Nodal downstaging to ypN0 after neoadjuvant chemotherapy positively impacts on survival of cT4N+ GC/GEJ patients

Background The prognostic value of histomorphologic regression in primary gastric and gastroesophageal cancers (GC/GEJ) has been previously established, however, the impact of lymph node (LN) regression on survival still remains unclear. Methods A prospectively maintained database was reviewed to id...

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Published inJournal of surgical oncology Vol. 126; no. 8; pp. 1403 - 1412
Main Authors Wu, Liucheng, Xing, Zhaoqiong, Huang, Mingwei, Yu, Hongping, Qin, Yuzhou, Jin, Qinwen, Zhou, Zihan, Chen, Jiansi
Format Journal Article
LanguageEnglish
Published Hoboken Wiley Subscription Services, Inc 01.12.2022
Subjects
Chemotherapy
Gastric cancer
gastroesophageal junction adenocarcinoma
Medical prognosis
neoadjuvant
nodal downstaging
prognosis
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Summary:Background The prognostic value of histomorphologic regression in primary gastric and gastroesophageal cancers (GC/GEJ) has been previously established, however, the impact of lymph node (LN) regression on survival still remains unclear. Methods A prospectively maintained database was reviewed to identify cT4N+ gastric and gastroesophageal cancers (GC/GEJ) after NAC (neoadjuvant chemotherapy). Patients were categorized into two groups based on LN status: cN+/ypN0 (downstaged N0) and cN+/ypN+ (persistent N+), long‐term survival were analyzed using Kaplan–Meier survival estimates. Results In total, 125 patients with cT4N+ GC/GEJ underwent NAC followed by surgery were enrolled. A total of 39 patients (31.2%) had cN+/ypN0 (ypN0) disease, 86 patients (68.8%) had cN+/ypN+ (ypN+) disease. Prognosis in ypN+ patients was significantly worse than those in ypN0 group for 3‐ and 5‐year overall survival (OS) (p < 0.05). The 3‐year OS was 83%, 44% in ypN0 and ypN+ group, respectively. The 5‐year OS was 75%, 35% in ypN0 and ypN+ group, respectively. Multivariable analysis suggested that multivisceral resection (hazard ratio [HR] = 0.33, 95% confidence interval [CI]: 0.14–0.76, p = 0.009), and ypN+ (HR = 3.42, 95% CI: 1.15–10.13, p =0.027) were independent prognostic factors for OS. Conclusion Nodal downstaging is an important hallmark representing the effectiveness of NAC for GC/GEJ, and it positively impacts on survival of these patients.
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ISSN:0022-4790
1096-9098
DOI:10.1002/jso.27065