Yonsei Med J.  2013 Jul;54(4):888-894. 10.3349/ymj.2013.54.4.888.

Pathologic and Oncologic Outcomes in Locally Advanced Gastric Cancer with Neoadjuvant Chemotherapy or Chemoradiotherapy

• An JY
• Kim HI
• Cheong JH
• Hyung WJ
• Kim CB
• Noh SH

• KMID: 2158222
• DOI: http://doi.org/10.3349/ymj.2013.54.4.888

Abstract

PURPOSE
Although neoadjuvant therapy has been accepted as a treatment option in locally-advanced gastric cancer, its prognostic value has been difficult to evaluate.
MATERIALS AND METHODS
Seventy-four gastric cancer patients who underwent gastrectomy after neoadjuvant treatment were divided into two groups according to the pathologic response: favorable (ypT0) and others (ypT1-4). The clinicopathologic characteristics, predictive factors for pathologic response, and oncologic outcome were evaluated.
RESULTS
Eleven patients (14.8%) demonstrated ypT0 and the remaining 63 patients (85.2%) were ypT1-4. Chemoradiotherapy (CCRTx) rather than chemotherapy (CTx) was the only predictive factor for a favorable pathologic response. Chemotherapeutic factors and tumor marker levels did not predict pathologic response. The 1-, 2-, and 3-year disease-free survivals were 83.4%, 70%, and 52.2%. The 1-, 3-, 5-year overall survivals were 88.5%, 67.5%, and 51.2%, respectively. Although a complete pathologic response (ypT0N0M0) was achieved in 7 patients, 28.6% of them demonstrated recurrence of the tumor within 6 months after curative surgery.
CONCLUSION
CCRTx rather than CTx appears to be more effective for achieving good pathologic response. Although favorable pathologic response has been achieved after neoadjuvant treatment, the survival benefit remains controversial.

Keyword

Gastric cancer; neoadjuvant chemotherapy; neoadjuvant chemoradiotherapy; gastrectomy; pathologic response; prognosis

MeSH Terms

Aged
Chemoradiotherapy/*methods
Disease-Free Survival
Female
Gastrectomy
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local/pathology
Stomach Neoplasms/*drug therapy/mortality/pathology/*radiotherapy/surgery
Treatment Outcome
Tumor Markers, Biological
Tumor Markers, Biological

Figure

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  Fig. 1 Overall survival curves according to ypT status (p=0.048).

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  Fig. 2 Overall survival curves according to ypN status (p=0.003).

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