Remnant gastric cancer: a neglected group with high potential for immunotherapy

Author(s)

Ramos, Marcus Fernando Kodama Pertille ^[1] ; Pereira, Marina Alessandra ^[1] ; de Castria, Tiago Biachi ^[1] ; Ribeiro e Ribeiro, Renan ^[1] ; Cardili, Leonardo ^[1] ; de Mello, Evandro Sobroza ^[1] ; Zilberstein, Bruno ^[1] ; Ribeiro-Junior, Ulysses ^[1] ; Cecconello, Ivan ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Inst Canc, Hosp Clin, Av Dr Arnaldo 251, BR-01249000 Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY; v. 146, n. 12 JUL 2020.
• Web of Science Citations: 0

Abstract

Purpose The importance of targeted therapy and interest in the study of predictive markers in gastric cancer (GC) have increased in recent years with the use of anti-HER2 therapy and immunotherapy with anti-PD1/PD-L1 for microsatellite instability (MSI) and PD-L1 + tumors. However, the behavior of remnant GC (RGC) in this scenario is poorly reported. Thus, this study aims to evaluate the clinicopathological characteristics and prognosis of RGC and its association with the expression of current markers for targeted therapy. Methods All RGC resections performed in a single center from 2009 to 2019 were retrospectively reviewed. As a comparison group, 53 primary proximal GC (PGC) who underwent total D2-gastrectomy were selected. HER2, MSI status and PD-L1 expression were analyzed by immunohistochemistry. Combined Positive Score (CPS) was used to determine PD-L1 positivity. Results A total of 40 RGC were included. RGC patients were older (p = 0.001), had lower BMI (p = 0.001) and number of resected lymph nodes (p < 0.001) compared to the PGC. Regarding markers expression, MSI was higher in RGC than PGC (27.5% vs 9.4%,p = 0.022). The frequency of CPS-positive was 32.5% and 26.4% in RGC and PGC, respectively (p = 0.522). HER2 positivity was 17.5% and 22.6% for RGC and PGC, respectively (p = 0.543). In survival analysis, DFS was better for RGC CPS-positive than RGC CPS-negative (p = 0.039) patients. There was no difference in survival considering MSI status. Conclusion RGC had higher incidence of MSI than PGC, and CPS-positive RGC was associated with better survival. The immunological profile of RGC patients suggests that they would be good candidates for immunotherapy. (AU)

• FAPESP's process: 16/25524-0 - Characterization of Helicobacter pylori infection, Epstein-Barr virus and gene-protein expression profile in gastric adenocarcinomas
• Grantee: Ulysses Ribeiro Júnior
• Support Opportunities: Regular Research Grants