Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Achilli, Pietro; Martini, Paolo De; Ceresoli, Marco; Mari, Giulio; Costanzi, Andrea; Maggioni, Dario; Pugliese, Raffaele; Ferrari, Giovanni

doi:10.21037/jgo.2017.08.13

Cited by 50 publications

(44 citation statements)

References 20 publications

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“…For the Mandard TRG, some studies supported that TRG 1-2 should be classified into responders, which was in accordance with our study [7,18,19], while some others believed that TRG 1-3 was better in distinguishing the prognosis [20][21][22]. For the Becker TRG, there were studies supporting the same consequence as ours [1,[23][24][25], while others suggested TRG 1-2 owned a better prognosis than TRG 3 [9,10,26,27]. This discrepancy might partly derive from the differences in subjective evaluations of the pathologists.…”

Section: Discussionsupporting

confidence: 89%

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

et al. 2021

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Tumor regression grade (TRG) has been widely used in gastrointestinal carcinoma to assess pathological responses to neoadjuvant chemotherapy (NCT). There are various standards without a consensus, and it is still unclear which kind of system has better predictive value. This study aims to investigate and compare the predictive ability of the Mandard and Becker TRGs in patients with locally advanced gastric cancer. Materials and Methods A total of 290 patients with locally advanced gastric adenocarcinoma who underwent NCT and curative surgery were studied. Survival analysis for overall survival (OS) and diseasefree survival (DFS) were based on the Kaplan-Meier method and Cox proportional hazards method. Predictive values of TRGs and models were assessed by time-dependent receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), nomogram, and calibration curve. Results In multivariable analysis, the Mandard TRG was associated with OS (hazard ratio [HR], 1.806; p=0.026) and DFS (HR, 1.792; p=0.017). The Becker TRG was also related to OS (HR, 1.880; p=0.014) and DFS (HR, 1.919; p=0.006). The Mandard and Becker TRG AUCs for 5-year survival were 0.72 and 0.71, respectively. The whole models showed an increased predictive value, with AUCs of 0.85 and 0.86, respectively. There was no significant difference between the two TRGs and two models. Conclusion TRG was an independent predictor for survival, and there was no significant difference between these two systems.

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Section: Discussionsupporting

confidence: 89%

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

et al. 2021

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“…This discrepancy suggests that the relationship between microsatellite status and Lauren's classification as well as its prognostic significance need to be further investigated for locally advanced GCs. After NAC, the ORR of the whole cohort was 55.9% (99/177), higher than 37.3% (25/67) reported by Achilli et al (25). However, the NAC regimens were different and these authors included cStage II tumors (51%) whereas we did not.…”

Section: Discussioncontrasting

confidence: 67%

Microsatellite Status Affects Tumor Response and Survival in Patients Undergoing Neoadjuvant Chemotherapy for Clinical Stage III Gastric Cancer

Cai

Rui

et al. 2020

Front. Oncol.

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BackgroundWe assessed the association between microsatellite instability-high (MSI-H) and tumor response to neoadjuvant chemotherapy (NAC) as well as its prognostic relevance in patients with clinical stage III gastric cancer (cStage III GC).Materials and MethodsThe NAC + surgery and the control cohorts consisted of 177 and 513 cStage III GC patients, respectively. The clinical and pathological features were compared between patients with MSI-H [n=57 (8.3%)] and microsatellite stability or microsatellite instability-low (MSS/MSI-L) [n=633 (91.7%)]. Radiological and histological response to NAC were evaluated based on response evaluation criteria in solid tumors (RECIST) and tumor regression grade (TRG) systems, respectively. The log-rank test and Cox analysis were used to determine the survival associated with MSI status as well as tumor regression between the two groups in both NAC + surgery and the control cohorts.ResultsA statistically significant association was found between MSI-H and poor histological response to NAC (p=0.038). Significant survival priority of responders over poor-responders could only be observed in MSS/MSI-L but not in MSI-H tumors. However, patients with MSI-H had statistically significantly better survival compared to patients with MSS/MSI-L in both the NAC + surgery (hazard ratio=0.125, 95% CI, 0.017–0.897, p=0.037 ) and the control cohort (hazard ratio=0.479, 95% CI, 0.268–0.856, p=0.013).ConclusionMSI-H was associated with poorer regression and better survival after NAC for cStage III GC. TRG evaluation had prognostic significance in MSS/MSI-L but not in MSI-H. Further studies are needed to assess the value of NAC for cStage III GC patients with MSI-H phenotype.

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“…There are many tumor regression grading (TRG) systems to categorize the amount of regressive changes after treatment; most of them evaluate the amount of therapy‐induced fibrosis in relation to residual tumor only at the primary lesion . Patients with complete response (pCR) or near complete regression of the tumor show significant survival benefit and reduced risk of recurrence …”

Section: Introductionmentioning

confidence: 99%

“…9 Patients with complete response (pCR) or near complete regression of the tumor show significant survival benefit and reduced risk of recurrence. [10][11][12] Nevertheless, some patients relapse even though they had good response to nCMT. 13,14 Additionally, as TRG systems only evaluate the primary tumor, it is unknown whether the assessment of lymph node (LN) regression would help predict the outcome.…”

Section: Introductionmentioning

confidence: 99%

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

Pereira

Ramos

Dias

et al. 2019

Journal of Surgical Oncology

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Background and Objective Neoadjuvant chemotherapy (nCMT) has been increasingly used in advanced gastric cancer (GC). However, the prognostic impact of tumor response remains unclear. This study aimed to evaluate if tumor response at the primary site and lymph nodes (LN) correlate with survival in GC patients after nCMT. Methods Patients with gastric adenocarcinoma treated with nCMT followed by gastrectomy were evaluated. Residual tumor was graded from 0% to 100%, defining two groups: poor (PR) and major response (MR). LN regression rate (LNRR) was determined based on tumor/fibrosis examination at each LN and a cutoff value established by receiver operating characteristic curve. Results Among 62 cases, 20 (32.2%) had MR and 42 (67.7%) PR. Smaller size, diffuse histology, lower ypT status and less advanced stage were associated with the MR group. Based on cutoff value of 57, 45.6% and 54.4% patients were classified as low‐LNRR and high‐LNRR. High‐LNRR correlated with absence of venous, lymphatic and perineural invasion, and less advanced stage. Survival was equivalent between MR and PR (P = .956). High‐LNRR had better disease‐free survival (DFS) than low‐LNRR (P < .001). In multivariate analysis, only LNRR associated with DFS. Conclusion High‐LNRR associates with DFS in GC treated with nCMT. Response at the primary site does not correlate with survival.

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Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Cited by 50 publications

References 20 publications

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

Evaluation and Comparison of Predictive Value of Tumor Regression Grades according to Mandard and Becker in Locally Advanced Gastric Adenocarcinoma

Microsatellite Status Affects Tumor Response and Survival in Patients Undergoing Neoadjuvant Chemotherapy for Clinical Stage III Gastric Cancer

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

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