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Tumor regression and survival after perioperative MAGIC-style chemotherapy in carcinoma of the stomach and gastroesophageal junction.

Mingol F, Gallego J, Orduña A, Martinez-Blasco A, Sola-Vera J, Moya P, Morcillo MA, Ruiz JA, Calpena R, Lacueva FJ - BMC Surg (2015)

Bottom Line: However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029).The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively.Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.

View Article: PubMed Central - PubMed

Affiliation: Surgery Department, Elche University Hospital, Elche, Spain. mingolnavarro_6@hotmail.com.

ABSTRACT

Background: We assessed the effectiveness of perioperative MAGIC-style chemotherapy in our series focused on the tumor regression grade and survival rate.

Methods: We conducted a retrospective study of 53 patients following a perioperative regimen of epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/X). Forty-four (83 %) neoplasias were located in the stomach and 9 (17 %) were located at the esophagogastric junction. Perioperative chemotherapy completion, resection, TNM staging, the tumor regression grade (Becker's classification) and survival were analyzed.

Results: Forty-five patients (85 %) completed the 3 preoperative cycles. R0 resection was achieved in 42 (79 %) patients. Thirty-five (66 %) patients completed the 3 postoperative cycles. Nine carcinomas (17 %) were considered major responders after preoperative chemotherapy. With multivariate analysis, only completion of perioperative chemotherapy (HR: 0.25; 95%CI: 0.08 - 0.79; p = 0.019) was identified as an independent prognostic factor for disease-specific survival. However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029). The tumor regression grade (major vs minor responders) was at the limit of significance only with univariate analysis. The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively.

Conclusions: The percentage of major responder tumors after preoperative chemotherapy was low. Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.

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Disease-specific survival of patients according to completion of perioperative chemotherapy, the lymph node status, depth of invasion and tumor regression grade (major and minor responders)
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Fig2: Disease-specific survival of patients according to completion of perioperative chemotherapy, the lymph node status, depth of invasion and tumor regression grade (major and minor responders)

Mentions: After univariate analysis of the 5-year disease-specific survival, the completion of perioperative chemotherapy (p < 0.001), completion of NAC (p < 0.007), depth of invasion (ypT0-2 vs ypT3-4) (p < 0.01), LN staging (ypN0 vs. ypN2-3) (p < 0.001), number of positive LNs (p < 0.001), and metastasis (ypM0 vs. ypM1) (p < 0.001) were shown to be significant (Fig. 2a–c). LN staging (ypN1 vs. ypN2-3) (p < 0.051) and tumor regression grade (major vs. minor responders) (p < 0.051) were at the limit of significance (Fig. 2c, 2d).Fig. 2


Tumor regression and survival after perioperative MAGIC-style chemotherapy in carcinoma of the stomach and gastroesophageal junction.

Mingol F, Gallego J, Orduña A, Martinez-Blasco A, Sola-Vera J, Moya P, Morcillo MA, Ruiz JA, Calpena R, Lacueva FJ - BMC Surg (2015)

Disease-specific survival of patients according to completion of perioperative chemotherapy, the lymph node status, depth of invasion and tumor regression grade (major and minor responders)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4440567&req=5

Fig2: Disease-specific survival of patients according to completion of perioperative chemotherapy, the lymph node status, depth of invasion and tumor regression grade (major and minor responders)
Mentions: After univariate analysis of the 5-year disease-specific survival, the completion of perioperative chemotherapy (p < 0.001), completion of NAC (p < 0.007), depth of invasion (ypT0-2 vs ypT3-4) (p < 0.01), LN staging (ypN0 vs. ypN2-3) (p < 0.001), number of positive LNs (p < 0.001), and metastasis (ypM0 vs. ypM1) (p < 0.001) were shown to be significant (Fig. 2a–c). LN staging (ypN1 vs. ypN2-3) (p < 0.051) and tumor regression grade (major vs. minor responders) (p < 0.051) were at the limit of significance (Fig. 2c, 2d).Fig. 2

Bottom Line: However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029).The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively.Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.

View Article: PubMed Central - PubMed

Affiliation: Surgery Department, Elche University Hospital, Elche, Spain. mingolnavarro_6@hotmail.com.

ABSTRACT

Background: We assessed the effectiveness of perioperative MAGIC-style chemotherapy in our series focused on the tumor regression grade and survival rate.

Methods: We conducted a retrospective study of 53 patients following a perioperative regimen of epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/X). Forty-four (83 %) neoplasias were located in the stomach and 9 (17 %) were located at the esophagogastric junction. Perioperative chemotherapy completion, resection, TNM staging, the tumor regression grade (Becker's classification) and survival were analyzed.

Results: Forty-five patients (85 %) completed the 3 preoperative cycles. R0 resection was achieved in 42 (79 %) patients. Thirty-five (66 %) patients completed the 3 postoperative cycles. Nine carcinomas (17 %) were considered major responders after preoperative chemotherapy. With multivariate analysis, only completion of perioperative chemotherapy (HR: 0.25; 95%CI: 0.08 - 0.79; p = 0.019) was identified as an independent prognostic factor for disease-specific survival. However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029). The tumor regression grade (major vs minor responders) was at the limit of significance only with univariate analysis. The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively.

Conclusions: The percentage of major responder tumors after preoperative chemotherapy was low. Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.

Show MeSH
Related in: MedlinePlus