat this aggressive disease.

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“…Comparison with initial clinical and pathologic stages revealed downstaging of T stage in 66.7% of patients (32/48) and downstaging of N stage in 45.8% of patients (22/48) (Table ). Although there is still no universally accepted grading system for pathologic regression, numerous studies have shown that the degree of pathologic response is a vital prognostic marker of local recurrence, distant metastases, and long‐term outcomes in locally advanced gastric cancer after neoadjuvant therapy . More importantly, pathologic response can guide clinical decisions about surgical strategies, adjuvant therapy, and long‐term surveillance .…”

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confidence: 99%

Oxaliplatin plus Capecitabine in the Perioperative Treatment of Locally Advanced Gastric Adenocarcinoma in Combination with D2 Gastrectomy: NEO-CLASSIC Study

Fang

Shen

et al. 2019

The Oncologist

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Lessons Learned The NEO‐CLASSIC study provided valuable insight for the clinical efficacy and tolerability profiles of perioperative chemotherapy with oxaliplatin and capecitabine, plus gastrectomy, in patients with localized resectable gastric cancer. The study was designed to explore the potential survival benefits of an eight‐cycle, perioperative oxaliplatin and capecitabine (XELOX) schedule in the above‐mentioned setting and to explore the feasibility of prolonging the cycles of preoperative chemotherapy. The projected endpoint was not met. Background This multicenter, open‐label study (NEO‐CLASSIC) evaluated the efficacy and safety of oxaliplatin and capecitabine (XELOX), plus D2 gastrectomy, in localized resectable gastric cancer. Methods Patients aged 18–75 years with histologically‐confirmed gastric adenocarcinoma (stage T2–4a/N+M0) were given eight cycles of XELOX (four preoperatively, four postoperatively). Each 3‐week cycle comprised capecitabine 1,000 mg/m2 twice daily on days 1–14 and oxaliplatin 130 mg/m2 on day 1. Curative D2 gastrectomy was scheduled 2–4 weeks after the last preoperative cycle. The primary objective of the study was to determine the objective response rate (ORR) of XELOX in the preoperative setting. Sample size was calculated by assuming that a minimum of 47 cases would be required to increase the ORR by 15% (from 40% to 55%). With an estimated 10% dropout rate, 55 patients would have to be recruited. Results Fifty‐five patients were enrolled, and one was excluded because of screening failure. R0 resections were achieved in 45 of 54 intent‐to‐treat patients (83.3%), and four patients received R1 resections (Fig. 1). There were no complete responses, 27 (50.0%) partial responses, 22 cases (40.7%) of stable disease, and 4 (7.4%) of progressive disease. The objective response rate was 50.0%. Median follow‐up was 52.97 months; 30 patients (55.6%) had disease progression (Table 1), and median progression‐free survival was 20.10 (95% confidence interval: 4.31—35.89) months; median overall survival was 30.77 months (95% confidence interval was not yet available) (Fig. 2). Fifty‐four patients completed 209 cycles of preoperative chemotherapy; 42 patients received 133 cycles of postoperative chemotherapy (Table 3). The rate of grade 3–4 adverse events was 8.5% (29/342 cycles); the most frequent events were neutropenia (9/342 cycles) and leukopenia (4/342 cycles). Conclusion These findings suggest that combination therapy with capecitabine and oxaliplatin as perioperative chemotherapy, followed by D2 gastrectomy, is effective and safe in late‐stage, locally advanced gastric cancer. Although enrollment exceeded the 47 patients required to identify an increase in the ORR by 15% (from 40% to 55%), results did not meet the primary endpoint.

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Tumor regression grade in gastric cancer: Predictors and impact on outcome

Abstract: Few gastric cancers demonstrate histologic response to neoadjuvant chemotherapy. While TRG may be a valid marker for treatment response, its predictive value and clinical application in gastric cancer remains unclear. J. Surg. Oncol. 2016;114:434-439. © 2016 Wiley Periodicals, Inc.

Cited by 49 publications

References 27 publications

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Does histology really influence gastric cancer prognosis?

Oxaliplatin plus Capecitabine in the Perioperative Treatment of Locally Advanced Gastric Adenocarcinoma in Combination with D2 Gastrectomy: NEO-CLASSIC Study

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