Impact of ypT, ypN, and Adjuvant Therapy on Survival in Gastric Cancer Patients Treated with Perioperative Chemotherapy and Radical Surgery

Autor(es):Mostrar menos -

Fernandez Coimbra, Felipe Jose ^[1] ; de Jesus, Victor Hugo F. ^[2] ; Ribeiro, Heber S. C. ^[1] ; Diniz, Alessandro L. ^[1] ; de Godoy, Andre Luis ^[1] ; de Farias, Igor Correia ^[1] ; Felismino, Tiago ^[2] ; Mello, Celso A. L. ^[2] ; Almeida, Maria Fernanda ^[3] ; Begnami, Maria Dirlei F. S. ^[4] ; Dias-Neto, Emmanuel ^[5] ; Riechelmann, Rachel S. P. ^[2] ; da Costa Jr, Wilson L.

Afiliação do(s) autor(es)

^[1] AC Camargo Canc Ctr, Dept Abdominal Surg, Sao Paulo - Brazil

^[2] AC Camargo Canc Ctr, Dept Clin Oncol, Sao Paulo - Brazil

^[3] AC Camargo Canc Ctr, Dept Radiol, Sao Paulo - Brazil

^[4] Hosp Sirio Libanes, Dept Surg Pathol, Sao Paulo - Brazil

^[5] AC Camargo Canc Ctr, Lab Med Genom, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: ANNALS OF SURGICAL ONCOLOGY; v. 26, n. 11, p. 3618-3626, OCT 2019.
• Citações Web of Science: 1

Resumo

Background Perioperative chemotherapy and surgery is the standard of care in advanced gastroesophageal cancer patients, but its impact among those treated with radical surgery still needs further assessment. We present the results of this multimodality treatment approach in a gastric cancer patients cohort treated with D2 lymphadenectomy. We aimed to identify prognostic factors associated with improved survival. Patients and Methods This retrospective cohort study enrolled patients treated with perioperative chemotherapy and resection in a single cancer center in Brazil between 2006 and 2016. Subjects presenting tumors of the gastric stump, esophageal tumors, or treated with intraperitoneal chemotherapy were excluded. Intention-to-treat survival analysis was performed for all subjects who started neoadjuvant chemotherapy, and prognostic factors were determined among those who had R0 resection. Results This study included 239 patients, of whom 198 had R0 resection. The mean age was 59.9 years, and most had clinical stage IIB or III disease (88%). Among the 239 patients who started neoadjuvant chemotherapy, 207 (86.6%) completed all neoadjuvant treatment cycles, and surgical resection was performed in 225 subjects (94.1%). Overall 60-day morbidity and mortality rates were 35.6% and 4.4%, respectively. For the entire cohort, median survival was 78 months and the 5-year survival rate was 55.3%. Factors associated with worse survival were ypT3-4 stage, ypN + stage, extended resection, and no adjuvant chemotherapy. Conclusions Perioperative chemotherapy resulted in very good outcomes for patients treated with radical surgery, and downstaging after chemotherapy was shown to be a major determinant of prognosis. (AU)

• Processo FAPESP: 14/26897-0 - Epidemiologia e genômica de adenocarcinomas gástricos no Brasil
• Beneficiário: Emmanuel Dias-Neto
• Modalidade de apoio: Auxílio à Pesquisa - Temático