Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute

Sun, Libo; Guo-jie, Zhao; Ding, Dayong; Song, Bin; Hou, Ruizhi; Li, Yongchao

doi:10.1186/1477-7819-12-280

Cited by 16 publications

(10 citation statements)

References 22 publications

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“… 21 The study from Sun et al demonstrated that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group for patients with locally advanced gastric cancer treated with neoadjuvant chemotherapy. 22 Not surprisingly, tumor differentiation was significantly associated with poor prognosis in the present study.…”

Section: Discussionsupporting

confidence: 54%

Clinical significance of prognostic score based on age, tumor size, and grade in gastric cancer after gastrectomy

Lu¹,

Chen²,

Liu³

et al. 2018

CMAR

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BackgroundPostoperative management and survival of gastric cancer is mainly determined by pathologic TNM stage. However, gastric cancer is a heterogeneity group, and the survival is quite different even when they are in the same TNM stage. Moreover, TNM stage system does not grasp other important clinicopathologic factors to determine the survival. The aim of the present study is to propose and validate prognostic score based on age, tumor size, and grade.Materials and methodsPatients diagnosed with gastric cancer in the Surveillance, Epidemiology, and End Results database from 1988 to 2012 were included in the present study. Kaplan–Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors.ResultsA total of 26,091 eligible patients diagnosed with noncardia gastric cancer were included in the study. In the univariate and multivariate survival analysis, age at diagnosis, tumor grade, and tumor size were validated as independent prognostic factors (P<0.05). Then, we proposed a prognostic score calculated from the number of risk factors, with 0, 1, and 2 points each given for favorable, intermediate, and poor prognostic categories of age (≤50, 50–70, and >70), grade (well, moderate, and poor differentiation), and size (≤3, 3–6, ≥7 cm). The prognostic score was verified as independent predictor in both univariate and multivariate survival analyses (P<0.001). In addition, nomograms on cause-specific survival were established according to prognostic factor and all other significant factors, and c-index was 0.715 (95% CI: 0.706–0.725).ConclusionPrognostic score based on age, tumor size, and grade is an independent predictor of survival after gastrectomy. The novel prognostic score can improve the accuracy of prediction for current TNM stage system. Patients who are with a high prognostic score should undergo extensive follow-up after surgery.

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Section: Discussionsupporting

confidence: 54%

Clinical significance of prognostic score based on age, tumor size, and grade in gastric cancer after gastrectomy

Lu¹,

Chen²,

Liu³

et al. 2018

CMAR

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“…In the subsequent univariate and multivariable analyses, age was shown to have no impact on pCR and long-term outcomes. With respect to tumor differentiation, previous studies showed that the more differentiated a tumor, the higher the pathology response rate when patients were treated with a XELOX regimen[ 22 , 23 ]. However, results from our univariate analysis contradict these previous findings.…”

Section: Discussionmentioning

confidence: 99%

Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes

Liu¹,

Zhang²,

Huang³

et al. 2018

WJG

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AIMTo evaluate whether the neoadjuvant chemotherapy (NACT)-surgery interval time significantly impacts the pathological complete response (pCR) rate and long-term survival.METHODSOne hundred and seventy-six patients with gastric cancer undergoing NACT and a planned gastrectomy at the Chinese PLA General Hospital were selected from January 2011 to January 2017. Univariate and multivariable analyses were used to investigate the impact of NACT-surgery interval time (< 4 wk, 4-6 wk, and > 6 wk) on pCR rate and overall survival (OS).RESULTSThe NACT-surgery interval time and clinician T stage were independent predictors of pCR. The interval time > 6 wk was associated with a 74% higher odds of pCR as compared with an interval time of 4-6 wk (P = 0.044), while the odds ratio (OR) of clinical T3 vs clinical T4 stage for pCR was 2.90 (95%CI: 1.04-8.01, P = 0.041). In Cox regression analysis of long-term survival, post-neoadjuvant therapy pathological N (ypN) stage significantly impacted OS (N0 vs N3: HR = 0.16, 95%CI: 0.37-0.70, P = 0.015; N1 vs N3: HR = 0.14, 95%CI: 0.02-0.81, P = 0.029) and disease-free survival (DFS) (N0 vs N3: HR = 0.11, 95%CI: 0.24-0.52, P = 0.005; N1 vs N3: HR = 0.17, 95%CI: 0.02-0.71, P = 0.020). The surgical procedure also had a positive impact on OS and DFS. The hazard ratio of distal gastrectomy vs total gastrectomy was 0.12 (95%CI: 0.33-0.42, P = 0.001) for OS, and 0.13 (95%CI: 0.36-0.44, P = 0.001) for DFS.CONCLUSIONThe NACT-surgery interval time is associated with pCR but has no impact on survival, and an interval time > 6 wk has a relatively high odds of pCR.

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“…However, the reader should be mindful that the effect of the NLR should be interpreted with caution in patients with intercurrent infectious processes, or in those undergoing corticosteroid therapy. On the other hand, although increasing American Joint Committee on Cancer (AJCC) histologic grade has been associated with decreasing survival in some reports ( Sun et al , 2014 ; Duma et al , 2016 ), it has not emerged as an independent prognostic factor in any of the prognostic scales that have contemplated it in their analyses. As for HER2 status, most previous prognostic models were developed before HER2 testing and trastuzumab therapy became standard and two most recent studies conducted in the era of trastuzumab have not analysed its prognostic role ( Hsieh et al , 2016 ; Wang et al , 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab

et al. 2017

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Background:To develop and validate a nomogram and web-based calculator to predict overall survival (OS) in Caucasian-advanced oesophagogastric adenocarcinoma (AOA) patients undergoing first-line combination chemotherapy.Methods:Nine hundred twenty-four AOA patients treated at 28 Spanish teaching hospitals from January 2008 to September 2014 were used as derivation cohort. The result of an adjusted-Cox proportional hazards regression was represented as a nomogram and web-based calculator. The model was validated in 502 prospectively recruited patients treated between October 2014 and December 2016. Harrell's c-index was used to evaluate discrimination.Results:The nomogram includes seven predictors associated with OS: HER2-positive tumours treated with trastuzumab, Eastern Cooperative Oncology Group performance status, number of metastatic sites, bone metastases, ascites, histological grade, and neutrophil-to-lymphocyte ratio. Median OS was 5.8 (95% confidence interval (CI), 4.5–6.6), 9.4 (95% CI, 8.5–10.6), and 14 months (95% CI, 11.8–16) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the derivation set and 4.6 (95% CI, 3.3–8.1), 12.7 (95% CI, 11.3–14.3), and 18.3 months (95% CI, 14.6–24.2) for high-, intermediate-, and low-risk groups, respectively (P<0.001), in the validation set. The nomogram is well-calibrated and reveals acceptable discriminatory capacity, with optimism-corrected c-indices of 0.618 (95% CI, 0.591–0.631) and 0.673 (95% CI, 0.636–0.709) in derivation and validation groups, respectively. The AGAMENON nomogram outperformed the Royal Marsden Hospital (c-index=0.583; P=0.00046) and Japan Clinical Oncology Group prognostic indices (c-index=0.611; P=0.03351).Conclusions:We developed and validated a straightforward model to predict survival in Caucasian AOA patients initiating first-line polychemotherapy. This model can contribute to inform clinical decision-making and optimise clinical trial design.

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Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute

Cited by 16 publications

References 22 publications

Clinical significance of prognostic score based on age, tumor size, and grade in gastric cancer after gastrectomy

Clinical significance of prognostic score based on age, tumor size, and grade in gastric cancer after gastrectomy

Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes

Nomogram-based prediction of survival in patients with advanced oesophagogastric adenocarcinoma receiving first-line chemotherapy: a multicenter prospective study in the era of trastuzumab

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