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Preoperative Therapy Regimen Influences the Incidence and Implication of Nodal Downstaging in Patients with Gastric Cancer

Journal of Gastric Cancer 2020년 20권 3호 p.313 ~ 327
Stark Alexander P., Blum Mariela M., Chiang Yi-Ju, Das Prajnan, Minsky Bruce D., Estrella Jeannelyn S., Ajani Jaffer A., Badgwell Brian D., Mansfield Paul, Ikoma Naruhiko,
소속 상세정보
 ( Stark Alexander P. ) - University of Texas MD Anderson Cancer Center Department of Surgical Oncology
 ( Blum Mariela M. ) - University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology
 ( Chiang Yi-Ju ) - University of Texas MD Anderson Cancer Center Department of Surgical Oncology
 ( Das Prajnan ) - University of Texas MD Anderson Cancer Center Department of Radiation Oncology
 ( Minsky Bruce D. ) - University of Texas MD Anderson Cancer Center Department of Radiation Oncology
 ( Estrella Jeannelyn S. ) - University of Texas MD Anderson Cancer Center Department of Pathology
 ( Ajani Jaffer A. ) - University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology
 ( Badgwell Brian D. ) - University of Texas MD Anderson Cancer Center Department of Surgical Oncology
 ( Mansfield Paul ) - University of Texas MD Anderson Cancer Center Department of Surgical Oncology
 ( Ikoma Naruhiko ) - University of Texas MD Anderson Cancer Center Department of Surgical Oncology

Abstract


Purpose: Nodal downstaging after preoperative therapy for gastric cancer has been shown to impart excellent prognosis, but this has not been validated in a national cohort. The role of neoadjuvant chemoradiation (NACR) in nodal downstaging remains unclear when compared with that of neoadjuvant chemotherapy alone (NAC). Furthermore, it is unknown whether the prognostic implications of nodal downstaging differ by preoperative regimen.

Materials and Methods: Using the National Cancer Database, overall survival (OS) duration was compared among natural N0 (cN0/ypN0), downstaged N0 (cN+/ypN0), and node-positive (ypN+) gastric cancer patients treated with NACR or NAC. Factors associated with nodal downstaging were examined in a propensity score-matched cohort of cN+ patients, matched 1:1 by receipt of NACR or NAC.

Results: Of 7,426 patients (natural N0 [n=1,858, 25.4%], downstaged N0 [n=1,813, 24.4%], node-positive [n=3,755, 50.4%]), 58.2% received NACR, and 41.9% received NAC. The median OS durations of downstaged N0 (5.1 years) and natural N0 (5.6 years) patients were similar to one another and longer than that of node-positive patients (2.1 years) (P<0.001). In the matched cohort of cN+ patients, more recent diagnosis (2010?2015 vs. 2004?2009) (odds ratio [OR], 2.57; P<0.001) and NACR (OR, 2.02; P<0.001) were independently associated with nodal downstaging. The 5-year OS rate of downstaged N0 patients was significantly lower after NACR (46.4%) than after NAC (57.7%) (P=0.003).

Conclusions: Downstaged N0 patients have the same prognosis as natural N0 patients. Nodal downstaging occurred more frequently after NACR; however, the survival benefit of nodal downstaging after NACR may be less than that when such is achieved by NAC.

키워드

Gastric cancer; Gastrectomy; Chemotherapy; Chemoradiation; Neoadjuvant therapy

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