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Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer
Author(s) -
Stark Alexander P.,
Estrella Jeannelyn S.,
Chiang YiJu,
Das Prajnan,
Minsky Bruce D.,
Blum Murphy Mariela A.,
Ajani Jaffer A.,
Mansfield Paul,
Badgwell Brian D.,
Ikoma Naruhiko
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.25984
Subject(s) - linitis plastica , medicine , gastrectomy , gastroenterology , cancer , hazard ratio , adenocarcinoma , confidence interval
Abstract Background and Objectives It is unknown whether the degree of response to preoperative therapy correlates with locoregional recurrence (LR) or distant recurrence (DR) after resection of gastric cancer. Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chemoradiation (1995‐2015) were reviewed. The tumor regression grade (TRG) was defined by the percentage of viable tumor cells in the specimen (TRG0 = 0%; TRG1 = 1%‐2%; TRG2 = 3%‐50%; TRG3 ≥ 50%). The relationships among TRG, recurrence‐free survival (RFS), LR, and DR were examined. Results Two hundred forty‐seven patients met the inclusion criteria (TRG0, 52 [21%]; TRG1, 49 [20%]; TRG2, 98 [40%]; TRG3, 48 [19%]). LR and DR occurred in 6.1% and 32.0% of patients, respectively. No patient with TRG0 experienced LR. R1 resection (6%‐15%) and LR (6%‐8%) rates were similar among TRG1‐3 patients. R1 resection was associated with LR (hazard ratio [HR], 17.85; P < .001). ypN status (HR, 2.44; P = .004) and linitis plastica (HR, 2.90; P < .001) were associated with DR. TRG was not independently associated with RFS, LR, or DR. Conclusions TRG0 imparted excellent local control. However, TRG1‐3 patients had similar R1 resection rates and therefore similar LR. DR is associated with ypN status and linitis plastica, not TRG.