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Recurrence and survival after pathologic complete response to preoperative therapy followed by surgery for gastric or gastrooesophageal adenocarcinoma.

Fields RC, Strong VE, Gönen M, Goodman KA, Rizk NP, Kelsen DP, Ilson DH, Tang LH, Brennan MF, Coit DG, Shah MA - Br. J. Cancer (2011)

Bottom Line: Recurrence at 5 years was significantly lower for pCR vs non-pCR patients (27% and 51%, respectively, P=0.01).Although the overall pattern of local/regional (LR) vs distant recurrence was comparable (43% LR vs 57% distant) between pCR and non-pCR groups, there was a significantly higher incidence of central nervous system (CNS) first recurrences in pCR patients (36 vs 4%, P=0.01).One third of the recurrences in the pCR group were symptomatic CNS recurrences.

View Article: PubMed Central - PubMed

Affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

ABSTRACT

Background: To characterise recurrence patterns and survival following pathologic complete response (pCR) in patients who received preoperative therapy for localised gastric or gastrooesophageal junction (GEJ) adenocarcinoma.

Methods: A retrospective review of a prospective database identified patients with pCR after preoperative chemotherapy for gastric or preoperative chemoradiation for GEJ (Siewert II/III) adenocarcinoma. Recurrence patterns, overall survival, recurrence-free survival, and disease-specific survival were analysed.

Results: From 1985 to 2009, 714 patients received preoperative therapy for localised gastric/GEJ adenocarcinoma, and 609 (85%) underwent a subsequent R0 resection. There were 60 patients (8.4%) with a pCR. Median follow-up was 46 months. Recurrence at 5 years was significantly lower for pCR vs non-pCR patients (27% and 51%, respectively, P=0.01). The probability of recurrence for patients with pCR was similar to non-pCR patients with pathologic stage I or II disease. Although the overall pattern of local/regional (LR) vs distant recurrence was comparable (43% LR vs 57% distant) between pCR and non-pCR groups, there was a significantly higher incidence of central nervous system (CNS) first recurrences in pCR patients (36 vs 4%, P=0.01).

Conclusion: Patients with gastric or GEJ adenocarcinoma who achieve a pCR following preoperative therapy still have a significant risk of recurrence and cancer-specific death following resection. One third of the recurrences in the pCR group were symptomatic CNS recurrences. Increased awareness of the risk of CNS metastases and selective brain imaging in patients who achieve a pCR following preoperative therapy for gastric/GEJ adenocarcinoma is warranted.

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Patient study group CONSORT diagram.
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fig1: Patient study group CONSORT diagram.

Mentions: From 1985 to 2009, 2676 patients underwent surgical treatment for gastric or GEJ (Siewert II/III) adenocarcinoma at MKSCC. In all, 714 of these patients (27%) received preoperative chemotherapy±RT. One hundred and five patients (15%) had either positive surgical margins after resection (64 patients, 9%) or presence of metastatic disease at surgical exploration/resection (41 patients, 6%) and were excluded from subsequent analysis. The final study population was 609 patients with gastric/GEJ adenocarcinoma treated with preoperative therapy (280 (46%) chemoradiotherapy, 329 (54%) chemotherapy alone) followed by complete (R0) resection. Sixty patients (8.4% of all preoperative treatment patients; 10% of preoperative treatment patients who underwent R0 resection) demonstrated no residual tumour on final pathology and are defined as the pCR group, and the remainder (n=549, 90% of all preoperative treatment patients who underwent R0 resection) had residual evidence of malignancy and are defined as the non-pCR group (Figure 1).


Recurrence and survival after pathologic complete response to preoperative therapy followed by surgery for gastric or gastrooesophageal adenocarcinoma.

Fields RC, Strong VE, Gönen M, Goodman KA, Rizk NP, Kelsen DP, Ilson DH, Tang LH, Brennan MF, Coit DG, Shah MA - Br. J. Cancer (2011)

Patient study group CONSORT diagram.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3111205&req=5

fig1: Patient study group CONSORT diagram.
Mentions: From 1985 to 2009, 2676 patients underwent surgical treatment for gastric or GEJ (Siewert II/III) adenocarcinoma at MKSCC. In all, 714 of these patients (27%) received preoperative chemotherapy±RT. One hundred and five patients (15%) had either positive surgical margins after resection (64 patients, 9%) or presence of metastatic disease at surgical exploration/resection (41 patients, 6%) and were excluded from subsequent analysis. The final study population was 609 patients with gastric/GEJ adenocarcinoma treated with preoperative therapy (280 (46%) chemoradiotherapy, 329 (54%) chemotherapy alone) followed by complete (R0) resection. Sixty patients (8.4% of all preoperative treatment patients; 10% of preoperative treatment patients who underwent R0 resection) demonstrated no residual tumour on final pathology and are defined as the pCR group, and the remainder (n=549, 90% of all preoperative treatment patients who underwent R0 resection) had residual evidence of malignancy and are defined as the non-pCR group (Figure 1).

Bottom Line: Recurrence at 5 years was significantly lower for pCR vs non-pCR patients (27% and 51%, respectively, P=0.01).Although the overall pattern of local/regional (LR) vs distant recurrence was comparable (43% LR vs 57% distant) between pCR and non-pCR groups, there was a significantly higher incidence of central nervous system (CNS) first recurrences in pCR patients (36 vs 4%, P=0.01).One third of the recurrences in the pCR group were symptomatic CNS recurrences.

View Article: PubMed Central - PubMed

Affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

ABSTRACT

Background: To characterise recurrence patterns and survival following pathologic complete response (pCR) in patients who received preoperative therapy for localised gastric or gastrooesophageal junction (GEJ) adenocarcinoma.

Methods: A retrospective review of a prospective database identified patients with pCR after preoperative chemotherapy for gastric or preoperative chemoradiation for GEJ (Siewert II/III) adenocarcinoma. Recurrence patterns, overall survival, recurrence-free survival, and disease-specific survival were analysed.

Results: From 1985 to 2009, 714 patients received preoperative therapy for localised gastric/GEJ adenocarcinoma, and 609 (85%) underwent a subsequent R0 resection. There were 60 patients (8.4%) with a pCR. Median follow-up was 46 months. Recurrence at 5 years was significantly lower for pCR vs non-pCR patients (27% and 51%, respectively, P=0.01). The probability of recurrence for patients with pCR was similar to non-pCR patients with pathologic stage I or II disease. Although the overall pattern of local/regional (LR) vs distant recurrence was comparable (43% LR vs 57% distant) between pCR and non-pCR groups, there was a significantly higher incidence of central nervous system (CNS) first recurrences in pCR patients (36 vs 4%, P=0.01).

Conclusion: Patients with gastric or GEJ adenocarcinoma who achieve a pCR following preoperative therapy still have a significant risk of recurrence and cancer-specific death following resection. One third of the recurrences in the pCR group were symptomatic CNS recurrences. Increased awareness of the risk of CNS metastases and selective brain imaging in patients who achieve a pCR following preoperative therapy for gastric/GEJ adenocarcinoma is warranted.

Show MeSH
Related in: MedlinePlus