Abstract
Background
Neoadjuvant chemotherapy is established in the treatment of gastric adenocarcinoma.
Histopathological regression may have important prognostic implications. There are
little data comparing clinical outcomes of patients with gastric adenocarcinoma that
received neoadjuvant treatment and those neoadjuvant naive. The aim of this study
is to determine the impact of neoadjuvant chemotherapy upon prognosis of patients
being treated for gastric adenocarcinoma.
Methods
Consecutive patients with gastric cancer from a single center between 2007 and 2017
were evaluated. Patients were treated with either a subtotal or total gastrectomy
with D2 lymphadenectomy. Stage-by-stage comparison of the extent of pathological downstaging
was conducted for patients who received neoadjuvant treatment (ypTNM) and those who
did not (pTNM) using the TNM eighth edition.
Results
Overall, 384 patients underwent gastrectomy, 141 patients received neoadjuvant chemotherapy,
and 86 patients (58.1%) were downstaged. Downstaged patients had improved overall
survival compared to patients who did not respond to neoadjuvant chemotherapy (not
reported vs 66 months, P < .001). Downstaging by >3 stages was the strongest independent predictor of overall
survival (hazard ratio: 0.17; 95% confidence interval 0.062–0.44). Overall survival
was significantly better among patients in the ypTNM groups when a stage-by-stage
comparison was performed with the pTNM group.
Conclusion
Pathological stage is a more accurate predictor of prognosis compared clinical stage
with downstaged patients benefiting from lower recurrence rates and improved overall
survival. Patients downstaged due to neoadjuvant chemotherapy may potentially have
more favorable clinical outcomes compared to stage-matched patients who did not receive
this.
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Article info
Publication history
Published online: April 07, 2022
Accepted:
March 3,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
