Role of histological regression grade after two neoadjuvant approaches with or without radiotherapy in locally advanced gastric cancer
Martin-Romano P (1), Sola JJ 2, Diaz-Gonzalez JA (1), Chopitea A (1), Iragorri Y (1), Martínez-Regueira F (3), Ponz-Sarvise M (1), Arbea L (1), Subtil JC (4), Cano D (5), Ceniceros L (1), Legaspi J (1), Hernandez JL (3), Rodríguez J (1).
(1) Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
(2) Department of Pathology, Hospital San Pedro, Logroño 26006, Spain.
(3) Department of Surgical Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
(4) Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
(5) Department of Radiology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
The degree of histopathological response after neoadjuvant therapy in locally advanced gastric cancer (GC) is a key determinant of patients' long-term outcome. We aimed to assess the pattern of histopathological regression after two neoadjuvant approaches and its impact on survival times.
Regression grade of the primary tumour (Becker criteria) and the degree of nodal response by a 4-point scale (grades A-D) were assessed. Grade A-true negative lymph nodes (LNs); grade B and C-infiltrated LNs with any or little evidence of nodal response; and grade D-complete pathological response in a previously infiltrated LN. A favourable pathological response was defined as Becker Ia-b and grade D.
From 2004 to 2014, 80 patients with GC (cT3-4/N+ by CT-scan/EUS) were treated with either preoperative chemotherapy (ChT, n=34) or chemoradiation (CRT, n=46). Patients in the CRT group had a higher likelihood of achieving a Becker Ia-b response (58 vs 32%, P=0.001), a grade D nodal regression (30 vs 6%, P=0.009) and a favourable pathological response (23 vs 3%; P=0.019).
Patients with a grade D nodal response had a longer 5-year PFS and OS compared with those with a grade B or C response. Patients with a baseline negative LN status had similar outcomes irrespective of the preoperative therapy received (5-year OS; ChT vs CRT, 58 vs 51%, P=0.92).
Preoperative chemoradiation increases the likelihood of achieving favourable histopathological features that correlate with a 5-year OS>70% in GC patients.
CITATION Br J Cancer. 2016 Aug 18. doi: 10.1038/bjc.2016.252