Impact of preoperative endoscopy for predicting treatment response and prognosis in patients with gastric cancer after neoadjuvant chemotherapy

 

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Abstract

Background and study aims Response evaluation criteria in solid tumors (RECIST) have been the gold standard to preoperatively predict treatment response and prognosis in patients with gastric cancer (GC) after neoadjuvant chemotherapy (NAC); however, methods for patients without evaluable lesions by RECIST are not yet confirmed. The aim of this study was to assess the utility of preoperative endoscopy for predicting treatment response and prognosis in patients with GC after NAC.

Patients and methods This retrospective study included 105 patients with initially resectable GC who underwent NAC followed by surgical treatment. Preoperative factors for predicting treatment response and survival outcomes were analyzed.

Results The number of patients classified as responders using preoperative endoscopic assessment, RECIST, and postoperative pathological evaluation were 25 (23.8 %), 28 (26.7 %), and 18 (17.1 %), respectively. Forty-three patients (41 %) were classified as non-targeted disease only, and their treatment responses were not evaluable by RECIST. Multivariate analysis identified endoscopic response as an independent preoperative factor to predict postoperative histological treatment response (odds ratio = 4.556, 95 % CI = 1.169–17.746, P = 0.029). Endoscopic treatment response was the only independent preoperative predictive factor for overall survival (OS) (hazard ratio = 0.419, 95 % confidence interval (CI) = 0.206–0.849, P = 0.016). Further, endoscopic treatment response was available for 33 patients (76.7 %) with non-targeted disease only, which showed significantly different OS between endoscopic responders (80.0 %) and non-responders (43.5 %) (P = 0.025).

Conclusions Endoscopic evaluation was an independent preoperative factor to predict treatment response and prognosis in patients with GC after NAC. Endoscopic assessment may be especially valuable for patients who could not be assessed by RECIST.

Publication History

Received: 06 May 2021

Accepted: 27 August 2021

Article published online:
14 January 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Terashima M, Yoshikawa T, Boku N. et al. Current status of perioperative chemotherapy for locally advanced gastric cancer and JCOG perspectives. Jpn J Clin Oncol 2020; 50: 528-534
  CrossrefPubMedGoogle Scholar
• 2 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021; DOI: 10.1007/s10120-020-01042-y. (Epub 2020 Feb 14)
  CrossrefPubMedGoogle Scholar
• 3 Sato Y, Kurokawa Y, Doki Y. et al. A Phase II study of preoperative chemotherapy with docetaxel, oxaliplatin and S-1 in gastric cancer with extensive lymph node metastasis (JCOG1704). Future Oncol 2020; 16: 31-38
  CrossrefPubMedGoogle Scholar
• 4 Beer AJ, Wieder HA, Lordick F. et al. Adenocarcinomas of esophagogastric junction: multi-detector row CT to evaluate early response to neoadjuvant chemotherapy. Radiology 2006; 239: 472-480
  CrossrefPubMedGoogle Scholar
• 5 Park SR, Choi IJ, Kim CG. et al. Use of a combination of computed tomography and endoscopy to assess the response to 5-fluorouracil/cisplatin and predict survival in gastric cancer. J Gastroenterol 2006; 41: 339-346
  CrossrefPubMedGoogle Scholar
• 6 Ott K, Fink U, Becker K. et al. Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: results of a prospective trial. J Clin Oncol 2003; 21: 4604-4610
  CrossrefPubMedGoogle Scholar
• 7 Park SR, Lee JS, Kim CG. et al. Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer. Cancer 2008; 112: 2368-2376
  CrossrefPubMedGoogle Scholar
• 8 Sarkaria IS, Rizk NP, Bains MS. et al. Post-treatment endoscopic biopsy is a poor-predictor of pathologic response in patients undergoing chemoradiation therapy for esophageal cancer. Ann Surg 2009; 249: 764-767
  CrossrefPubMedGoogle Scholar
• 9 Sugawara N, Ota K, Terazawa T. et al. Endoscopic evaluation of neoadjuvant chemotherapeutic efficacy in gastric cancer before gastrectomy might be as useful as histological assessment after gastrectomy. Digestion 2020; 101: 466-472 DOI: 10.1159/000500907. (Epub 2019 Jun 28)
  CrossrefPubMedGoogle Scholar
• 10 Tahara T, Shibata T, Okubo M. et al. Evaluations of primary lesions by endoscopy clearly distinguishes prognosis in patients with gastric cancer who receive chemotherapy. PLoS One 2017; 12: e0173663
  CrossrefPubMedGoogle Scholar
• 11 Heger U, Bader F, Lordick F. et al. Interim endoscopy results during neoadjuvant therapy for gastric cancer correlate with histopathological response and prognosis. Gastric Cancer 2014; 17: 478-488
  CrossrefPubMedGoogle Scholar
• 12 Kato S, Okamura R, Baumgartner JM. et al. Analysis of circulating tumor DNA and clinical correlates in patients with esophageal, gastroesophageal junction, and gastric adenocarcinoma. Clin Cancer Res 2018; 24: 6248-6256
  CrossrefPubMedGoogle Scholar
• 13 Willis J, Lefterova MI, Artyomenko A. et al. Validation of microsatellite instability detection using a comprehensive plasma-based genotyping panel. Clin Cancer Res 2019; 25: 7035-7045
  CrossrefPubMedGoogle Scholar
• 14 Ott K, Herrmann K, Schuster T. et al. Molecular imaging of proliferation and glucose utilization: utility for monitoring response and prognosis after neoadjuvant therapy in locally advanced gastric cancer. Ann Surg Oncol 2011; 18: 3316-3323
  CrossrefPubMedGoogle Scholar
• 15 Terashima M, Iwasaki Y, Mizusawa J. et al. Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer, the short-term safety and surgical results: Japan Clinical Oncology Group Study (JCOG0501). Gastric Cancer 2019; 22: 1044-1052
  CrossrefPubMedGoogle Scholar
• 16 Tsuburaya A, Mizusawa J, Tanaka Y. et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg 2014; 101: 653-660
  CrossrefPubMedGoogle Scholar
• 17 Sano T, Sasako M, Mizusawa J. et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg 2017; 265: 277-283
  CrossrefPubMedGoogle Scholar
• 18 Monig SP, Zirbes TK, Schroder W. et al. Staging of gastric cancer: correlation of lymph node size and metastatic infiltration. AJR Am J Roentgenol 1999; 173: 365-367
  CrossrefPubMedGoogle Scholar
• 19 Sakuramoto S, Sasako M, Yamaguchi T. et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007; 357: 1810-1820
  CrossrefPubMedGoogle Scholar
• 20 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
  CrossrefPubMedGoogle Scholar
• 21 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
  CrossrefPubMedGoogle Scholar
• 22 Komatsu S, Otsuji E. Essential updates 2017/2018: Recent topics in the treatment and research of gastric cancer in Japan. Ann Gastroenterol Surg 2019; 3: 581-591
  CrossrefPubMedGoogle Scholar
• 23 Al-Batran SE, Homann N, Pauligk C. et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019; 393: 1948-1957
  CrossrefPubMedGoogle Scholar
• 24 Tokunaga M, Sato Y, Nakagawa M. et al. Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives. Surg Today 2020; 50: 30-37
  CrossrefPubMedGoogle Scholar
• 25 Alderson D, Cunningham D, Nankivell M. et al. Neoadjuvant cisplatin and fluorouracil versus epirubicin, cisplatin, and capecitabine followed by resection in patients with oesophageal adenocarcinoma (UK MRC OE05): an open-label, randomised phase 3 trial. Lancet Oncol 2017; 18: 1249-1260
  CrossrefPubMedGoogle Scholar
• 26 Ajani JA, Xiao L, Roth JA. et al. A phase II randomized trial of induction chemotherapy versus no induction chemotherapy followed by preoperative chemoradiation in patients with esophageal cancer. Ann Oncol 2013; 24: 2844-2849
  CrossrefPubMedGoogle Scholar
• 27 Sumpter K, Harper-Wynne C, Cunningham D. et al. Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 2005; 92: 1976-1983
  CrossrefPubMedGoogle Scholar
• 28 Yoshida K, Kodera Y, Kochi M. et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol 2019; 37: 1296-1304
  CrossrefPubMedGoogle Scholar
• 29 Kim IH, Park SS, Lee CM. et al. Efficacy of adjuvant S-1 versus xelox chemotherapy for patients with gastric cancer after D2 lymph node dissection: a retrospective, multi-center observational study. Ann Surg Oncol 2018; 25: 1176-1183
  CrossrefPubMedGoogle Scholar
• 30 Park HS, Jung M, Kim HS. et al. Proper timing of adjuvant chemotherapy affects survival in patients with stage 2 and 3 gastric cancer. Ann Surg Oncol 2015; 22: 224-231
  CrossrefPubMedGoogle Scholar
• 31 Yoshikawa T, Terashima M, Mizusawa J. et al. Four courses versus eight courses of adjuvant S-1 for patients with stage II gastric cancer (JCOG1104 [OPAS-1]): an open-label, phase 3, non-inferiority, randomised trial. Lancet Gastroenterol Hepatol 2019; 4: 208-216
  CrossrefPubMedGoogle Scholar
• 32 Kim DJ, Kim W. Is lymph node size a reliable factor for estimating lymph node metastasis in early gastric cancer?. J Gastric Cancer 2018; 18: 20-29
  CrossrefPubMedGoogle Scholar
• 33 Fukagawa T, Katai H, Mizusawa J. et al. A prospective multi-institutional validity study to evaluate the accuracy of clinical diagnosis of pathological stage III gastric cancer (JCOG1302A). Gastric Cancer 2018; 21: 68-73
  CrossrefPubMedGoogle Scholar
• 34 Furukawa K, Miyahara R, Itoh A. et al. Diagnosis of the invasion depth of gastric cancer using MDCT with virtual gastroscopy: comparison with staging with endoscopic ultrasound. AJR Am J Roentgenol 2011; 197: 867-875
  CrossrefPubMedGoogle Scholar
• 35 Moschetta M, Scardapane A, Telegrafo M. et al. Differential diagnosis between benign and malignant ulcers: 320-row CT virtual gastroscopy. Abdom Imaging 2012; 37: 1066-1073
  CrossrefPubMedGoogle Scholar