Validating a nodal regression system for gastric cancer: An ancillary cohort study of the GASTRODOC trial.
Journal
International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
02
04
2021
revised:
24
08
2021
accepted:
13
09
2021
pubmed:
19
9
2021
medline:
12
11
2021
entrez:
18
9
2021
Statut:
ppublish
Résumé
To validate a nodal regression system for gastric cancer and to verify its impact on prognosis. This is an ancillary study which included 47 patients of the GASTRODOC trial. The dedicated pathologists of each Institute were invited to revise all the lymph nodes included in the surgical specimens in order to classify the regression according to the grading system proposed by Tsekrekos et al. The association of the nodal regression system and the clinico-pathological characteristics and prognosis were investigated. According to the classification of Tsekrekos et al., there were 19 (40.4%) patients with grade a, 14 (29.8%) with grade b and 14 (29.8%) with grade c nodal regression. This regression system showed significant statistical associations with pathological N status (p < 0.001), residual tumor classification (p = 0.003) and Becker regression system (p = 0.011). At multivariable analysis only Tsekrekos' grading regression system was significantly associated with the PFS (HR 10.1, 95% CI 1.3-75.5; p = 0.025). The analyzed nodal regression system is significantly associated with Becker's regression system and it has a strong correlation with prognosis.
Sections du résumé
BACKGROUND
BACKGROUND
To validate a nodal regression system for gastric cancer and to verify its impact on prognosis.
METHODS
METHODS
This is an ancillary study which included 47 patients of the GASTRODOC trial. The dedicated pathologists of each Institute were invited to revise all the lymph nodes included in the surgical specimens in order to classify the regression according to the grading system proposed by Tsekrekos et al. The association of the nodal regression system and the clinico-pathological characteristics and prognosis were investigated.
RESULTS
RESULTS
According to the classification of Tsekrekos et al., there were 19 (40.4%) patients with grade a, 14 (29.8%) with grade b and 14 (29.8%) with grade c nodal regression. This regression system showed significant statistical associations with pathological N status (p < 0.001), residual tumor classification (p = 0.003) and Becker regression system (p = 0.011). At multivariable analysis only Tsekrekos' grading regression system was significantly associated with the PFS (HR 10.1, 95% CI 1.3-75.5; p = 0.025).
CONCLUSIONS
CONCLUSIONS
The analyzed nodal regression system is significantly associated with Becker's regression system and it has a strong correlation with prognosis.
Identifiants
pubmed: 34536601
pii: 01279778-202110000-00010
doi: 10.1016/j.ijsu.2021.106112
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
106112Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.
Références
Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, 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.
Aoyama T, Nishikawa K, Fujitani K, Tanabe K, Ito S, Matsui T, et al. Early results of a randomized two-by-two factorial phase II trial comparing neoadjuvant chemotherapy with two and four courses of cisplatin/S-1 and docetaxel/cisplatin/S-1 as neoadjuvant chemotherapy for locally advanced gastric cancer. Ann. Oncol . 2017;28:1876-1881.
Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med . 2006;355:11-20.
Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J. Clin. Oncol . 2011;29:1715-1721.
Yoshikawa T, Morita S, Tanabe K, Nishikawa K, Ito Y, Matsui T, et al. Survival results of a randomised two-by-two factorial phase II trial comparing neoadjuvant chemotherapy with two and four courses of S-1 plus cisplatin (SC) and paclitaxel plus cisplatin (PC) followed by D2 gastrectomy for resectable advanced gastric cancer. Eur. J. Canc . 2016;62:103-111.
Blackham AU, Yue B, Almhanna K, Saeed N, Fontaine JP, Hoffe S, et al. The prognostic value of residual nodal disease following neoadjuvant chemoradiation for esophageal cancer in patients with complete primary tumor response. J. Surg. Oncol . 2015;112:597-602.
Ikoma N, Estrella JS, Hofstetter W, Das P, Minsky BD, Ajani JA, et al. Nodal downstaging in gastric cancer patients: promising survival if ypN0 is achieved. Ann. Surg Oncol . 2018;25:2012-2017.
Stark AP, Blum MM, Chiang YJ, Das P, Minsky BD, Estrella JS, et al. Preoperative therapy regimen influences the incidence and implication of nodal downstaging in patients with gastric cancer. J Gastric Cancer . 2020;20:313-327.
Zanoni A, Verlato G, Giacopuzzi S, Motton M, Casella F, Weindelmayer J, et al. ypN0: does it matter how you get there? Nodal downstaging in esophageal cancer. Ann. Surg Oncol . 2016;23:998-1004.
Monti M, Morgagni P, Nanni O, Framarini M, Saragoni L, Marrelli D, et al. Preoperative or perioperative docetaxel, oxaliplatin, and capecitabine (GASTRODOC regimen) in patients with locally-advanced resectable gastric cancer: a randomized phase-II trial. Cancers 2020;12:2790.
Tsekrekos A, Detlefsen S, Riddell R, Conner J, Mastracci L, Sheahan K, et al. Histopathologic tumor regression grading in patients with gastric carcinoma submitted to neoadjuvant treatment: results of a Delphi survey. Hum. Pathol . 2019;84:26-34.
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int. J. Surg . 2019;72:156-165.
Becker K, Mueller JD, Schulmacher C, Ott K, Fink U, Busch R, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer . 2003;98:1521-1530.
De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment. Gastric Cancer . 2015;20:20-30.
Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. an attempt at a histo-clinical classification. Acta Pathol. Microbiol. Scand . 1965;64:31-49.
Tsekrekos A, Vieth M, Ndegwa N, Bateman A, Flejou JF, Grabsch HI, et al. Interobserver agreement of a gastric adenocarcinoma tumor regression grading system that incorporates assessment of lymph nodes. Hum. Pathol . 2021;116:94-101.
Davies AR, Gossage JA, Zystra J, Mattson F, Lagergren J, Smyth EC, et al. Tumor stage after neoadjuvant chemotherapy determines survival after surgery for adenocarcinoma of the esophagus and esophagogastric junction. J. Clin. Oncol . 2014;32:2983-2990.
Tong Y, Zhu Y, Zhao Y, Shan Z, Liu D, Zhang J. Evaluation and comparison of predictive value of tumor regression grades according to mandard and becker in locally advanced gastric cancer adenocarcinoma. Cancer Res Treat . 2021;53:112-122.