Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer? Journal Article


Authors: Mansour, J. C.; Tang, L.; Shah, M.; Bentrem, D.; Klimstra, D. S.; Gonen, M.; Kelsen, D. P.; Brennan, M. F.; Coit, D. G.
Article Title: Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer?
Abstract: Background: After publication of the MAGIC trial results, preoperative chemotherapy is increasingly used to treat advanced gastric cancer before resection. Tools for measuring response must be assessed. Methods: We identified all patients with gastric cancer treated with neoadjuvant chemotherapy and R0 resection between 1991 and 2005 from a prospective database. Patients receiving preoperative radiation were excluded. Histologic response to treatment was graded from 0% to 100% by a single pathologist. Kaplan-Meier survival analysis was performed to identify the relationship between response and outcome and to identify factors predictive of disease-specific survival (DSS). Multivariate analysis was performed to identify independent predictors. Results: A total of 168 patients underwent R0 resection after receiving neoadjuvant chemotherapy. Thirty-three percent of tumors were at the gastroesophageal junction. Cisplatin-based therapy was used for 68% of patients. Twenty-two percent of patients had a >50% pathologic response to treatment. Median follow-up after resection for all patients was 25 months. Median DSS for all patients was 33 months. Three-year DSS improved from 44% to 69% with at least a 50% histologic response (P = .01). Factors associated with decreased DSS included positive nodes at resection, pT3 tumor or greater, high grade, perineural or vascular invasion, and <50% response. Multivariate analysis identified nodal status and perineural or vascular invasion as independent predictors of survival. Conclusions: Posttreatment nodal status and perineural or vascular invasion at resection, but not graded histologic response, independently predict DSS after neoadjuvant chemotherapy and surgical resection of gastric cancer. © 2007 Society of Surgical Oncology.
Keywords: adult; cancer survival; controlled study; treatment outcome; treatment response; aged; middle aged; cancer surgery; survival rate; major clinical study; cisplatin; doxorubicin; fluorouracil; paclitaxel; adjuvant therapy; disease free survival; chemotherapy, adjuvant; combined modality therapy; neoadjuvant therapy; chemotherapy; methotrexate; follow up; neoplasm staging; cancer grading; prospective study; lymph node excision; prospective studies; adenocarcinoma; antineoplastic combined chemotherapy protocols; combination chemotherapy; pathology; data base; irinotecan; cancer invasion; antiinfective agent; adjuvant chemotherapy; lymph node; remission induction; gastrectomy; predictor variable; stomach cancer; multivariate analysis; neoplasm invasiveness; kaplan meier method; stomach neoplasms; neoadjuvant; lower esophagus sphincter; gastric cancer; graded histologic response; pathologic response
Journal Title: Annals of Surgical Oncology
Volume: 14
Issue: 12
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2007-12-01
Start Page: 3412
End Page: 3418
Language: English
DOI: 10.1245/s10434-007-9574-6
PUBMED: 17909917
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 12" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. David Jason Bentrem
    14 Bentrem
  2. Murray F Brennan
    1059 Brennan
  3. Mithat Gonen
    1030 Gonen
  4. David S Klimstra
    978 Klimstra
  5. Manish Shah
    177 Shah
  6. Laura Hong Tang
    447 Tang
  7. Daniel Coit
    542 Coit
  8. David P Kelsen
    537 Kelsen