Results of sımultaneous pancreas resectıon after neoadjuvant chemotherapy in local advenced gastric cancers

120 Background: Following the results of 3 randomized controlled trials, neoadjuvant chemotherapy has become standard of care for locally advanced gastric cancer in Europe. All of these trials included patients with cancers located in the gastric corpus, antrum, and pylorus (distal gastric cancers, DGC) as well as cancers of the esophagogastric junction and fundus (proximal gastric cancers, PGC). However, data suggest that DGC and PGC may be two distinct tumor entities. The aim of our study was to investigate if the capacity of neoadjuvant chemotherapy to downstage gastric cancers is different for DGC and PGC. Methods: We used data from the clinical regional tumor registry of Magdeburg which covers the northern section of the federal district of Saxony-Anhalt, Germany, to compare pretherapeutic (clinical) and postoperative (histopathological) UICC tumor stages in patients with DGC and PGC treated with neoadjuvant chemotherapy followed by surgery. Results: Of 2,460 gastric cancer patients entered into the registry between January 1993 and September 2010, 189 (7.7%) received neoadjuvant chemotherapy. Of these, 149 underwent surgery with curative intent. Pretherapeutic and postoperative UICC stages were not available for 34 of these patients. A further 42 patients had UICC stage IV documented at laparotomy; since this was likely due to peritoneal carcinomatosis which may have gone unnoticed at the start of neoadjuvant chemotherapy and thus does not reliably indicate upstaging, these patients were excluded from analysis. Of the 73 evaluable patients, 33 (45.2%) had DGC and 40 (54.8%) had PGC. UICC tumor stage decreased during therapy in 55.1% and 75.0%, remained unchanged in 16.3% and 20.8%, and increased in 28.6% and 4.2% of DGC and PGC patients, respectively (p=0.039, Fisher’s exact test). Conclusions: Despite the limited statistical power, these preliminary data suggest that DGC and PGC may differ in their response to neoadjuvant chemotherapy. With more widespread use of neoadjuvant chemotherapy in gastric cancer in recent years, we expect a steep increase in evaluable patients in the tumor registry which will allow for future multivariate analyses regarding this issue.

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Investigation of thrombospondin 1 (THBS1) as prognostic and predictive factor of neoadjuvant chemotherapy for advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.49 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 49-49

Author(s):

Noriko Matsumoto

Keyword(s):

Gastric Cancer ◽

Prognostic Factor ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Predictive Factor ◽

Stage Ii ◽

Resected Specimen ◽

Positive Staining ◽

Gastric Cancers ◽

Thrombospondin 1

49 Background: Curative R0 operation is the best treatment for patients with Stage II/III gastric cancer, but still there are recurrent cases. Although chemotherapy is an important treatment, there is no evidence of neoadjuvant chemotherapy (NAC) for both R0 operated advanced gastric cancer and inoperable cases. Thrombospondin 1 (THBS1) plays a role in angiogenesis in many cancers, and we reported that THBS1 could be prognostic factor of Stage IV gastric cancer and predictive factor of S-1+ paclitaxel chemotherapy. The aim of this study is to investigate THBS1 plays as prognostic and predictive factor of neoadjuvant chemotherapy for advanced gastric cancer. Methods: Study 1. Investigation of THBS1 as prognostic factor in R0 cases: 129 patients with R0 operated for stage II/III gastric cancer (II: 56, III: 73) were enrolled in this study. THBS1 expression was investigated by immunostaining with resected specimen. Relationship between THBS1 expression and disease free survival (DFS), and recurrence rate were evaluated. Study 2. Investigation of THBS1 as predictive factor in unresectable cases: Among 111 patients who had unresectable gastric cancer, 55 patients had NAC (NAC (+) group; S-1+PTX i.p.: 23, Docetaxel+CDDP+S-1 (DCS): 17, S-1+CDDP 6, Docetaxel{S-1 (DS): 5, S-1 alone: 4) were compared with NAC (-) group (n=56) by evaluation of relationship between immunohistological expression of THBS1 and overall survival. Results: Study 1: There were 39 (30%) gastric cancers with positive staining for THBS1, 19 patients (49%) recurred cancer and 5-year DFS was 20% in THBS (+) group. Among 90 patients of THBS (-) group, 19 patients (20%) recurred, and DFS was 73%. Study 2: there were 32 (29%) unresectable gastric cancers with THBS1 (+). NAC (+) group showed 30.4% of 2-year OS, whereas 13.1% of NAC (-) group. Among NAC (+) group, 24 (43.6%) patients showed response of NAC, and among responder group, 13 (54%) patients showed THBS1 (+), whereas 10 (28.6%) patients showed THBS (+) in non-responder group. Conclusions: THBS1 expression showed reverse correlation with prognosis and positive correlation with prediction of neoadjuvant chemotherapy for Stage II/III gastric cancer.

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