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. 2017 Dec;8(6):1018-1025.
doi: 10.21037/jgo.2017.08.13.

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Pietro Achilli  1 , Paolo De Martini  2 , Marco Ceresoli  3 , Giulio M Mari  4 , Andrea Costanzi  4 , Dario Maggioni  4 , Raffaele Pugliese  2 , Giovanni Ferrari  2
Affiliations

Tumor response evaluation after neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma: a prospective, multi-center cohort study

Pietro Achilli et al. J Gastrointest Oncol. 2017 Dec.

Abstract

Background: To verify the prognostic value of the pathologic and radiological tumor response after neoadjuvant chemotherapy in the treatment of locally advanced gastric adenocarcinoma.

Methods: A total of 67 patients with locally advanced gastric cancer (clinical ≥ T2 or nodal disease and without evidence of distant metastases) underwent perioperative chemotherapy (ECF or ECX regimen) from December 2009 through June 2015 in two surgical units. Histopathological and radiological response to chemotherapy were evaluated by using tumor regression grade (TRG) (Becker's criteria) and volume change assessed by CT.

Results: Fifty-one (86%) patients completed all chemotherapy scheduled cycles successfully and surgery was curative (R0) in 64 (97%) subjects. The histopathological analysis showed 19 (29%) specimens with TRG1 (less than 10% of vital tumor left) and 25 (37%) patients had partial or complete response (CR) assessed by CT scan. Median disease free survival (DFS) and overall survival (OS) were 25.70 months (range, 14.52-36.80 months) and 36.60 months (range, 24.3-52.9 months), respectively. The median follow up was 27 months (range, 5.00-68.00 months). Radiological response and TRG were found to be a prognostic factor for OS and DFS, while tumor histology was not significantly related to survival.

Conclusions: Both radiological response and TRG have been shown as promising survival markers in patients treated with perioperative chemotherapy for locally advanced gastric cancer. Other predictive markers of response to chemotherapy are strongly required.

Keywords: Gastric cancer; pathologic response; perioperative chemotherapy; prognostic factors; tumor regression grade (TRG).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Disease free survival according to radiological response. DFS, disease free survival; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.
Figure 2
Figure 2
Overall survival according to Radiological response. OS, overall survival; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.
Figure 3
Figure 3
Disease free survival according to TRG. DFS, disease free survival; TRG, tumor regression grade.
Figure 4
Figure 4
Overall survival according to TRG. OS, overall survival; TRG, tumor regression grade.
See this image and copyright information in PMC

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