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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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Kaplan–Meier estimates of overall (A), disease-specific (B), and recurrence-free (C) survival stratified by pathologic complete response (pCR) vs non-pathologic complete response (non-pCR). Statistical comparisons between pCR and non-pCR groups were determined using the log-rank test.
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fig2: Kaplan–Meier estimates of overall (A), disease-specific (B), and recurrence-free (C) survival stratified by pathologic complete response (pCR) vs non-pathologic complete response (non-pCR). Statistical comparisons between pCR and non-pCR groups were determined using the log-rank test.

Mentions: Median follow-up for all surviving patients was 46 months (interquartile range=16–90). Of the 549 patients with a non-pCR, 153 (28%) received postoperative (adjuvant) chemotherapy, and of the 60 patients with a pCR, one patient received additional postoperative chemotherapy. Overall survival, DSS, and RFS was significantly greater in the pCR group compared with the non-pCR group (Figure 2). The timing and pattern of recurrences are summarised in Table 3. For patients achieving a pCR, there was no difference in recurrence between patients who received chemoradiotherapy vs chemotherapy alone (26% and 15%, respectively, P=0.2). While the non-pCR group had a higher risk of recurrence at 1, 3, and 5 years (5-year recurrence=27 vs 51% for pCR and non-pCR, respectively, P=0.02), the pattern of recurrence was similar. There was no difference in the distribution of local/regional vs distant recurrences (43% vs 57%, respectively) between pCR and non-pCR groups. However, we did observe a significantly higher incidence of first recurrences in the central nervous system (CNS) in pCR (36%) compared with non-pCR (4%) patients (P=0.01). All of the patients with a CNS recurrence in the pCR group presented symptomatically (four with seizures and one with localising neurologic symptoms), and similarly 8 of the 10 patients (4%) in the non-pCR group who initially recurred in the CNS presented symptomatically (seven with seizures and one with localising neurologic symptoms).


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)

Kaplan–Meier estimates of overall (A), disease-specific (B), and recurrence-free (C) survival stratified by pathologic complete response (pCR) vs non-pathologic complete response (non-pCR). Statistical comparisons between pCR and non-pCR groups were determined using the log-rank test.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Kaplan–Meier estimates of overall (A), disease-specific (B), and recurrence-free (C) survival stratified by pathologic complete response (pCR) vs non-pathologic complete response (non-pCR). Statistical comparisons between pCR and non-pCR groups were determined using the log-rank test.
Mentions: Median follow-up for all surviving patients was 46 months (interquartile range=16–90). Of the 549 patients with a non-pCR, 153 (28%) received postoperative (adjuvant) chemotherapy, and of the 60 patients with a pCR, one patient received additional postoperative chemotherapy. Overall survival, DSS, and RFS was significantly greater in the pCR group compared with the non-pCR group (Figure 2). The timing and pattern of recurrences are summarised in Table 3. For patients achieving a pCR, there was no difference in recurrence between patients who received chemoradiotherapy vs chemotherapy alone (26% and 15%, respectively, P=0.2). While the non-pCR group had a higher risk of recurrence at 1, 3, and 5 years (5-year recurrence=27 vs 51% for pCR and non-pCR, respectively, P=0.02), the pattern of recurrence was similar. There was no difference in the distribution of local/regional vs distant recurrences (43% vs 57%, respectively) between pCR and non-pCR groups. However, we did observe a significantly higher incidence of first recurrences in the central nervous system (CNS) in pCR (36%) compared with non-pCR (4%) patients (P=0.01). All of the patients with a CNS recurrence in the pCR group presented symptomatically (four with seizures and one with localising neurologic symptoms), and similarly 8 of the 10 patients (4%) in the non-pCR group who initially recurred in the CNS presented symptomatically (seven with seizures and one with localising neurologic symptoms).

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