Abstract
There is conflicting evidence regarding the efficacy of neoadjuvant/perioperative chemotherapy (NCT) for gastro-esophageal cancer (GEC) on overall survival. This study aimed to analyze the outcomes of multimodal treatments in a large single center cohort. We performed a retrospective analysis of patients treated with NCT, followed by intended curative oncological surgery for locally advanced gastric cancer. Uni- and multivariate regression analysis were performed to identify the predictors of overall survival. From over 3000 patients, 702 eligible patients were analyzed. In the univariate analysis clinical stage, application of preoperative PLF, requirement of surgical extension, UICC-stage, grading, R-status, Lauren histotype, and HPR were the prognostic survival factors. In multivariate analysis PLF regimen, UICC-stages, R-status, Lauren histotype, and histopathologic regression (HPR) were significant predictors of overall survival. Overall HPR-rate was 26.9%. HPR was highest in the cT2cN0 stage (55.9%), and lowest in the cT3/4 cN+ stage (21.6%). FLOT demonstrated the highest HPR (37.5%). Independent predictors for HPR were the clinical stage and grading. Kaplan Meier analyses demonstrated significant survival benefits for the responding patients (p < 0.0001). HPR after NCT was an important prognostic factor to predict overall survival for locally advanced GEC. FLOT should be the preferred regimen in patients undergoing NCT ahead of surgery.
Highlights
Gastric cancer belongs to the most common malignant diseases worldwide, with the highest incidence in Eastern Asia [1]
In the Western hemisphere, gastric malignancy is often diagnosed at an advanced stage and in contrast to Eastern Asia, it is preferably located in the proximal third of the stomach or the gastro-esophageal junction (GEJ) [2]
There is still conflicting evidence, that perioperative chemotherapy might not be effective for all patients, especially those with non-cardia gastric cancer and poorly cohesive type gastro-esophageal cancer [6,7,8]
Summary
Gastric cancer belongs to the most common malignant diseases worldwide, with the highest incidence in Eastern Asia [1]. In the Western hemisphere, gastric malignancy is often diagnosed at an advanced stage and in contrast to Eastern Asia, it is preferably located in the proximal third of the stomach or the gastro-esophageal junction (GEJ) [2]. Multimodal treatment concepts were introduced, after demonstrating outcome benefits in randomized controlled trials [3,4,5]. There is still conflicting evidence, that perioperative chemotherapy might not be effective for all patients, especially those with non-cardia gastric cancer and poorly cohesive type gastro-esophageal cancer [6,7,8]. New chemotherapeutic regimens were introduced into clinical practice in the last few years, the most promising being the Cancers 2020, 12, 2244; doi:10.3390/cancers12082244 www.mdpi.com/journal/cancers
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