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

Abstract

PurposeAlthough neoadjuvant therapy has been accepted as a treatment option in locally-advanced gastric cancer, its prognostic value has been difficult to evaluate.Materials and MethodsSeventy-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.ResultsEleven 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.ConclusionCCRTx 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.

The Influence of Perineural Invation on the Prognosis of Patients with Gastric Cancer after Radical Operation _A Retrospective Study

“…However, it is showed that PNI is an independent pathway of metastasis because the perineural space is different from the lymphatic canal in anatomical and microstructural aspects. In our study it is showed that the positive rate of PNI was closely related to the invasion of blood vessels and lymphatic vessels, which may be one of the reasons for the high incidence of PNI [7].…”

Observational Study Comparing Efficacy and Safety Between Preoperative Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

“…In recent years, a multidisciplinary treatment approach including preoperative chemotherapy, radiotherapy, and target therapy has emerged for advanced or metastatic GC, resulting in increased curability and improved survival 14 . Recent studies have suggested that neoadjuvant chemotherapy in patients with locally advanced or metastatic GC can enable curative resection and improve survival [15,16]. In our previous study, we observed that survival and quality of life of patients with locally advanced or metastatic GC who received neoadjuvant chemotherapy were superior to those of patients who received only supportive care [2,3].…”

“…GC remains a leading malignancy worldwide, and management of patients with locally advanced or metastatic GC has not substantially changed in the last few decades. A neoadjuvant strategy may increase the likelihood of completing multimodality therapy, particularly when surgical management is associated with significant morbidity and complications that may preclude timely adjuvant therapy [9][10][11][12][13][14][15]. Preoperative concurrent chemoradiotherapy (CCRT) is a well-established primary treatment modality in other gastrointestinal malignancies including esophageal [9,11] and rectal cancer [12,13].…”

Observational Study Comparing Efficacy and Safety Between Preoperative Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

“…GC remains a leading malignancy worldwide, and management of patients with locally advanced or metastatic GC has not substantially changed in the last few decades. A neoadjuvant strategy may increase the likelihood of completing multimodality therapy, particularly when surgical management is associated with significant morbidity and complications that may preclude timely adjuvant therapy [9][10][11][12][13][14].…”