Posttherapy Nodal Status, Not Graded Histologic Response, Predicts Survival after Neoadjuvant Chemotherapy for Advanced Gastric Cancer

Abstract

Neoadjuvant chemotherapy (NAC) has been attempted as a means of improving survival of potentially resectable advanced gastric cancer (AGC). In the course of exploring the most promising NAC regimen, a superior surrogate marker reflecting overall survival (OS) is necessary. We investigated prognostic factors in AGC patients who underwent NAC followed by gastric resection and evaluated whether histologic response to NAC was predictive of survival. Seventy consecutive patients with gastric cancer treated with NAC followed by surgical resection between Jan 1, 2000, and Dec 31, 2009, at Osaka National Hospital were identified from a prospective database. Prognostic factors for OS were investigated by univariate and multivariate analyses. Median survival time for all patients was 668 days after surgical resection. Age less than 65 years (hazard ratio 0.463, 95% confidence interval 0.244-0.879) and pathologic nodal stage of N0-1 (hazard ratio 0.318, 95% confidence interval 0.160-0.635) were identified as significant independent prognostic factors for longer OS, whereas graded histologic response of primary tumor to NAC was statistically significant on univariate analysis, but not on multivariate analysis, as a prognostic factor. Posttherapy nodal status, not graded histologic response, predicts survival after NAC for AGC and could serve as a reliable surrogate marker for OS in the course of exploring the most promising regimen for NAC.