Impact of Induction Chemotherapy on Nodal and Distal Disease Control in Locally Advanced Buccal Mucosa Cancer

Background: Buccal mucosa squamous cell cancer is the most common cancer in India. Majority of them presenting in advanced stage whose prognosis after surgery depends significantly upon the regional and distal spread. We studied the impact of neoadjuvant chemotherapy (NACT) on nodal and distal control of disease in operated cases of advanced buccal mucosa cancer. Aim: A retrospective study to evaluate the impact of induction chemotherapy (NACT) on nodal and distal failure in locally advanced buccal mucosa cancer. Methods: A total of 224 patients of advanced buccal mucosal cancer who underwent surgery between 2014 and 2015 were evaluated retrospectively with a follow-up of two years. Total 111 of the above had received NACT prior to surgery while 113 patients underwent upfront surgery. The CT scans and histologic reports were then compared for evaluation and analysis. Results: Among patients with T4a disease, 45.85% in upfront surgery group compared with 54% in NACT group showed metastatic pathologic nodes, while in T4b patients, the rates were 83.33% compared with 49.18% respectively. In patients with clinical/radiologic positive neck nodes at presentation, 87.5% in upfront surgery group as compared with 55.55% in NACT group showed metastatic nodes in histopathologic evaluation. 13.27% patients in the upfront surgery group had nodal and/or distal failure in the two years follow-up, whereas only 3.6% patients in the NACT group. 25% patients with peri-nodal extension in upfront surgery group showed nodal and/or distal failure, while only 6% in NACT group. The results in different nodal-ratio strata was evaluated. It showed that NACT has equal failure rate as in upfront group in nodal-ratio > 50, which is considered as very advanced and aggressive tumor. But in patients with nodal-ratio < 50, NACT group showed lesser failure rate than upfront group. Conclusion: We show regressional effect of NACT on nodal metastases. This study also shows NACT to be having a significantly positive impact on nodal and distal control. Hence role of induction chemotherapy needs to be considered in advanced cases of buccal mucosa cancer with nodal metastases.

Combining prognostic value of nodal ratio and neutrophil to lymphocyte ratio in completely resected gastric cancer with D2 lymph node dissection.

e15565 Background: Outcomes in gastric cancer (GC) are still dismal even with complete D2 resection surgery and chemotherapy (CT), therefore identification of prognostic factors is critical to stratify patients at risk of recurrence or death. Nodal ratio (NR) has been recognized as a valuable prognostic factor and neutrophil to lymphocyte ratio (NLR) as systemic inflammation biomarker in some neoplasms. We evaluate overall survival (OS) combining NR and NLR among completely resected GC patients with D2 lymph node dissection in a Peruvian population. Methods: We reviewed retrospectively 791 medical records from GC pts with complete radical D2 resection between 2008 and 2012 at Instituto Nacional de Enfermedades Neoplasicas. We grouped according NR in < 0.2(Low), 0.2-0.5(Intermediate) and > 0.5(High), and NLR with cut-off < 3 and ≥3. We evaluated overall survival combining NR and NLR, also univariate and multivariate cox analysis were performed. OS was based on national registry and cannot evaluate DFS as long most patients return to their primary hospitals to follow-up. Results: Mean age was 60y [rank: 19-89]. Most frequent characteristics were distal localization (52.4%), intestinal subtype (52.6%) and poor differentiated histology (53%). From 791 patients, 156, 194 and 441 were diagnosed at I, II and III CS, respectively. Most patients had nodal involvement (66.8%), 21% and 28.4% received RT and CT, respectively. NLR < 3 was associated to early disease (p < 0.05). In nodal ratio groups, 68.9% had low, 23% intermediate and 8.1% high ratio, no differences were observed with NLR. At 5years median follow up, patients with NLR < 3 and low nodal ratio had better 5-year OS in this nodal group (71% vs 58% on NLR≥3; HR:0.75, 95%CI:0.49-0.94, p = 0.016]), and patients with intermediate and high nodal ratio had worse outcomes (25 and 15% 5year OS, respectively) without differences with NLR. Multivariate analysis showed higher nodal ratio had negative impact on OS. Conclusions: Neutrophil to lymphocyte ratio < 3 was associated to better OS in patients with low nodal ratio ( < 0.2), indeed this approach could be usefull to identify high risks patients with early disease in further studies.

Survival impact of adjuvant regimens for advanced gastric cancer after radical D2 resection in a Peruvian population.

e15576 Background: The benefit of chemoradiotherapy(CRT) or chemotherapy (CT) for gastric cancer with high metastatic lymph node involvement after complete radical D2 resection is still controversial, previous studies had reported better disease free survival (DFS) but no differences in overall survival (OS). Our aim was to compare DFS and OS between CRT and CT. Methods: Retrospectively, 201 medical records were reviewed from patients with advanced gastric cancer (nodes +ve) after complete radical D2 resection between 2008 and 2012 at Instituto Nacional de Enfermedades Neoplasicas (Peru). Patients received CRT (5FU and RT as Macdonald’s protocol) or CT (capecitabine 2g/m2/14days + oxaliplatin 135mg/m2/day1 q21d for 6months). We describe clinical and pathological characteristics, DFS/OS with univariate and multivariate cox analysis were performed. Results: Mean age was 54.4years [19-83] and 17.9% were < 40years. Distal localization (46%), high histological grade (69.7%) and poorly cohesive subtype (38.3%) were most frequent characteristics among patients, 140(69.7%) and 130(64.7%) were T4 and N3, respectively. From 201 patients, 134 underwent to CRT and 67 to CT, with no clinical differences between groups. We observed a significant higher nodal ratio in CT group (0.27 vs 0.35, p = 0.009). 69.5% patients completed treatment with CRT, while only 54.5% in CT (p = 0.04). At 5years median of follow-up, 66 (49.3%) and 26(38.8%) recurrences were documented in CRT and CT groups, respectively. Median DFS were 19 and 23 months in CRT and CT group (HR:1.04, 95%CI:0.7-1.4, p = 0.8), while median OS were 25 and 26 months, respectively (HR:1.07, 95%CI:0.75-1-5, p = 0.6). At multivariate analysis, higher T stage and nodal ratio were associated to worse DFS, and patients who completed treatment were associated to better DFS (HR:0.59, 95%CI:0.4-0.8, p = 0.004). Higher T stage and nodal ratio had significant negative impact on OS. Conclusions: We found a benefit of CT over CRT in gastric cancer with high metastatic lymph nodes, however in our population it was not statistically significant, indeed further larger clinical trials are needed. In this study, higher T stage and nodal ratio were associated to worse prognosis.

Disease control and survival outcomes for rectal adenocarcinoma (RA) managed with neoadjuvant chemoradiotherapy (nCRT): Performance of serum CEA changes as a biomarker.

552 Background: nCRT is commonly employed in advanced or distal RA, with validated associations between tumor response and disease control; however, the identification of patients likely to respond remains elusive. The present investigation seeks to determine whether absolute CEA levels and changes during treatment are associated with pathologic complete response (pCR), freedom from failure (FFF), disease specific survival (DSS), and overall survival (OS). Methods: Retrospective analysis of clinicopathologic and treatment factor association with outcomes. Eligible patients underwent nCRT followed by mesorectal resection; patients with pre-nCRT evidence of metastasis or who did not undergo resection were excluded. CEA levels were recorded at 3 times: pre-nCRT (C1), post-nCRT/pre-op (C2), and post-op (C3; < 45 days of surgery, or < 225 days if post-op C given). Univariate analysis was performed to identify clinicopathologic factor association with pCR, FFF, DSS, and OS. The absolute and relative changes in interval CEA levels were computed and included as factors in the analysis. Results: From 2003-11, 71 patients were eligible. At median follow-up of 57 months (range, 5-124), 20 patients had RA recurrence and 25 had died (19 recurrent). nCRT resulted in pCR for 19 patients (27%), which was associated with DSS (p = 0.04). The estimated 5-year FFF, DSS, and OS for the entire population were 69%, 77%, and 72%, respectively. Clinical and pathologic N-stage, nodal ratio, ypTNM stage, and stage migration post-CRT were significantly associated with FFF, DSS, and OS. The relative change from C1 to C2 was significantly associated with pCR (exp(b); p = 0.031). Absolute C3 was associated with FFF (1.091; 0.001), DSS (1.183; 0.018), and OS (1.092; 0.002); however, absolute and relative changes at C2 and C3 as compared with C1 did not demonstrate associations with disease control or survival endpoints. Conclusions: Within the present study, changes in CEA levels following CRT were associated with pCR. Additionally, initial post-op CEA demonstrated associations with disease control and survival endpoints.