Prognostic Significance of Complete Pathologic Response Obtained with Chemotherapy Versus Chemoradiotherapy in Gastric Cancer

Trumbull, Denslow; Lemini, Riccardo; Vico, Tamara Díaz; Jorgensen, Matthew S.; Attwood, Kristopher; Ji, Wenyan; Brady, Maureen; Gabriel, Emmanuel; Kukar, Moshim

doi:10.1245/s10434-020-08921-9

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…In that study, NCRT was primarily administered to patients with proximal LAGC. This finding may partly explain why NCRT did not produce significant survival benefits despite providing more favorable local disease control in other studies [ 46 , 51 , 52 , 54 , 58 , 59 ]. However, this supposition necessitates validation through further large-scale clinical trials.…”

Section: Toxicity Therapeutical Considerations and Biomarkers Of Ncrtmentioning

confidence: 83%

“…NCT has demonstrated survival benefits over upfront surgery [ 10 , 57 ], and this approach is embraced under current treatment guidelines [ 8 ]. Nonrandomized studies have compared NCRT and NCT ( Table 3 ) [ 46 , 51 , 52 , 54 , 58 , 59 ]. In general, NCRT is more likely to achieve a pCR and enable R0 resection than is NCT.…”

Section: Ncrt For Locally Advanced Resectable Noncardia Gastric Cancermentioning

confidence: 99%

“…However, the advantage of more favorable local control does not confer OS benefits. Trumbull et al [ 59 ] observed greater survival benefits in terms of pCR under NCT than under NCRT in patients with LAGC. Another study found that NCRT was beneficial in patients with initial lymph node metastasis, as indicated by the association of a complete nodal response with significantly improved survival.…”

Section: Ncrt For Locally Advanced Resectable Noncardia Gastric Cancermentioning

confidence: 99%

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Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Cancer: Where Are We at?

Yeh

Tsai

et al. 2022

Cancers

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Locally advanced gastric cancer (LAGC) has a poor prognosis with surgical resection alone, and neoadjuvant treatment has been recommended to improve surgical and oncological outcomes. Although neoadjuvant chemotherapy has been established to be effective for LAGC, the role of neoadjuvant chemoradiotherapy (NCRT) remains under investigation. Clinical experience and research evidence on esophagogastric junction adenocarcinoma (e.g., cardia gastric cancers) indicate that the likelihood of achieving sustainable local control is higher through NCRT than through resection alone. Furthermore, NCRT also has an acceptable treatment-related toxicity and adverse event profile. In particular, it increases the likelihood of achieving an R0 resection and a pathological complete response (pCR). Moreover, NCRT results in higher overall and recurrence-free survival rates than surgery alone; however, evidence on the survival benefits of NCRT versus neoadjuvant chemotherapy (NCT) remains conflicting. For noncardia gastric cancer, the efficacy of NCRT has mostly been reported in retrospective studies, and several large clinical trials are ongoing. Consequently, NCRT might play a more essential role in unresectable LAGC, for which NCT alone may not be adequate to attain disease control. The continual improvements in systemic treatments, radiotherapy techniques, and emerging biomarkers can also lead to improved personalized therapy for NCRT. To elucidate the contributions of NCRT to gastric cancer treatment in the future, the efficacy, potential toxicity, predictive biomarkers, and clinical considerations for implementing NCRT in different types of LAGC were reviewed.

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Section: Toxicity Therapeutical Considerations and Biomarkers Of Ncrtmentioning

confidence: 83%

Section: Ncrt For Locally Advanced Resectable Noncardia Gastric Cancermentioning

confidence: 99%

Section: Ncrt For Locally Advanced Resectable Noncardia Gastric Cancermentioning

confidence: 99%

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Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Cancer: Where Are We at?

Yeh

Tsai

et al. 2022

Cancers

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“…Many contemporary studies showed that perioperative chemotherapy could significantly improve progression-free and overall survival in patients with operable gastric or lower esophageal adenocarcinomas ( 35 , 36 ). Using neoadjuvant chemotherapy significantly increases overall survival in complete pathologic response patients compared to neoadjuvant chemoradiotherapy ( 37 ). The performance of the current prognostic prediction model would be further improved with well-developed information.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of survival prediction model for gastric adenocarcinoma patients using deep learning: A SEER-based study

Zeng

Cao

et al. 2023

Front. Oncol.

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BackgroundThe currently available prediction models, such as the Cox model, were too simplistic to correctly predict the outcome of gastric adenocarcinoma patients. This study aimed to develop and validate survival prediction models for gastric adenocarcinoma patients using the deep learning survival neural network.MethodsA total of 14,177 patients with gastric adenocarcinoma from the Surveillance, Epidemiology, and End Results (SEER) database were included in the study and randomly divided into the training and testing group with a 7:3 ratio. Two algorithms were chosen to build the prediction models, and both algorithms include random survival forest (RSF) and a deep learning based-survival prediction algorithm (DeepSurv). Also, a traditional Cox proportional hazard (CoxPH) model was constructed for comparison. The consistency index (C-index), Brier score, and integrated Brier score (IBS) were used to evaluate the model’s predictive performance. The accuracy of predicting survival at 1, 3, 5, and 10 years was also assessed using receiver operating characteristic curves (ROC), calibration curves, and area under the ROC curve (AUC).ResultsGastric adenocarcinoma patients were randomized into a training group (n = 9923) and a testing group (n = 4254). DeepSurv showed the best performance among the three models (c-index: 0.772, IBS: 0.1421), which was superior to that of the traditional CoxPH model (c-index: 0.755, IBS: 0.1506) and the RSF with 3-year survival prediction model (c-index: 0.766, IBS: 0.1502). The DeepSurv model produced superior accuracy and calibrated survival estimates predicting 1-, 3- 5- and 10-year survival (AUC: 0.825-0.871).ConclusionsA deep learning algorithm was developed to predict more accurate prognostic information for gastric cancer patients. The DeepSurv model has advantages over the CoxPH and RSF models and performs well in discriminative performance and calibration.

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“…The tolerance to and efficacy of various treatment protocols differ. Trumbull DA et al ( 13 ) found that the use of NACT led to a significant increase in overall survival (OS) compared with NACRT for those who achieved pCR in gastric adenocarcinoma (5-year survival rate: 94% vs. 60%). Nonetheless, the time interval until surgery after the completion of NAT is a common question without a definite answer.…”

Section: Introductionmentioning

confidence: 99%

Current status and future perspectives on neoadjuvant therapy in gastric cancer

Ao¹,

Wang²,

Song³

et al. 2021

Chinese Journal of Cancer Research

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Gastric cancer, with high morbidity and mortality rates, is one of the most heterogeneous tumors. Radical gastrectomy and postoperative chemotherapy are the standard treatments. However, the safety and efficacy of neoadjuvant therapy (NAT) need to be confirmed by many trials before implementation, creating a bottleneck in development. Although clinical benefits of NAT have been observed, a series of problems remain to be solved. Before therapy, more contributing factors should be offered for choice in the intended population and ideal regimens. Enhanced computed tomography (CT) scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors (RECIST), yet CT scanning results sometimes differ from pathological responses. After NAT, the appropriate time for surgery is still empirically defined. Our review aims to discuss the abovementioned issues regarding NAT for GC, including indications, selection of regimens, lesion assessment and NAT-surgery interval time.

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Prognostic Significance of Complete Pathologic Response Obtained with Chemotherapy Versus Chemoradiotherapy in Gastric Cancer

Cited by 11 publications

References 31 publications

Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Cancer: Where Are We at?

Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Cancer: Where Are We at?

Development and validation of survival prediction model for gastric adenocarcinoma patients using deep learning: A SEER-based study

Current status and future perspectives on neoadjuvant therapy in gastric cancer

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