Abstract
BackgroundAlthough pathological evaluation has been considered an effective evaluation method, some problems still exist in practice. Therefore, we explored whether there are more reasonable and practical pathological evaluation criteria for neoadjuvant chemotherapy in patients with advanced gastric cancer. Here, we aim to determine pathological judgment criteria for neoadjuvant chemotherapy in patients with advanced gastric cancer.MethodsEighty-seven patients with cT2–4 or cN+ were enrolled in this study. Pathological factors for overall survival (OS) were investigated using univariate and multivariate analyses, and the pathological criteria for neoadjuvant chemotherapy were then determined.ResultsA total of 87 patients underwent 3–4 cycles of neoadjuvant chemotherapy, with 67 (77.0%), 15 (17.2%), and 5 (5.8%) receiving Folfox6, Xelox, and SOX regimens, respectively. All patients showed different levels of graded histological regression (GHR) of the primary tumor, with a ≥ 50% regression rate of 50.6%. The univariate analysis showed that GHR ≥ 50% (p = 0.022), 66.7% (p = 0.013), and 90% (p = 0.028) were significantly correlated with OS. The multivariate analysis demonstrated that ypTNM (II/III) stage was significantly associated with OS compared with ypTNM (0+I) stage [HR = 3.553, 95% CI 1.886–6.617; HR = 3.576, 95% CI 1.908–6.703, respectively] and that the Lauren classification of diffuse type was also an independent risk factor for OS compared with the intestinal type (HR = 3.843, 95% CI 1.443–10.237).ConclusionsThe Lauren classification and ypTNM stage after neoadjuvant chemotherapy are independent prognostic factors in advanced gastric cancer. A GHR ≥ 50%/< 50% can be used as the primary criterion for advanced gastric cancer after neoadjuvant chemotherapy to determine postoperative adjuvant chemotherapy regimens.
Highlights
Pathological evaluation has been considered an effective evaluation method, some problems still exist in practice
Whether the patients who have benefited from neoadjuvant chemotherapy can be identified only by these “rigorous” pathological criteria or if more reasonable criteria can be established for easier screening and implementation of clinical decisions remains unknown; this question warrants further research
Study population We included patients with advanced Gastric cancer (GC) whose disease was confirmed by gastroscopic biopsy and who were treated with neoadjuvant chemotherapy from April 2007 to December 2015 at Peking Union Medical College Hospital
Summary
Pathological evaluation has been considered an effective evaluation method, some problems still exist in practice. We explored whether there are more reasonable and practical pathological evaluation criteria for neoadjuvant chemotherapy in patients with advanced gastric cancer. The common accepted standard for evaluation of therapeutic efficacy is pathological examination of tumor specimens from surgical resection following neoadjuvant chemotherapy to determine graded histological regression (GHR). As the most commonly used criteria, pathological efficacy evaluation (GHR ≥ 2/3 is effective) was proposed by Japan’s Gastric Cancer Research Association (JCGC) in 1999, and histopathological regression classification of primary tumor beds (GHR ≥ 90% is effective) was proposed by Becker et al in 2003 [15, 16]. The effective rate of GHR ≥ 2/3 reported by Kurokawa et al was 34% [18] Based on these standards, most patients with advanced GC who undergo neoadjuvant chemotherapy are faced with a replacement chemotherapy regimen after surgery, which is a burden to clinical practice. Whether the patients who have benefited from neoadjuvant chemotherapy can be identified only by these “rigorous” pathological criteria or if more reasonable criteria can be established for easier screening and implementation of clinical decisions remains unknown; this question warrants further research
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