Histologic Lymph Nodes Regression after Preoperative Chemotherapy as Prognostic Factor in Non-metastatic Advanced Gastric Adenocarcinoma

Baušys, Augustinas; Senina, Veslava; Lukšta, Martynas; Anglickienė, Giedrė; Molnikaite, Greta; Bausys, Bernardas; Rybakovas, Andrius; Baltruskeviciene, Edita; Laurinavičius, Arvydas; Poškus, Tomas; Baušys, Rimantas; Šeinin, Dmitrij; Strupas, Kęstutis

doi:10.7150/jca.49673

Cited by 8 publications

(13 citation statements)

References 37 publications

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Section: Nodal Regression Gradementioning

confidence: 99%

“…Histologic downstage of cN+ status results in prolonged survival [107,108]. Moreover, regression of LN status is more significant than regression of the primary tumour in predicting GC recurrence [107]. Additionally, LN regression, regardless of the percent of tumour cells in the primary site, independently influences the survival in patients who underwent NAC [109].…”

Section: Nodal Regression Gradementioning

confidence: 99%

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Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Pelc

Skórzewska

Rawicz‐Pruszyński

et al. 2021

Cancers

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Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. A favourable prognostic impact for ypN0 patients is observed, either due to truly negative LN before the start of therapy or because preoperative therapy achieved a pathologically complete nodal response. Ongoing trials investigating the extent of lymphadenectomy after neoadjuvant therapy will standardise the LN dissection from the multimodal therapy perspective. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC.

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Section: Nodal Regression Gradementioning

confidence: 99%

Section: Nodal Regression Gradementioning

confidence: 99%

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Pelc

Skórzewska

Rawicz‐Pruszyński

et al. 2021

Cancers

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Section: Discussionmentioning

confidence: 88%

“…Other studies have similarly concluded that survival is improved in patients who have lymph node responses to chemotherapy, despite poor response to chemotherapy in primary tumors [8,[13][14][15]. It has been reported that the survival of patients with Mandard score (3-5) in the ypN0 group was similar to that of patients with Mandard score (1-2) [15]. Our study further compared median survival in different ypN stage subgroups of patients with Mandard Radiography plays an important role in evaluating tumor regression after chemotherapy [20][21][22].…”

Section: Discussionmentioning

confidence: 94%

Can Gastric Cancer Patients with High Mandard Score Benefit from Neoadjuvant Chemotherapy?

Kang

Wang

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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A high Mandard score may indicate the tumor is insensitive to chemotherapy. We analyzed tumor regression and lymph node response under different Mandard scores to assess the impact of Mandard score on prognosis. Methods. Mandard scores and ypN stage of postoperative pathological reports were recorded. The results were reviewed by a professional pathologist. The radiologist compared the tumor regression before and after chemotherapy by computed tomography (CT). The survival of all patients was obtained by telephone follow-up. Multivariate Cox regression was used to assess the relationship between overall risk of death and Mandard score, imaging evaluation, and ypN stage. Results. In the Mandard score (4-5) group, the median survival time for PR and ypN0 patients was 68.5 and 76.7 months. While in the Mandard score (1-2) group, the median survival time for PD and ypN3a patients was 15.6 and 14.5 months. Imaging evaluation of tumor regression (PR 68.5 months, SD 27.8 months, and PD 10.2 months) and lymph node remission (ypN0 76.7 months, ypN1 61.6 months, ypN2 18.0 months, ypN3a 18.7 months, and ypN3b 18.3 months) showed improved survival. Mandard score, imaging evaluation, and ypN stage are important prognostic factors affecting prognosis. Conclusion. A high Mandard score does not mean neoadjuvant chemotherapy is ineffective in gastric cancer. Patients with imaging evaluation of tumor regression and ypN stage reduction may benefit from neoadjuvant chemotherapy.

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“…The three-tier system is the most investigated classification in both upper 6,[8][9][10]12,13,15,17,30 and lower gastrointestinal tumours, 2,4,7,16 where node-negative patients with (ypNÀReg+) and without response (ypNÀRegÀ) are compared with ypN+ patients. In our cohorts, we observed that patients with ypNÀReg+ have at least similar OS to and even better DFS than those with never positive nodes (ypNÀRegÀ).…”

Section: Discussionmentioning

confidence: 99%

Lymph node regression after neoadjuvant chemoradiotherapy in rectal cancer

Ozturk,

Martinez,

Mens

et al. 2024

Histopathology

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AimsLymph node metastases (LNM) are one of the most important prognostic indicators in solid tumours and a major component of cancer staging. Neoadjuvant therapy might influence nodal status by induction of regression. Our aim is to determine the prevalence and role of regression of LNM on outcomes in patients with rectal cancer.Methods and resultsFour independent study populations of rectal cancer patients treated with similar regimens of chemoradiotherapy were pooled together to obtain a total cohort of 469 patients. Post‐treatment nodal status (ypN) and signs of tumour regression (Reg) were incorporated to form three‐tiered (ypN− Reg+, ypN− Reg− and ypN+) and four‐tiered (ypN− Reg+, ypN− Reg−, ypN+ Reg+ and ypN+ Reg−) classifications. In our cohort, 31% of patients presented with ypN+ rectal cancer. As expected, we found significantly worse overall survival (OS) in ypN+ patients compared to ypN− patients (P = 0.002). The percentage of ypN− patients with lymph nodes with complete regression was 20% in our cohort. While node‐negative patients with and without regression had similar OS (P = 0.09), disease‐free survival (DFS) was significantly better in node‐negative patients with regression (P = 0.009).ConclusionsRegression in lymph nodes is frequent, and node‐negative patients with evidence of lymph node regression have better DFS compared to node‐negative patients without such evidence.

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Histologic Lymph Nodes Regression after Preoperative Chemotherapy as Prognostic Factor in Non-metastatic Advanced Gastric Adenocarcinoma

Cited by 8 publications

References 37 publications

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Can Gastric Cancer Patients with High Mandard Score Benefit from Neoadjuvant Chemotherapy?

Lymph node regression after neoadjuvant chemoradiotherapy in rectal cancer

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