Significance of neoadjuvant downstaging in gastric adenocarcinoma

Prasad, Pooja; Sivaharan, Ashwin; Navidi, M; Fergie, Bridget H; Griffin, SM; Phillips, Alexander W

doi:10.1016/j.surg.2022.03.005

Cited by 8 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was no indication that patients with chemotherapy-induced ypT0-1 had a worse prognosis, that is, the down-staging was not merely a cosmetic finding but seemed to confer a true survival benefit. Other studies have reported a similar prognosis of ypT1-2 cancers compared with pT1-2 cancers treated by upfront surgery [ 61 , 62 ], which parallels recently published observations even for stage II and III disease in the current control group [ 63 ].…”

Section: Discussionsupporting

confidence: 88%

Early Gastric Cancers in Central Norway 2001 to 2016—A Population-Based Study

Kvamme,

Stillingen,

Sandø

et al. 2024

Cancers

View full text Add to dashboard Cite

Early gastric cancers (EGCs) are confined to the gastric mucosa and submucosa irrespective of lymph node metastases and constitute only a minor proportion of gastric cancer in Western countries. We aimed to characterize EGCs and assess the survival of EGC in Central Norway during 2001–2016. A retrospective population-based study on 1205 patients with gastric cancer was performed. At the time, surgical resection was the standard treatment, and 88 (7.3%) EGCs were identified. Histopathological specimens were re-examined, and the eCura score and survival were evaluated. The number of gastric cancers declined (p = 0.010), but the relative proportion of EGC was unchanged during the study period. EGCs were more often of the Lauren intestinal type (p < 0.001) compared with controls. A significant proportion (9.4%, n = 5) of the patients with a low-risk eCura had lymph node metastases, whereas further exclusion of tumors with histological ulceration or SM2 invasion identified an N0 cohort. The median survival for EGC patients was 117.1 months (95% CI 99.8–134.3) and the 5-year overall survival was 75%. Twelve deaths were cancer-related, either due to postoperative complications (5.7%, n = 5) or cancer recurrence (8%, n = 7). In conclusion, EGCs constituted a minor but constant proportion of gastric cancers. eCura alone was insufficient in predicting patients with pN0 disease.

show abstract

Section: Discussionsupporting

confidence: 88%

Early Gastric Cancers in Central Norway 2001 to 2016—A Population-Based Study

Kvamme,

Stillingen,

Sandø

et al. 2024

Cancers

View full text Add to dashboard Cite

show abstract

“…We observed a higher ORR and a higher proportion of patients achieving T downstaging (66.0% and 52.9%, respectively) in the CA-SAP group than in the SAP group (43.4% and 32.1%, respectively). As previously reported, significant downstaging could provide favorable conditions for curative surgery 77 . In addition to the promising tumor response results, a remarkable improvement in the R0 resection rate was observed with CA-SAP.…”

Section: Discussionmentioning

confidence: 65%

Neoadjuvant camrelizumab and apatinib combined with chemotherapy versus chemotherapy alone for locally advanced gastric cancer: a multicenter randomized phase 2 trial

Lin,

Tang,

Zheng

et al. 2024

Nat Commun

View full text Add to dashboard Cite

Prospective evidence regarding the combination of programmed cell death (PD)−1 and angiogenesis inhibitors in treating locally advanced gastric cancer (LAGC) is limited. In this multicenter, randomized, phase 2 trial (NCT04195828), patients with gastric adenocarcinoma (clinical T2-4N + M0) were randomly assigned (1:1) to receive neoadjuvant camrelizumab and apatinib combined with nab-paclitaxel plus S-1 (CA-SAP) or chemotherapy SAP alone (SAP) for 3 cycles. The primary endpoint was the major pathological response (MPR), defined as <10% residual tumor cells in resection specimens. Secondary endpoints included R0 resection rate, radiologic response, safety, overall survival, and progression-free survival. The modified intention-to-treat population was analyzed (CA-SAP [n = 51] versus SAP [n = 53]). The trial has met pre-specified endpoints. CA-SAP was associated with a significantly higher MPR rate (33.3%) than SAP (17.0%, P = 0.044). The CA-SAP group had a significantly higher objective response rate (66.0% versus 43.4%, P = 0.017) and R0 resection rate (94.1% versus 81.1%, P = 0.042) than the SAP group. Nonsurgical grade 3-4 adverse events were observed in 17 patients (33.3%) in the CA-SAP group and 14 (26.4%) in the SAP group. Survival results were not reported due to immature data. Camrelizumab and apatinib combined with chemotherapy as a neoadjuvant regimen was tolerable and associated with favorable responses for LAGC.

show abstract

“…This approach did meet the requirement for the response mode to translate into strata of significantly different long-term survival rates ( Figure 3 and Figure 4 ), and it complies with the intuitive notion of improved survival following downstaging. These findings are novel, as published data on this approach to response evaluation are scarce [ 31 , 32 , 33 , 44 ]. In a multivariable ordinal regression model, the tumor location and Lauren histological type were significant determinants of the response mode, whereas gender, age, and rTNM stage were not.…”

Section: Discussionmentioning

confidence: 97%

“…To circumvent this problem, a composite method of downstaging is suggested, where the radiological stage at diagnosis (rTNM) is compared to the pathological stage following chemotherapy (ypTNM). Published data on this approach to response evaluation in gastric cancer are scarce [ 31 , 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer

Sandø

Fougner

Røyset

et al. 2023

Cancers

View full text Add to dashboard Cite

Background: The method of response evaluation following neoadjuvant chemotherapy (NAC) in resectable gastric cancer has been widely debated. An essential prerequisite is the ability to stratify patients into subsets of different long-term survival rates based on the response mode. Histopathological measures of regression have their limitations, and interest resides in CT-based methods that can be used in everyday settings. Methods: We conducted a population-based study (2007–2016) on 171 consecutive patients with gastric adenocarcinoma who were receiving NAC. Two methods of response evaluation were investigated: a strict radiological procedure using RECIST (downsizing), and a composite radiological/pathological procedure comparing the initial radiological TNM stage to the pathological ypTNM stage (downstaging). Clinicopathological variables that could predict the response were searched for, and correlations between the response mode and long-term survival rates were assessed. Results: RECIST failed to identify half of the patients progressing to metastatic disease, and it was unable to assign patients to subsets with different long-term survival rates based on the response mode. However, the TNM stage response mode did achieve this objective. Following re-staging, 48% (78/164) were downstaged, 15% (25/164) had an unchanged stage, and 37% (61/164) were upstaged. A total of 9% (15/164) showed a histopathological complete response. The 5-year overall survival rate was 65.3% (95% CI 54.7–75.9%) for TNM downstaged cases, 40.0% (95% CI 20.8–59.2%) for stable disease, and 14.8% (95% CI 6.0–23.6%) for patients with TNM progression, p < 0.001. In a multivariable ordinal regression model, the Lauren classification and tumor site were the only significant determinants of the response mode. Conclusions: Downsizing, as a method for evaluating the response to NAC in gastric cancer, is discouraged. TNM re-staging by comparing the baseline radiological CT stage to the pathological stage following NAC is suggested as a useful method that may be used in everyday situations.

show abstract

Significance of neoadjuvant downstaging in gastric adenocarcinoma

Cited by 8 publications

References 21 publications

Early Gastric Cancers in Central Norway 2001 to 2016—A Population-Based Study

Early Gastric Cancers in Central Norway 2001 to 2016—A Population-Based Study

Neoadjuvant camrelizumab and apatinib combined with chemotherapy versus chemotherapy alone for locally advanced gastric cancer: a multicenter randomized phase 2 trial

Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer

Contact Info

Product

Resources

About