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

Abstract

Background: Neoadjuvant chemotherapy (NAC) followed by surgery currently offers promise as a strategy for patients with locally advanced gastric cancer (GC). However, there is limited evidence to guide treatment for TRG 0 and 1 patients with locally advanced GC after R0 resection. This study set out to explore the optimal management for TRG 0 and 1 patients with locally advanced GC after R0 resection. Methods:The retrospective data of 154 TRG 0 and 1 patients with locally advanced GC following R0 resection who were treated between January 2012 and December 2018 were collected and analyzed. The Kaplan-Meier method was used to estimate the survival rate. Multivariate analysis was performed using the Cox proportional hazards model. Results:The median follow-up was 34.1 (range, 6.6-90.9) months. Six patients (3.9%) were lost during follow-up. Of the 27 patients who experienced relapse, 12 died, including 2 patients who died of nonneoplastic causes. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) were 71.6% (95% CI: 68.5-79.6) and 82.9% (95% CI: 76.9-86.1) for the whole cohort, respectively. Univariate analysis revealed that patients with carcinoembryonic antigen (CEA) <5.0 ng/ml after NAC (77.7% vs. 20.1%, P<0.001), distal gastrectomy (91.7% vs. 67.5%, P=0.046) had higher 5-year RFS. Meanwhile, combined resection (55.6% vs. 73.1%, P=0.042), major complications (42.7% vs. 80.50%, P<0.001), and lymph node metastasis (ypN+) (52.0% vs. 83.7%, P<0.001) had lower 5-year RFS. The multivariate analysis showed that

Deep learning nomogram for predicting neoadjuvant chemotherapy response in locally advanced gastric cancer patients

“…The aforementioned methods evaluate patients' response to NAC based on the extent of residual tumor in postoperative tissue specimens, providing clinicians with crucial information regarding patients' treatment response and guiding further treatment strategies. Previous studies have found that for TRG 0 or 1 patients without adverse prognostic factors, the option of no postoperative chemotherapy may be considered, whereas for patients with TRG 2 or 3, postoperative chemotherapy may be necessary [9,10]. However, these methods rely on pathologic results obtained after tumor surgical resection, making them challenging to apply for predictions before NAC.…”

Determination of the UGT1A1 polymorphism as guidance for irinotecan dose adjustment in gastric cancer treated with second-line chemotherapy

“…Due to the lack of typical symptoms in early GC, nearly two-thirds of the patients were diagnosed with extensive local lymph node involvement and/or invasion of adjacent structures in late stages of the disease, the 5-year survival rate is unsatisfactory (Feng et al 2020;Ma et al 2020). Some phase III studies have shown a survival bene t from irinotecan or docetaxel as second-line chemotherapy compared to best supportive therapy (Ford et al 2014; Kang et al 2012;Thuss-Patience et al 2011).…”