Year 2020 / Volume 112 / Number 8
Original
Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer

598-604

DOI: 10.17235/reed.2020.6763/2019

Juan Ocaña Jiménez, Pablo Priego, Marta Cuadrado, Luis Alberto Blázquez, Silvia Sánchez Picot, Paula Pastor Peinado, Federico Longo, Fernando López, María Alejandra Caminoa-Lizarralde, Julio Galindo,

Abstract
Introduction: neoadjuvant chemotherapy (NACT) followed by radical surgery is the optimal approach for locally advanced gastric cancer (GC). Interval timing to surgery after NACT in GC is controversial. The aim of this study was to evaluate the impact of NACT interval time on tumor response and overall survival. Material and methods: a retrospective analysis from a prospective database was performed at a single referral tertiary hospital, from January 2010 to October 2018. Patients were assigned to three groups according to the surgical interval time after NACT: < 4 weeks, 4-6 weeks and > 6 weeks. Univariate and multivariable analyses were performed in order to clarify the impact of NACT on post-neoadjuvant pathological complete response rate (ypCR), downstaging (DS) and overall survival (OS). Results: of the 60 patients analyzed, 18 patients (30 %) had an interval time to surgery < 4 weeks, 26 (43.3 %) between 4-6 weeks and 16 (26.7 %) > 6 weeks. Two patients (3 %) had achieved ypCR and 37 patients (62 %) had achieved DS. There were no differences in DS rates among the interval time groups (p: 0.66). According to the multivariate analysis, only poorly differentiated carcinoma was significantly related to lower DS rates (p: 0.04). Cox regression analysis showed that the NACT interval time had no impact on OS. According to the multivariate analysis, > 25 lymph node harvested (HR: 0.35) and female sex (HR: 5.67) were OS independent predictors. Conclusions: the NACT interval time prior gastrectomy for locally advanced GC is not associated with ypCR or DS and has no impact on overall survival.
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References
1. Reis CA. Gastric Cancer. Encycl Cancer. 2008;1209–12.
2. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(August):v38–49.
3. Petrelli F, Coinu A, Cabiddu M, Ghilardi M, Vavassori I, Barni S. Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: A meta-analysis. Eur Urol 2014;65(2):350–7.
4. Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data. Lancet Oncol 2010;11(9):835–44.
5. Fields RC, Strong VE, Gönen M, Goodman KA, Rizk NP, Kelsen DP, et al. Recurrence and survival after pathologic complete response to preoperative therapy followed by surgery for gastric or gastrooesophageal adenocarcinoma. Br J Cancer. 2011;104(12):1840–7.
6. Lordick F, Stein HJ, Peschel C, Siewert JR. Neoadjuvant therapy for oesophagogastric cancer. Br J Surg. 2004;91(5):540–51.
7. Lorenzen S, Thuss-Patience P, Al-Batran SE, Lordick F, Haller B, Schuster T, et al. Impact of pathologic complete response on disease-free survival in patients with esophagogastric adenocarcinoma receiving preoperative docetaxel-based chemotherapy. Ann Oncol. 2013;24(8):2068–73.
8. Becker K, Langer R, Reim D, Novotny A, Meyer Zum Buschenfelde C, Engel J, et al. Significance of histopathological tumor regression after neoadjuvant chemotherapy in gastric adenocarcinomas: A summary of 480 cases. Ann Surg. 2011;253(5):934–9.
9. Brenner B, Shah MA, Karpeh MS, Gonen M, Brennan MF, Coit DG, et al. A phase II trial of neoadjuvant cisplatin-fluorouracil followed by postoperative intraperitoneal floxuridine-leucovorin in patients with locally advanced gastric cancer. Ann Oncol. 2006;17(9):1404–11.
10. Mansour JC, Tang L, Shah M, Bentrem D, Klimstra DS, Gonen M, et al. Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer? Ann Surg Oncol. 2007;14(12):3412–8.
11. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJH, Nicolson M, et al. Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. N Engl J Med. 2006;
12. Hashemzadeh S, Pourzand A, Somi MH, Zarrintan S, Javad-Rashid R, Esfahani A. The effects of neoadjuvant chemotherapy on resectability of locally-advanced gastric adenocarcinoma: A clinical trial. Int J Surg [Internet]. 2014;12(10):1061–9. Available from: http://dx.doi.org/10.1016/j.ijsu.2014.08.349
13. Liu Y, Zhang KC, Huang XH, Xi HQ, Gao YH, Liang WQ, et al. Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes. World J Gastroenterol. 2018;24(2):257–65.
14. Francois BY, Nemoz CJ, Baulieux J, Vignal J, Grandjean J, Partensky C, et al. Influen ce of the Interval Between Preoperative Radiation Therapy and Surgery on Downstaging and on the Rate of Sphincter-Sparing Surgery for Rectal Cancer : The Lyon. 2017;17(8):2396–402.
15. Tran CL, Udani S, Holt A, Arnell T, Kumar R, Stamos MJ. Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg. 2006;192(6):873–7.
16. Lee A, Wong AT, Schwartz D, Weiner JP, Osborn VW, Schreiber D. Is There a Benefit to Prolonging the Interval Between Neoadjuvant Chemoradiation and Esophagectomy in Esophageal Cancer? Ann Thorac Surg 2016;102(2):433–8.
17. Shapiro J, Van Hagen P, Lingsma HF, Wijnhoven BPL, Biermann K, Ten Kate FJW, et al. Prolonged time to surgery after neoadjuvant chemoradiotherapy increases histopathological response without affecting survival in patients with esophageal or junctional cancer. Ann Surg. 2014;260(5):807–14.
18. Lin G, Han SY, Xu YP, Mao WM. Increasing the interval between neoadjuvant chemoradiotherapy and surgery in esophageal cancer: a meta-analysis of published studies. Dis Esophagus. 2016;29(8):1107–14.
19. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.
20. Washington K. 7th edition of the AJCC cancer staging manual: Stomach. Ann Surg Oncol. 2010;17(12):3077–9.
21. Kim MS, Lim JS, Hyung WJ, Lee YC, Rha SY, Keum KC, et al. Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer. World J Gastroenterol. 2015;21(9):2711–8.
22. Xiong BH, Cheng Y, Ma L, Zhang CQ. An updated meta-analysis of randomized controlled trial assessing the effect of neoadjuvant chemotherapy in advanced gastric cancer. Cancer Invest. 2014;32(6):272–84.
23. Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB, et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO. Lancet Oncol. 2016;17(12):1697–708.
24. 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) Lancet 2019;393(10184):1948–57.
25. Wang LB, Teng RY, Jiang ZN, Hu WX, Dong MJ, Yuan XM, et al. Clinicopathologic variables predicting tumor response to neoadjuvant chemotherapy in patients with locally advanced gastric cancer. J Surg Oncol. 2012;105(3):293–6.
26. Sun LB, Zhao GJ, Ding DY, Song B, Hou RZ, Li YC. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: A retrospective, comparative study at a single tertiary care institute. World J Surg Oncol. 2014;12(1):1–5.
27. Yoshikawa T, Tanabe K, Nishikawa K, Ito Y, Matsui T, Kimura Y, et al. Induction of a pathological complete response by four courses of neoadjuvant chemotherapy for gastric cancer: Early results of the randomized phase II COMPASS trial. Ann Surg Oncol. 2014;21(1):213–9.
28. Abdul-Jalil KI, Sheehan KM, Kehoe J, Cummins R, O’Grady A, Mcnamara DA, et al. The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer. Color Dis. 2014;16(1).
29. Meredith KL, Weber JM, Turaga KK, Siegel EM, McLoughlin J, Hoffe S, et al. Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer. Ann Surg Oncol. 2010;17(4):1159–67.
30. Huntington CR, Boselli D, Symanowski J, Hill JS, Crimaldi A, Salo JC. Optimal Timing of Surgical Resection After Radiation in Locally Advanced Rectal Adenocarcinoma: An Analysis of the National Cancer Database. Ann Surg Oncol. 2016;23(3):877–87.
31. Lorimer PD, Motz BM, Kirks RC, Boselli DM, Walsh KK, Prabhu RS, et al. Pathologic Complete Response Rates After Neoadjuvant Treatment in Rectal Cancer: An Analysis of the National Cancer Database. Ann Surg Oncol. 2017;24(8):2095–103.
32. Garcia-Aguilar J, Smith DD, Avila K, Bergsland EK, Chu P, Krieg RM. Optimal Timing of Surgery After Chemoradiation for Advanced Rectal Cancer. Ann Surg. 2011;254(1):97–102.
33. Kim JY, Correa AM, Vaporciyan AA, Roth JA, Mehran RJ, Walsh GL, et al. Does the timing of esophagectomy after chemoradiation affect outcome? Ann Thorac Surg. 2012;93(1):207–13.
34. Tessier W, Gronnier C, Messager M, Hec F, Mirabel X, Robb WB, et al. Does timing of surgical procedure after neoadjuvant chemoradiation affect outcomes in esophageal cancer? Ann Thorac Surg 2014;97(4):1181–9.
35. Schwarz L, Vernerey D, Bachet JB, Tuech JJ, Portales F, Michel P, et al. Resectable pancreatic adenocarcinoma neo-adjuvant FOLFIRINOX-based chemotherapy - a multicenter, non-comparative, randomized, phase II trial (PANACHE01-PRODIGE48 study). BMC Cancer. 2018;18(1):1–14.
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Ocaña Jiménez J, Priego P, Cuadrado M, Blázquez L, Sánchez Picot S, Pastor Peinado P, et all. Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer. 6763/2019


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Publication history

Received: 21/11/2019

Accepted: 23/01/2020

Online First: 04/06/2020

Published: 30/07/2020

Article revision time: 55 days

Article Online First time: 196 days

Article editing time: 252 days


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