Impact of pathologic complete response on disease-free survival in patients with esophagogastric adenocarcinoma receiving preoperative docetaxel-based chemotherapy

Lorenzen, Sylvie; Thuss‐Patience, Peter; Al‐Batran, Salah‐Eddin; Lordick, Florian; Haller, Bernhard; Schuster, Tibor; Pauligk, Claudia; Luley, Kim; Bichev, Dmitry; Schumacher, Guido; Homann, Nils

doi:10.1093/annonc/mdt141

Cited by 101 publications

(68 citation statements)

References 21 publications

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“…In our study, there are 31 patients with ypT0 stage and the 5.9% pCR rate was comparable to the data from previous studies (3-15%) [14][15][16][17][18][19][20]. We found that the DFS and OS of pCR patients were similar to the ypStage I patients.…”

Section: Discussionsupporting

confidence: 89%

ypTNM staging after neoadjuvant chemotherapy in the Chinese gastric cancer population: an evaluation on the prognostic value of the AJCC eighth edition cancer staging system

Wang

Shan

et al. 2018

Gastric Cancer

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Background This study aims to evaluate the new ypTNM staging system in Chinese gastric cancer patients. Methods We conducted retrospective survival and regression analyses using a database of gastric cancer patients who underwent neoadjuvant chemotherapy at the Peking University Cancer Hospital and Institute from January 2007 to January 2015. Results A total of 473 patients were included in the study with 28 pathological complete response (pCR) cases, 3 ypT0N1 cases, 65 stage I cases, 126 stage II cases, and 251 stage III cases. The pCR cases had similar survival to stage I patients (p > 0.05). The 3-year disease-free survival (DFS) and 5-year overall survival (OS) rates of stage I, II and III patients were significantly different (3-year DFS: 89.0, 75.5, and 39.6%, p < 0.001; 5-year OS: 89.6, 65.5, and 36.5%, p = 0.001). Both ypT and ypN are independent predictors of patient survival, while further log-rank tests showed that the ypN stage is of better prognostic value than ypT. Subgrouping analysis revealed that stage III patients of ypT4b and ypN3 had worse survival compared to the rest of stage III cases (p < 0.001). The c-index values of the ypTNM stage and modified ypTNM stage (stage III divided into IIIa and IIIb) were 0.657 and 0.708, respectively (p < 0.001). Conclusions Our data showed significant differences in survival among gastric cancer patients at different ypTNM stages, indicating its prognostic value in the Chinese population. Further detailed analyses may facilitate the subgrouping of each stage to allow for a more accurate evaluation of disease prognosis in gastric cancer patients.

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Section: Discussionsupporting

confidence: 89%

ypTNM staging after neoadjuvant chemotherapy in the Chinese gastric cancer population: an evaluation on the prognostic value of the AJCC eighth edition cancer staging system

Wang

Shan

et al. 2018

Gastric Cancer

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“…Our data as well as data from three other groups are in strong contrast to the data of Messager et al [24] who could not demonstrate an effectiveness of preoperative chemotherapy in patients with signet ring cell histology [11,15,10,24]. However, two other groups (Fields et al [15] and Ott et al [11]) also included patients treated with radiochemotherapy, and Lorenzen et al [20] showed a decreased percentage of pCR on diffuse-type cancer in comparison to the intestinal type [11,15,20]. Schmidt et al [7] also show a correlation between the Lauren type and histopathological remission grade.…”

Section: Discussioncontrasting

confidence: 91%

“…These results indicate that the hypothesis raised in the cooperative analysis of the AIO [20] of an improved pCR rate and prognosis under preoperative integration of taxanes in comparison to ECF can only be answered in a randomized trial, which is currently conducted by the AIO (Clinical-Trial.gov No. NCT01216644).…”

Section: Discussionmentioning

confidence: 97%

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High Impact of Histopathological Remission for Prognosis after Perioperative Chemotherapy with ECF and ECF-Like Regimens for Gastric and Gastroesophageal Adenocarcinoma

Bichev¹,

Treese

Winterfeld

et al. 2015

Oncology

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Background: Perioperative chemotherapy with epirubicin, cisplatin and 5-fluorouracil (5-FU) (ECF)-like regimens is the European standard for patients with adenocarcinoma of the gastroesophageal junction (GEJ) or gastric body (GaCa) stage UICC II/III (staged according to the Union for International Cancer Control). However, limited data exist on the histopathological response and relevance of prognosis for patients homogeneously treated with ECF(-like) therapies. Methods: All patients with GEJ/GaCa treated from September 2004 to September 2008 by perioperative ECF(-like) chemotherapy were retrospectively analyzed. Cisplatin and 5-FU were substituted with oxaliplatin or capecitabine when indicated. The histopathological response was assessed using the Becker score. Results: Seventy-seven patients were analyzed with a median follow-up of 72.3 months. R0 resection was achieved in 53 of 68 operated patients. Recurrence was observed in 25 (32.5%) of these curatively treated patients, whereas 53/77 patients (68.8%) died, 39 (50.6%) of whom tumor related. The 5-year overall survival (OS) for the intention-to-treat population was 36.3%, and the 5-year tumor-specific survival was 42.2%. Pathological complete response (pCR) was seen in 10 patients (13.0%) and near pCR in 3 patients (3.9%). Patients with pCR had a significantly prolonged 5-year OS of 80.0 versus 29.7% compared to the nonhistopathological complete remission group (p = 0.01). Conclusion: In our retrospective analysis, ECF(-like) pretreatment resulted in a (near) pCR rate of 16.9%. In line with other regimens, our data suggest that histopathological response predicts the OS in patients treated with ECF(-like) regimens.

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“…A multidisciplinary tumor board, including upper GI surgeons, gastroenterologists, oncologists, and specialized radiologists, determined the therapeutic approach. In patients with adenocarcinoma and suspected lymph node involvement or tumor stage >T3, a perioperative chemotherapy with regimens including 5-FU, epirubicin, and cisplatin or 5-FU and oxaliplatin [8, 9] or docetaxel, cisplatin, and capecitabine [10, 11] was administered. Patients suffering from esophageal squamous cell carcinoma received neoadjuvant systemic therapy with carboplatin and paclitaxel complemented with 41 Gy radiotherapy [12-14].…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

et al. 2017

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Background: Data on the typical time point of occurrence of anastomotic leak (AL) after esophagectomy for esophageal cancer are currently scarce. Therefore, the usefulness of routine radiocontrast agent studies (RRCS) for testing proper healing of the anastomosis after esophagectomy remains unclear. Furthermore, preferred available tools to diagnose postoperative AL and therapeutic options are still under debate. Methods: We present a retrospective analysis of 328 consecutive patients who underwent esophagectomy for esophageal cancer between 2005 and 2015. A RRCS has been performed to date in our center on the fifth postoperative day (POD), before returning to normal oral intake. Results: In total, 49 of 328 patients developed AL after esophagectomy (15%). A total of 11 patients (23%) developed AL before the RRCS and 34 patients (69%) after an unremarkable RRCS; and 4 patients (8%) with AL were diagnosed by RRCS, resulting in overall sensitivity of 16%. The median time point of occurrence of AL was POD 9, the majority of AL (84%) occurred between POD 1 and 19. Computed tomography led to the diagnosis of AL in 41% of patients. The most frequent therapy of AL was stenting in 47% of patients. Endoscopic vacuum therapy was used in 4 patients. Conclusions: The majority of AL occurred within the first 3 weeks after esophagectomy without a typical time point. In our series, RRCS on the fifth POD had a low sensitivity of 16%. Therefore, standardized RRCS and fasting till the examination cannot be generally recommended. In case of clinical suspicion of AL, computed tomography of the chest and abdomen with oral contrast agent should be performed, followed by endoscopy. Endoscopic stent placement remains the standard therapy of AL in our center. Endoscopic vacuum therapy evolves as it is an interesting alternative therapeutic option and can be combined with stenting in selected cases.

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Impact of pathologic complete response on disease-free survival in patients with esophagogastric adenocarcinoma receiving preoperative docetaxel-based chemotherapy

Abstract: A pCR following preoperative docetaxel/platin/fluoropyrimidine indicates favorable outcome in patients with gastric or EGJ adenocarcinoma. Tumor location in the EGJ is associated with a higher pCR rate.

Cited by 101 publications

References 21 publications

ypTNM staging after neoadjuvant chemotherapy in the Chinese gastric cancer population: an evaluation on the prognostic value of the AJCC eighth edition cancer staging system

ypTNM staging after neoadjuvant chemotherapy in the Chinese gastric cancer population: an evaluation on the prognostic value of the AJCC eighth edition cancer staging system

High Impact of Histopathological Remission for Prognosis after Perioperative Chemotherapy with ECF and ECF-Like Regimens for Gastric and Gastroesophageal Adenocarcinoma

Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

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