scholarly journals Predictive value of NLR, TILs (CD4+/CD8+) and PD-L1 expression for prognosis and response to preoperative chemotherapy in gastric cancer

2021 ◽  
Author(s):  
Ina Valeria Zurlo ◽  
Mattia Schino ◽  
Antonia Strippoli ◽  
Maria Alessandra Calegari ◽  
Alessandra Cocomazzi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Perioperative Chemotherapy ◽  
Locally Advanced Gastric Cancer ◽  
Response To Chemotherapy ◽  
First Choice ◽  
Complete Surgical Resection ◽  
Pre Treatment

AbstractThe combination of perioperative chemotherapy plus complete surgical resection is currently accounted as the first-choice strategy in patients with locally advanced Gastric Cancer (LAGC). Nevertheless, the partial response rate makes it necessary to search biological parameters useful to select patients who would benefit most from neoadjuvant chemotherapy (NAD-CT). We performed a retrospective analysis on a cohort of 65 LAGC cases, EBV negative and without MMR defect, submitted to perioperative chemotherapy plus surgical resection. We evaluated the neutrophil-lymphocytes ratio (NLR) in peripheral blood, the TILs density (reported as CD4/CD8 tissue ratio) and PD-L1 expression by immunohistochemistry on bioptic tissues before the treatment. Results were correlated with the biological features, histological response (TRG) and clinical outcome (PFS and OS). We found that NLR, TILs and PD-L1 expression showed a significant correlation with TNM stage, lymphovascular invasion and response to NAD-CT (TRG). Correlating the NLR, TILs and PD-L1 expression with PFS and OS, we found that patients with lower NLR levels (< 2.5 ratio), lower TILs (< 0.2 ratio) and higher PD-L1 level (CPS ≥ 1) had a significantly better PFS and OS than those with higher NLR, higher TILs and lower PD-L1 expression (p < 0.0001). Multivariate and multiple regression analyses confirmed the predictive and prognostic role of all three parameters, especially when all three parameters are combined. Our study demonstrated that pre-treatment NLR, TILs and PD-L1 expression are predictive and prognostic parameters in NAD-CT-treated LAGC suggesting a pivotal role of the systemic and tumor microenvironment immunological profile in the response to chemotherapy.

scholarly journals PERIOPERATIVE CHEMOTHERAPY IN LOCALLY ADVANCED GASTRIC CANCER

2013 ◽  
Vol 50 (3) ◽  
pp. 236-242 ◽  
Author(s):  
Thales Paulo BATISTA ◽  
Candice Amorim de Araujo Lima SANTOS ◽  
Gustavo Fernandes Godoy ALMEIDA
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Standard Treatment ◽  
Treatment Options ◽  
Locally Advanced ◽  
Special Focus ◽  
Perioperative Chemotherapy ◽  
Locally Advanced Gastric Cancer ◽  
Advanced Stages

Gastric cancer is one of the most common cancers and a main cause of cancer-related death worldwide, since the majority of patients suffering of this malignancy are usually faced with a poor prognosis due to diagnosis at later stages. In order to improve treatment outcomes, the association of surgery with chemo and/or radiotherapy (multimodal therapy) has become the standard treatment for locally advanced stages. However, despite several treatment options currently available for management of these tumors, perioperative chemotherapy has been mainly accepted for the comprehensive therapeutic strategy including an appropriated D2-gastrectomy. This manuscript presents a (nonsystematic) critical review about the use of perioperative chemotherapy, with a special focus on the drugs delivery.

scholarly journals Correction to: Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives

Surgery Today ◽  
2020 ◽  
Vol 50 (4) ◽  
pp. 424-424
Author(s):  
Masanori Tokunaga ◽  
Yuya Sato ◽  
Masatoshi Nakagawa ◽  
Tomoki Aburatani ◽  
Takatoshi Matsuyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Open Access ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Perioperative Chemotherapy ◽  
Future Perspectives ◽  
Locally Advanced Gastric Cancer

The article Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives, written by Masanori Tokunaga, Yuya Sato, Masatoshi Nakagawa, Tomoki Aburatani, Takatoshi Matsuyama, Yasuaki Nakajima and Yusuke Kinugasa was originally published Online First without Open Access.

Population-based analysis of multimodality treatment of gastric cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 124-124
Author(s):  
P. Cen ◽  
Y. Xing ◽  
C. J. Wray ◽  
M. B. Fallon ◽  
V. I. Machicao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Locally Advanced ◽  
Community Setting ◽  
Multimodality Treatment ◽  
Population Based ◽  
Entire Group ◽  
Perioperative Chemotherapy ◽  
Trimodality Therapy

124 Background: Limited data is available for the role of multimodality management for gastric adenocarcinoma and its outcome in the community. Methods: We retrospectively reviewed the outcomes for 341 patients (pts) who were diagnosed with gastric cancer in a community-based health-care system, including 9 hospitals, from 2000 to 2009. Results: 148/341 pts had undergone surgery and were included in the analysis. Median age at diagnosis was 68 year (range: 32-96), 56% were male, 55% were Caucasian and 25% were black. The stage distribution was as follows: 27% (40 pts) localized, 61% (90 pts) locally advanced and 12% (18 pts) with distant metastasis. 98 pts (66%) received surgery alone, 22 pts (15%) received perioperative chemotherapy, and 28 pts (19%) received perioperative chemo-radiation. After a median follow-up time of 5.2 yrs, the median OS for the entire group was 1.9 years, and 88 deaths had occurred at the last follow up. By stage, the median OS was 7 yrs, 2.3 yrs, and 0.3 yrs for localized stage, regional stage, and metastatic disease, respectively. The 5-yr survival was significantly better in pts who received perioperative chemo-radiation (68%), compared to those who received with surgery alone (33%) or perioperative chemotherapy (0%) (p=0.002). The 5-yr survivals by stage and treatment are shown in the table. Conclusions: Perioperative chemo-radiation was associated with a significantly better OS compared to surgery alone. Trimodality therapy for gastric cancer appears to be underutilized in the community setting described here. The survival advantage of surgery plus chemoradiation compared to surgery plus chemotherapy remains controversial and should be investigated in clinical trials. [Table: see text] No significant financial relationships to disclose.

scholarly journals Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

2021 ◽  
Vol 11 ◽  
Author(s):  
Zining Liu ◽  
Yinkui Wang ◽  
Fei Shan ◽  
Xiangji Ying ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
R0 Resection ◽  
Perioperative Chemotherapy ◽  
Tree Model ◽  
Less Is More ◽  
Locally Advanced Gastric Cancer ◽  
Significant Difference

BackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in the adjuvant chemotherapy (AC) phase for ypN0 patients.MethodsWe included LAGC patients who achieved ypN0 after NAC in our institution from 2005 to 2018. The risk/benefit of AC and other covariates were majorly measured by overall survival (OS) and progression-free survival (PFS). We developed a survival-tree-based model to determine the optimal PEC duration for ypN0 patients in different classes.ResultsA total of 267 R0 resection patients were included. There were 55 patients who did not receive AC. The 5-year OS was 74.34% in the non-AC group and 83.64% in the AC group with a significant difference (p = 0.012). Multivariate Cox regression revealed that both AC (AC vs. non-AC: HR, 0.49; 95%CI, 0.27–0.88; p = 0.018) and ypT stages (ypT3-4 vs. ypT0-2: HR, 2.00; 95%CI, 1.11–3.59; p = 0.021) were significant protective/risk factors on patients OS and PFS. A decision tree model for OS indicated an optimal four to six cycles of PEC, which was recommended for ypT0-2N0 patients, while a minimum of five PEC cycles was recommended for ypT3-4N0 patients.ConclusionAC treatment is still necessary for ypN0. The duration reduction could be applied for the ypT0-2N0 stage patients but may not be suitable for higher ypT stages and beyond. A multicenter-based study is required.

scholarly journals Perioperative chemotherapy for gastric cancer: the current state

2018 ◽  
Vol 20 (2) ◽  
pp. 56-60
Author(s):  
V K Lyadov ◽  
O A Pardabekova ◽  
M A Lyadova
Keyword(s):  
Gastric Cancer ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
High Rate ◽  
Phase Iii ◽  
Perioperative Chemotherapy ◽  
Phase Iii Trial ◽  
Locally Advanced Gastric Cancer ◽  
Current State ◽  
Resectable Gastric Cancer

Gastric cancer has one of the leading positions in the world in the prevalence and mortality among malignant tumors. The results of surgical treatment of locally advanced gastric cancer remain generally poor due to the high rate of relapse after surgery. Currently, perioperative (pre- and postoperative) chemotherapy in combination with surgery is recommended for patients with stage ≥IB resectable gastric cancer. We analyzed the studies devoted to the problem of choosing the optimal regimen of perioperative chemotherapy in locally advanced and oligometastatic gastric cancer. The highest efficacy was observed in the taxan-containing regimen FLOT which allowed to increase the median overall survival up to 50 months in a randomized controlled phase III trial. The use of perioperative chemotherapy with anti-Her2 therapy, immunotherapy or any other biologic drug remains investigational.

Clinical significance of peritoneal molecular markers in patients with locally advanced gastric cancer (LAGC) without macroscopic peritoneal implants treated with perioperative chemotherapy (ChT).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15583-e15583
Author(s):  
Luis Paul Del Carpio Huerta ◽  
Mariona Calvo ◽  
Olbia Serra ◽  
Mar Varela ◽  
Gloria Hormigo ◽  
...  
Keyword(s):  
Molecular Markers ◽  
Locally Advanced ◽  
High Volume ◽  
Gastric Surgery ◽  
Gastric Body ◽  
Perioperative Chemotherapy ◽  
Curative Gastrectomy ◽  
Locally Advanced Gastric Cancer ◽  
Peritoneal Implants ◽  
Pre Treatment

e15583 Background: Presence of malignant cells in the peritoneal lavage (Cyt+) of patients with LAGC in absence of macroscopic peritoneal implants reflects bad prognosis and is a surrogate of metastatic disease. The presence of molecular markers (Mol+), such as CEA and CK20 mRNA, had also been suggested to carry the same bad prognosis as Cyt+ after upfront curative gastrectomy. There is no recommendation about the management of Mol+ patients (pts) within the current perioperative ChT. Methods: We retrospectively analyzed all pts treated in our high volume multidisciplinary team between 2011 – 2015, with LAGC amenable to surgical resection, without macroscopic peritoneal implants in laparoscopy staging and treated with perioperative ChT. Pre-treatment peritoneal Cyt and Mol analysis (CEA and CK20 mRNA detected by RT-PCR), as well other clinical factors were analyzed. Results: From a total a 310 pts, 60 were included. Median follow up was 72.9 months (m). Mean age was 60y, 37% had PS0, 37% had diffuse histology, 85% wereT4(a-b), 93% N+ stage and 50% were located in gastric body. Accordig Cyt and Mol markers: 3% were Cyt+ and 18% were Mol+, 63% were Cyt-/Mol-, 15% Cyt-/Mol+, 3% Cyt+/Mol+, 0% Cyt+/Mol-, and 18% were Cyt or Mol unknown (uk). 83% underwent gastric surgery, of them, 93% achieved R0. Median PFS (mPFS) was 61.9m. mPFS for Mol+ was 11.0m (95%CI 2.6-19.4) vs the rest (Mol-/uk and Cyt +/-/uk) 69.9m (95%CI 45.0-94.8), p < 0.001. HR = 3.8. mOS was 68.3m. mOS for Mol+ vs the rest was 20.7m (95%CI 4.5-36.8) and not reached, respectively, p = 0.002. HR = 3.4. Mol+ pts who underwent surgery had longer mOS than Mol+ pts which did not (not-reached vs 7.8m (95CI% 3.4-12.9), p = 0.03). In the multivariate adjusted analysis PS (0 vs 1-2) and Mol (- vs +) were significant both for mPFS and mOS. Mol+: HR = 4.0 (95%CI 2.0-11.0),p < 0.001 for mPFS and HR = 5.4 (95%CI 1.9-14.9),p = 0.001 for mOS. Conclusions: Molecular peritoneal analysis may identify a subset of LAGC patients with bad prognosis despite negative cytology and absence of peritoneal macroscopic implants (Cyt-Mol+). Gastric surgery and perioperative chemotherapy may improve prognosis in some Mol+ patients

scholarly journals Role of histological regression grade after two neoadjuvant approaches with or without radiotherapy in locally advanced gastric cancer

2016 ◽  
Vol 115 (6) ◽  
pp. 655-663 ◽  
Author(s):  
Patricia Martin-Romano ◽  
Jose J Sola ◽  
Juan A Diaz-Gonzalez ◽  
Ana Chopitea ◽  
Yohana Iragorri ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Locally Advanced Gastric Cancer ◽  
Regression Grade ◽  
Histological Regression
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