Comparison of perioperative and histopathologic outcomes among neoadjuvant treatment strategies for locoregional gastric cancer
© 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC..
BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NAC) and chemoradiation (NCRT) have demonstrated improved survival for gastric cancer. However, the optimal neoadjuvant treatment remains unclear. We sought to evaluate perioperative and histopathologic outcomes among neoadjuvant treatments for locoregional gastric cancer.
METHODS: The National Cancer Database queried patients who received NAC or NCRT followed by resection for T2-T4 and/or node-positive gastric cancer (2006-2018). Logistic and Poisson regression assessed perioperative (30-day readmission, 30- and 90-day mortality, length of stay [LOS]) and histopathologic outcomes (pathologic complete response [PCR], margin status, and negative pathologic lymph nodes [ypN0]). Kaplan-Meier methods and Cox regression assessed overall survival (OS).
RESULTS: Of 9831 patients, 4221 (42.9%) received NAC and 5610 (57.1%) NCRT. There were no differences in perioperative outcomes, apart from patients treated with NCRT exhibiting increased LOS (incidence rate ratio 1.09, 95% confidence interval [CI] 1.03-1.16). Patients who received NCRT were more likely to achieve PCR, margin-negative resection, and ypN0 (all p < 0.05). Median OS was 36.8 months for NAC and 33.6 months for NCRT (p < 0.001). NCRT independently predicted worse OS (vs. NAC, hazard ratio 1.10, 95% CI 1.03-1.18).
CONCLUSION: NCRT was associated with better histologic tumor response although NAC was associated with improved OS. Better understanding prognostication through histologic assessment following neoadjuvant therapy is needed.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:129 |
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| Enthalten in: |
Journal of surgical oncology - 129(2024), 3 vom: 01. Feb., Seite 481-488 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Janczewski, Lauren M [VerfasserIn] |
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| Links: |
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| Themen: |
Chemoradiation |
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| Anmerkungen: |
Date Completed 07.02.2024 Date Revised 17.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/jso.27521 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364779403 |
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| 500 | |a Date Revised 17.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NAC) and chemoradiation (NCRT) have demonstrated improved survival for gastric cancer. However, the optimal neoadjuvant treatment remains unclear. We sought to evaluate perioperative and histopathologic outcomes among neoadjuvant treatments for locoregional gastric cancer | ||
| 520 | |a METHODS: The National Cancer Database queried patients who received NAC or NCRT followed by resection for T2-T4 and/or node-positive gastric cancer (2006-2018). Logistic and Poisson regression assessed perioperative (30-day readmission, 30- and 90-day mortality, length of stay [LOS]) and histopathologic outcomes (pathologic complete response [PCR], margin status, and negative pathologic lymph nodes [ypN0]). Kaplan-Meier methods and Cox regression assessed overall survival (OS) | ||
| 520 | |a RESULTS: Of 9831 patients, 4221 (42.9%) received NAC and 5610 (57.1%) NCRT. There were no differences in perioperative outcomes, apart from patients treated with NCRT exhibiting increased LOS (incidence rate ratio 1.09, 95% confidence interval [CI] 1.03-1.16). Patients who received NCRT were more likely to achieve PCR, margin-negative resection, and ypN0 (all p < 0.05). Median OS was 36.8 months for NAC and 33.6 months for NCRT (p < 0.001). NCRT independently predicted worse OS (vs. NAC, hazard ratio 1.10, 95% CI 1.03-1.18) | ||
| 520 | |a CONCLUSION: NCRT was associated with better histologic tumor response although NAC was associated with improved OS. Better understanding prognostication through histologic assessment following neoadjuvant therapy is needed | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a chemoradiation | |
| 650 | 4 | |a chemotherapy | |
| 650 | 4 | |a locoregional gastric cancer | |
| 650 | 4 | |a neoadjuvant treatment | |
| 650 | 4 | |a perioperative outcomes | |
| 650 | 4 | |a response to treatment | |
| 700 | 1 | |a Logan, Charles D |e verfasserin |4 aut | |
| 700 | 1 | |a Vitello, Dominic J |e verfasserin |4 aut | |
| 700 | 1 | |a Buchheit, Joanna T |e verfasserin |4 aut | |
| 700 | 1 | |a Abad, John D |e verfasserin |4 aut | |
| 700 | 1 | |a Bentrem, David J |e verfasserin |4 aut | |
| 700 | 1 | |a Chawla, Akhil |e verfasserin |4 aut | |
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