Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Abstract Background Although the preoperative immune status is associated with the prognosis in some tumors, less is known about the prognostic significance of immune status change during the treatment of patients with locally advanced gastric cancer (LAGC).Methods The records of 210 patients with LAGC were retrospectively analysed. The pre-, and post-treatment (after gastrectomy and three cycles of chemotherapy) values of lymphocyte-to-monocyte ratio (LMR) and change of LMR (cLMR) were evaluated. A novel immunity change score (ICS) incorporated both preoperative LMR (pLMR) and cLMR was developed and its prognostic value was evaluated.Results cLMR was an independent predictor and patients with cLMR >1 after treatment had a favorable survival compared with the others (51 vs 31 months, P < 0.001). Based on the cLMR and pLMR, the ICS was defined as follows: ICS=1 (pLMR≤4.53 and cLMR≤1); ICS=2 (pLMR≤4.53 and cLMR>1, or pLMR>4.53 and cLMR≤1); and ICS=3 (pLMR>4.53 and cLMR>1). Multivariate analysis revealed that the ICS was a significant independent biomarker ( P < 0.001). The performances of ICS in terms of the time-dependent receiver operating characteristics (t-ROC) curve and concordance index (C-index) analysis were better than those of pLMR and cLMR. Then we established a nomogram incorporated the ICS, CEA, and TNM stage to predict the 3- and 5- year survival. Decision curve analysis and calibration curve demonstrated that the nomogram was clinically useful.Conclusion The dynamic change of immune status is significantly associated with prognosis for LAGC patients. Combining with the cLMR and pLMR could improve the prognostication for LAGC patients.

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Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: Where we Stand; An Italian Single Center Perspective

In Vivo ◽

10.21873/invivo.12646 ◽

2021 ◽

Vol 35 (6) ◽

pp. 3459-3466

Author(s):

ELISABETTA MARINO ◽

LUIGINA GRAZIOSI ◽

ANNIBALE DONINI

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Locally Advanced ◽

Single Center ◽

Locally Advanced Gastric Cancer

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Neoadjuvant Docetaxel, Oxaliplatin, Leucovorin, and 5-Fluorouracil (FLOT) Versus S-1 plus Oxaliplatin (SOX) for Patients with Locally Advanced Gastric Cancer

10.1101/2020.06.21.20136887 ◽

2020 ◽

Author(s):

Birendra Kumar Sah ◽

Benyan Zhang ◽

Huan Zhang ◽

Jian Li ◽

Fei Yuan ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Tumor Regression ◽

Locally Advanced ◽

Pathological Response ◽

Clinicopathological Parameters ◽

Regression Grading ◽

Locally Advanced Gastric Cancer ◽

Significant Difference

AbstractBackgroundDespite growing trends of neoadjuvant chemotherapy for advanced gastric cancer, there is still no consensus of optimal regimens between East and West countries. Neoadjuvant chemotherapy with docetaxel, oxaliplatin, fluorouracil, and Leucovorin (FLOT) regimen has shown promising results in terms of pathological response and survival rate. However, S-1 plus oxaliplatin (SOX) is a more favorable chemotherapy regimen in Eastern countries. We conducted this study to evaluate the safety and efficacy of both regimens, and to explore a suitable regimen for Chinese patients.MethodsPatients with locally advanced gastric cancer(LAGC) were 1:1 randomly assigned to receive either 4 cycles of FLOT or 3 cycles of SOX regimen before curative gastrectomy. The primary endpoint was the comparison of complete or sub-total tumor regression grading (TRG1a+ TRG1b) in the primary tumor.ResultsAltogether 74 cases enrolled between August 2018 and March 2020. All 74 randomly assigned cases were considered as intention-to-treat (ITT) population, and the 55 patients who completed the planned chemotherapy plus surgery were considered as per protocol (PP) population. There was no significant difference in pre-treatment clinicopathological parameters between the FLOT and SOX group(p>0.05). There was no significant difference in adverse effects or postoperative morbidity and mortality between two groups (p>0.05). Similarly, there was no significant difference in the proportion of tumor regression grading between the FLOT and SOX group(p>0.05). In the ITT population, complete or sub-total TRG was 20.0 % in FLOT versus 32.4 % in the SOX group (p>0.05).ConclusionsOur study demonstrates that FLOT and SOX regimens are similarly effective for locally advanced gastric cancer patients in terms of clinical downstaging and pathological response. Both regimens were well-tolerated in this study. A large scale phase 3 randomized controlled trial is necessary to validate this result.

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ROLE OF COMPUTED TOMOGRAPHY WITH PNEUMOGASTROGRAPHY IN DETERMINING THE REGRESSION GRADE OF LOCALLY ADVANCED GASTRIC CANCER AFTER NEOADJUVANT CHEMOTHERAPY

Siberian Journal of Oncology ◽

10.21294/1814-4861-2021-20-5-18-30 ◽

2021 ◽

Vol 20 (5) ◽

pp. 18-30

Author(s):

I. D. Amelina ◽

A. M. Karachun ◽

D. V. Nesterov ◽

L. N. Shevkunov ◽

A. S. Artemieva ◽

...

Keyword(s):

Gastric Cancer ◽

Computed Tomography ◽

Lymph Node ◽

Advanced Gastric Cancer ◽

Tumor Response ◽

Response Rate ◽

Locally Advanced ◽

Imaging Biomarkers ◽

Locally Advanced Gastric Cancer ◽

Regression Grade

Introduction. A multimodal approach to the treatment of locally advanced gastric cancer with the addition of systemic or local treatment methods, such as chemotherapy and radiation therapy, reduces the risk of cancer recurrence, thus improving survival of patients. Advances in anticancer therapy dictate the need to develop systems for assessing tumor response to new treatment modalities.Material and Methods. The study included 162 patients with locally advanced gastric cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. All patients underwent subtotal gastric resection or gastrectomy with lymph node dissection and previously received neoadjuvant polychemotherapy. Patients were in the age range 30 to 80 years old. The tumor pathomorphological response to chemotherapy was assessed in all patients using a pathomorphological response rate system according to the classification of the Japanese Gastric Cancer Association (JGCA, 3rd English edition). All patients underwent computed tomography with pneumogastrography before neoadjuvant chemotherapy and immediately before surgery. For each of 162 patients, 96 qualitative and quantitative biomarkers of tumor and paragastric lymph node imaging were analyzed.Results. The accuracy of determining the tumor response rate using computed tomography with pneumogastrography was 82.6 % for TRG-0/1, 90 % for TRG-1/2, and 88 % for TRG-2/3. Discussion. The tumor pathomorphological response to treatment is a predictor of long-term results; however, it can be assessed only after analyzing the surgical specimen, and this marker cannot be used in inoperable cases and for correction of palliative chemotherapy. The study of imaging biomarkers based on quantitative and qualitative data reflecting the histopathological features of the tumor and lymph nodes can help determine the tumor regression grade and optimize treatment.Conclusion. The proposed algorithm for assessing the response grade of locally advanced gastric cancer to chemotherapy using imaging biomarkers is a promising prognostic marker and requires further study.

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