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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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Cumulative incidences and probabilities of recurrence by stage (treating death from other causes as a competing risk) in patients undergoing preoperative chemotherapy±radiation therapy for gastric and gastrooesophageal junction adenocarcinoma, followed by R0 resection. Abbreviations: pCR=pathologic complete response, non-pCR=non-pathologic complete response.
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fig3: Cumulative incidences and probabilities of recurrence by stage (treating death from other causes as a competing risk) in patients undergoing preoperative chemotherapy±radiation therapy for gastric and gastrooesophageal junction adenocarcinoma, followed by R0 resection. Abbreviations: pCR=pathologic complete response, non-pCR=non-pathologic complete response.

Mentions: Figure 3 summarises the probability of recurrence by final pathologic stage when treating death from other causes as a competing risk. When compared with pCR patients, the probability of recurrence is significantly higher only for pathologically stage III (pIII) non-pCR patients (5-year CI of recurrence=74 vs 27%, P<0.001). Among the pIII patients, although the majority were stage III by virtue of residual nodal involvement, the three node negative (i.e., T4N0) pIII patients also had a high risk of recurrence, each one developing recurrence within 1 year of resection. There is no significant difference in the probability of recurrence between pCR patients and stage pI or stage pII non-pCR patients (5-year CI of recurrence=39% and 25%, respectively, P=0.49 for pCR vs non-pCR stage I and P=0.36 for pCR vs non-pCR stage II).


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)

Cumulative incidences and probabilities of recurrence by stage (treating death from other causes as a competing risk) in patients undergoing preoperative chemotherapy±radiation therapy for gastric and gastrooesophageal junction adenocarcinoma, followed by R0 resection. Abbreviations: pCR=pathologic complete response, non-pCR=non-pathologic complete response.
© Copyright Policy
Related In: Results  -  Collection

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

fig3: Cumulative incidences and probabilities of recurrence by stage (treating death from other causes as a competing risk) in patients undergoing preoperative chemotherapy±radiation therapy for gastric and gastrooesophageal junction adenocarcinoma, followed by R0 resection. Abbreviations: pCR=pathologic complete response, non-pCR=non-pathologic complete response.
Mentions: Figure 3 summarises the probability of recurrence by final pathologic stage when treating death from other causes as a competing risk. When compared with pCR patients, the probability of recurrence is significantly higher only for pathologically stage III (pIII) non-pCR patients (5-year CI of recurrence=74 vs 27%, P<0.001). Among the pIII patients, although the majority were stage III by virtue of residual nodal involvement, the three node negative (i.e., T4N0) pIII patients also had a high risk of recurrence, each one developing recurrence within 1 year of resection. There is no significant difference in the probability of recurrence between pCR patients and stage pI or stage pII non-pCR patients (5-year CI of recurrence=39% and 25%, respectively, P=0.49 for pCR vs non-pCR stage I and P=0.36 for pCR vs non-pCR stage II).

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