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Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer
Author(s) -
Pereira Marina Alessandra,
Ramos Marcus Fernando Kodama Pertille,
Dias Andre Roncon,
Cardili Leonardo,
Ribeiro Renan Ribeiro e,
Charruf Amir Zeide,
Castria Tiago Biachi,
Zilberstein Bruno,
Ceconello Ivan,
Avancini Ferreira Alves Venancio,
Ribeiro Ulysses,
Mello Evandro Sobroza
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25785
Subject(s) - medicine , perineural invasion , chemotherapy , lymph node , stage (stratigraphy) , neoadjuvant therapy , cancer , gastrectomy , adenocarcinoma , proportional hazards model , oncology , primary tumor , lymphovascular invasion , gastroenterology , metastasis , breast cancer , paleontology , biology
Background and Objective Neoadjuvant chemotherapy (nCMT) has been increasingly used in advanced gastric cancer (GC). However, the prognostic impact of tumor response remains unclear. This study aimed to evaluate if tumor response at the primary site and lymph nodes (LN) correlate with survival in GC patients after nCMT. Methods Patients with gastric adenocarcinoma treated with nCMT followed by gastrectomy were evaluated. Residual tumor was graded from 0% to 100%, defining two groups: poor (PR) and major response (MR). LN regression rate (LNRR) was determined based on tumor/fibrosis examination at each LN and a cutoff value established by receiver operating characteristic curve. Results Among 62 cases, 20 (32.2%) had MR and 42 (67.7%) PR. Smaller size, diffuse histology, lower ypT status and less advanced stage were associated with the MR group. Based on cutoff value of 57, 45.6% and 54.4% patients were classified as low‐LNRR and high‐LNRR. High‐LNRR correlated with absence of venous, lymphatic and perineural invasion, and less advanced stage. Survival was equivalent between MR and PR ( P = .956). High‐LNRR had better disease‐free survival (DFS) than low‐LNRR ( P < .001). In multivariate analysis, only LNRR associated with DFS. Conclusion High‐LNRR associates with DFS in GC treated with nCMT. Response at the primary site does not correlate with survival.