The value of restaging CT following neoadjuvant chemotherapy for resectable gastric cancer. A population-based study

Abstract

Background Response evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC. Methods Retrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment. Results Of 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004–0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode. Conclusions Routine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.

Gastric hydrodistension CT versus CT without gastric distension in preoperative TN staging of gastric carcinoma: analysis of single-center cancer registry

“…There was, however, a trend toward higher stage concordance in the Nondistension group. In a Norwegian study on restaging CT following neoadjuvant chemotherapy, only 24% had stage concordance, 38% overstaged and 38% understaged (kappa = 0.06 [95% CI 0.004–0.12]) 23 . In the Japanese JCOG1302A trial, stage concordance for pT2, pT3, pT4a and pT4b was 40% (94/235), 45% (184/407), 55% (209/380) and 4% (1/25) respectively 24 .…”

Gastric Cancers Missed at Upper Endoscopy in Central Norway 2007 to 2016—A Population-Based Study

“…A retrospective cohort study was performed using a database described in previous publications [ 5 , 14 , 15 ]. The patient cohort consisted of 730 consecutive patients diagnosed with gastric cancer in Central Norway between January 2007 and December 2016.…”

“…Patients with Siewert type I cancer were excluded, whereas patients with type II and III cancers were retained for further analyses. Clinical and histopathological characteristics were recorded as previously described [ 5 , 14 , 15 ]. A dedicated pathologist reviewed histological sections from all patients to ensure a uniform histological classification according to Lauren [ 3 ].…”

Komplette Response nach neoadjuvanter Therapie beim Magenkarzinom: Implikationen für die Chirurgie

“…In einer retrospektiven Studie, die an 164 Patienten durchgeführt wurde, die eine neoadjuvante Chemotherapie mit Epirubicin, Capecitabin und Cisplatin oder Oxaliplatin erhielten [32], hatten nur 24 % der Probanden eine Übereinstimmung im yrTNM (CT)-und ypTNM-Staging, 38 % waren over-und 38 % understaged. Im T-Stadium war die CT in 33 % der Fälle genau, 46 % davon waren over-und 21 % understaged.…”