Preoperative Therapy Regimen Influences the Incidence and Implication of Nodal Downstaging in Patients with Gastric Cancer.

Autor:	Stark AP; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Blum MM; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Chiang YJ; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Das P; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Minsky BD; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Estrella JS; Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Ajani JA; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Badgwell BD; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Mansfield P; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Ikoma N; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Journal of gastric cancer [J Gastric Cancer] 2020 Sep; Vol. 20 (3), pp. 313-327. Date of Electronic Publication: 2020 Sep 17.
DOI:	10.5230/jgc.2020.20.e29
Abstrakt:	Purpose: Nodal downstaging after preoperative therapy for gastric cancer has been shown to impart excellent prognosis, but this has not been validated in a national cohort. The role of neoadjuvant chemoradiation (NACR) in nodal downstaging remains unclear when compared with that of neoadjuvant chemotherapy alone (NAC). Furthermore, it is unknown whether the prognostic implications of nodal downstaging differ by preoperative regimen. Materials and Methods: Using the National Cancer Database, overall survival (OS) duration was compared among natural N0 (cN0/ypN0), downstaged N0 (cN+/ypN0), and node-positive (ypN+) gastric cancer patients treated with NACR or NAC. Factors associated with nodal downstaging were examined in a propensity score-matched cohort of cN+ patients, matched 1:1 by receipt of NACR or NAC. Results: Of 7,426 patients (natural N0 [n=1,858, 25.4%], downstaged N0 [n=1,813, 24.4%], node-positive [n=3,755, 50.4%]), 58.2% received NACR, and 41.9% received NAC. The median OS durations of downstaged N0 (5.1 years) and natural N0 (5.6 years) patients were similar to one another and longer than that of node-positive patients (2.1 years) (P<0.001). In the matched cohort of cN+ patients, more recent diagnosis (2010-2015 vs. 2004-2009) (odds ratio [OR], 2.57; P<0.001) and NACR (OR, 2.02; P<0.001) were independently associated with nodal downstaging. The 5-year OS rate of downstaged N0 patients was significantly lower after NACR (46.4%) than after NAC (57.7%) (P=0.003). Conclusions: Downstaged N0 patients have the same prognosis as natural N0 patients. Nodal downstaging occurred more frequently after NACR; however, the survival benefit of nodal downstaging after NACR may be less than that when such is achieved by NAC. Competing Interests: Conflict of Interest: Prajnan Das has received an honorarium from Adlai Nortye, Ltd. (Copyright © 2020. Korean Gastric Cancer Association.)
Databáze:	MEDLINE
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