Prediction of Response and Prognosis by a Score Including Only Pretherapeutic Parameters in 410 Neoadjuvant Treated Gastric Cancer Patients

• Published in: Annals of surgical oncology Vol. 19; no. 7; pp. 2119 - 2127
• Main Authors: Lorenzen, Sylvie, Blank, Susanne, Lordick, Florian, Siewert, Jörg-Rüdiger, Ott, Katja
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-07-2012; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cisplatin - administration & dosage; Clinical Trials, Phase II as Topic; Combined Modality Therapy; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Gastrointestinal Oncology; Humans; Leucovorin - administration & dosage; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Oncology; Organoplatinum Compounds - administration & dosage; Paclitaxel - administration & dosage; Prognosis; Retrospective Studies; Risk Factors; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - therapy; Surgery; Surgical Oncology; Survival Rate; Young Adult; Gastric Cancer; Advanced Gastric Cancer; Prognostic Index; Gastric Cancer Patient; Lymph Node Ratio
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2254-1

Background
Response to neoadjuvant chemotherapy is an independent prognostic factor in locally advanced gastric cancer. However, no prospectively tested pretherapeutic parameters predicting response and/or survival in gastric cancer are available in clinical routine.
Methods
We evaluated the prognostic significance of various clinical pathologic parameters in 410 patients who were treated with neoadjuvant chemotherapy followed by gastrectomy. Clinical and histopathologic response evaluation was performed by using standardized criteria. A prognostic score was created on the basis of the variables identified in the multivariate analysis.
Results
Three pretherapeutic parameters were identified as positive predictive factors for response and prognosis: tumor localization in the middle third of the stomach (
P
 = 0.001), well-differentiated tumors (
P
 = 0.001), and intestinal tumor type according to Laurén classification (
P
 = 0.03). A prognostic index was constructed, dividing the patients into three risk groups: low (
n
 = 73), intermediate (
n
 = 274), and high (
n
 = 63). The three groups had significantly different clinical (
P
 = 0.007) and histopathologic response rates (
P
 = 0.001) and survival times, with a median survival time that was not reached in the low-risk group, 39.2 months in the intermediate-risk group, and 20.5 months in the high-risk group. The corresponding 5-year survival rates were 65.3, 41.2, and 21.2% (
P
 < 0.001), respectively.
Conclusions
A simple scoring system based on three clinicopathologic parameters accurately predicts response and prognosis in neoadjuvant treated gastric cancer. This system provides additional useful information that could be applied to select gastric cancer patients pretherapeutically for different treatment approaches. Prospective testing of the score in an independent patient cohort is warranted.