Interim endoscopy results during neoadjuvant therapy for gastric cancer correlate with histopathological response and prognosis.

Abstract

BACKGROUND:

Neoadjuvant chemotherapy for locally advanced gastric cancer leads to major histopathological response in less than 30 % of patients. Data on interim endoscopic response assessment do not exist. This exploratory prospective study evaluates early endoscopy after 50 % of the chemotherapy as predictor for later response and prognosis.

METHODS:

Forty-seven consecutive patients were included (45 resected; 33 R0 resections). All patients received baseline endoscopy and CT scans, after 50 % of their chemotherapy (EGD-1, CT-1) and after completion of chemotherapy (EGD-2, CT-2). Interim endoscopic response (EGD-1) was assessed after having received 50 % (6 weeks) of the planned 12 weeks of neoadjuvant chemotherapy. Post-chemotherapy response was clinically assessed by a combination of CT scan (CT-2) and endoscopy (EGD-2). Histopathological response was determined by a standardized scoring system (Becker criteria). Endoscopic response was defined as a reduction of >75 % of the tumor mass.

RESULTS:

Twelve patients were responders at EGD-1 and 13 at EGD-2. Nine patients (19.1 %) were clinical responders and 7 patients (15.6 %) were histopathological responders after chemotherapy. Specificity, accuracy, and negative predictive value of the interim EGD-1 for subsequent histopathological response were 31/38 (82 %), 36/47 (76 %), and 31/33 (93 %); and for recurrence or death, 28/30 (93.3 %), 38/47 (80.9 %), and 28/35 (80.0 %). Response at EGD-1 was significantly associated with histopathological response (p = 0.010), survival (p < 0.001), and recurrence-free survival (p = 0.009).

CONCLUSIONS:

Interim endoscopy after 6 weeks predicts response and prognosis. Therefore, tailoring treatment according to interim endoscopic assessment could be feasible, but the findings of this study should be validated in a larger patient cohort.

• Authors: Ulrike Heger, Franz Bader, Florian Lordick, Maria Burian, Rupert Langer, Martin Dobritz, Susanne Blank, Thomas Bruckner, Karen Becker, Ken Herrmann, Jörg-Rüdiger Siewert, Katja Ott
• Journal: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (Gastric Cancer) Vol. 17 Issue 3 Pg. 478-88 ( 2014) ISSN: 1436-3305 [Electronic] Japan
• PMID: 23996162 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Aged
• Antineoplastic Agents (administration & dosage, therapeutic use)
• Female
• Gastroscopy (methods)
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy (methods)
• Neoplasm Recurrence, Local
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Reproducibility of Results
• Sensitivity and Specificity
• Stomach Neoplasms (pathology, therapy)
• Survival Rate
• Time Factors
• Tomography, X-Ray Computed (methods)
• Treatment Outcome