Öz
Background and Aims: Neoadjuvant therapy has become the standard of care for patients with locally advanced gastric and gastroesophageal junction adenocarcinoma. This study aimed to evaluate the prognostic and predictive value of the neoadjuvant rectal score, originally developed for rectal cancer, in this patient population. Materials and Methods: Sixty-six patients who underwent surgery after neoadjuvant chemotherapy for locally advanced gastric or gastroesophageal junction adenocarcinoma between 2017 and 2024 were retrospectively analyzed. Neoadjuvant rectal score, a validated biomarker for evaluating treatment response and prognosis in rectal cancer patients who underwent surgery after neoadjuvant therapy, was calculated using a mathematical formula that includes residual tumor size, pathological lymph node status, and pretreatment clinical stage. Survival analyses were performed using Kaplan-Meier and Cox regression methods. The optimal cutoff value was determined by ROC curve analysis. Results: The optimal neoadjuvant rectal cutoff was 13.78 (AUC: 0.71; p < 0.001), classifying 80.3% of patients as high risk. Median disease-free survival in the high-risk group was 25 months, while it was not reached in the low-risk group (p = 0.046). The difference in overall survival showed a trend but was not statistically significant (p = 0.083). In multivariate analysis, the neoadjuvant rectal score (p = 0.010) and adjuvant chemotherapy (p < 0.001) were independent predictors of disease-free survival. For overall survival, only adjuvant therapy was statistically significant (p = 0.001). No significant interaction was observed between neoadjuvant rectal score and adjuvant therapy (p = 0.605). Conclusion: The neoadjuvant rectal score is a useful prognostic tool reflecting pathological response and survival in gastric and gastroesophageal junction adenocarcinomas treated with neoadjuvant therapy. However, its predictive value for adjuvant treatment benefit was not demonstrated. Prospective studies are needed for external validation.
Anahtar Kelimeler
Gastric cancer gastroesophageal junction NAR score neoadjuvant therapy adjuvant chemotherapy survival
Kaynakça
- 1. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021.
- 2. National Cancer Institute. Cancer of the Stomach - Cancer Stat Facts [Available from: https://seer.cancer.gov/statfacts/html/stomach.html.
- 3. Cunningham D, Allum WH, Stenning SP, et al; MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20.
- 4. Ychou M, Boige V, Pignon JP, 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(13):1715-21.
- 5. Al-Batran SE, Homann N, Pauligk C, et al; FLOT4-AIO Investigators. 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(10184):1948-57.
- 6. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26(5):778-85.
- 7. Hellmann MD, Chaft JE, William WN Jr, et al; University of Texas MD Anderson Lung Cancer Collaborative Group. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet Oncol. 2014;15(1):e42-50.
- 8. Maas M, Nelemans PJ, Valentini V, 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.
- 9. Sun Y, Zhang Y, Wu X, et al. Prognostic significance of neoadjuvant rectal score in locally advanced rectal cancer after neoadjuvant chemoradiotherapy and construction of a prediction model. J Surg Oncol. 2018;117(4):737-44.
- 10. Derieux S, Svrcek M, Manela S, et al. Evaluation of the prognostic impact of pathologic response to preoperative chemotherapy using Mandard's Tumor Regression Grade (TRG) in gastric adenocarcinoma. Dig Liver Dis. 2020;52(1):107-14.
- 11. Sandø AD, Fougner R, Røyset ES, et al. Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer. Cancers (Basel). 2023;15(8):2318.
- 12. George TJ Jr, Allegra CJ, Yothers G. Neoadjuvant Rectal (NAR) Score: a New Surrogate Endpoint in Rectal Cancer Clinical Trials. Curr Colorectal Cancer Rep. 2015;11(5):275-80.
- 13. Mukai T, Uehara K, Aiba T, et al. Importance of the neoadjuvant rectal (NAR) score to the outcome of neoadjuvant chemotherapy alone for locally advanced rectal cancer. Surg Today. 2020;50(8):912-9.
- 14. Shah S, Asawa P, Abel S, Wegner RE. Validation of the Neoadjuvant Rectal Cancer (NAR) Score for Prognostication Following Total Neoadjuvant Therapy (TNT) for Locally Advanced Rectal Cancer. J Gastrointest Cancer. 2023;54(3):829-36.
- 15. Ucar G, Acikgoz Y, Ergun Y, et al. Prognostic and Predictive Value of NAR Score in Gastric Cancer. J Gastrointest Cancer. 2021;52(3):1054-60.
- 16. Wehrle CJ, Seavey CN, Chang J, et al. Neoadjuvant Gastric Score: How Response to Neoadjuvant Chemotherapy Affects Overall Survival and Adjuvant Benefit. Ann Surg Oncol. 2023;30(12):7240-50.
Öz
Giriş ve Amaç: Lokal ileri mide ve gastroözofageal bileşke adenokarsinomlarında neoadjuvan tedavi standart yaklaşım haline gelmiştir. Bu çalışmada, rektum kanserinde kullanılan neoadjuvan rektal skorunun bu hasta grubunda sağkalım üzerindeki prognostik ve prediktif değerini araştırmayı amaçladık. Gereç ve Yöntem: 2017–2024 yılları arasında neoadjuvan kemoterapi sonrası cerrahi uygulanan lokal ileri mide veya gastroözofageal bileşke adenokarsinomlu 66 hasta retrospektif olarak değerlendirildi. Neoadjuvan tedavi sonrası opere olan rektum kanserli hastalarda tedavi yanıtı ve prognozu değerlendirmede valide edilmiş bir biyobelirteç olan neoadjuvan rektal skoru rezidü tümör boyutu ve patolojik lenf nodu durumu ve tedavi öncesi klinik evreyi içeren matematiksel bir formülle hesaplandı. Sağkalım analizleri Kaplan-Meier ve Cox regresyon yöntemleriyle yapıldı. ROC analiziyle optimal kesim değeri belirlendi. Bulgular: Neoadjuvan rektal skoru için optimal kesim değeri 13.78 idi (AUC: 0.71; p < 0.001). Hastaların %80.3’ü yüksek riskli olarak sınıflandırıldı. Yüksek risk grubunda medyan hastalıksız sağkalım 25 ay olup, düşük risk grubunda medyana ulaşılamadı (p = 0.046). Genel sağkalımda fark eğilim düzeyindeydi (p = 0.083). Çok değişkenli analizde neoadjuvan rektal skoru (p = 0.010) ve adjuvan tedavi (p < 0.001) hastalıksız sağkalım için bağımsız belirteçti. Genel sağkalım için yalnızca adjuvan tedavi anlamlı bulundu (p = 0.001). Neoadjuvan rektal skoru ile adjuvan tedavi arasında anlamlı etkileşim saptanmadı (p = 0.605). Sonuç: Neoadjuvan rektal skoru, mide ve gastroözofageal bileşke kanserinde neoadjuvan tedavi yanıtını yansıtan, sağkalımı öngörmede etkili bir prognostik araçtır. Ancak prediktif rolü desteklenmemiştir. Prospektif çalışmalarla doğrulanması gereklidir.
Anahtar Kelimeler
Mide kanseri Gastroözofageal bileşke Neoadjuvan tedavi NAR skoru Prognostik faktör Patolojik yanıt Adjuvan kemoterapi Sağkalım
Etik Beyan
Bu çalışma Ankara Üniversitesi Tıp Fakültesi İnsan Araştırmaları Etik Kurulu’nun 25.10.2024 tarih ve İ09-708-24 sayılı kararı ile onaylanmıştır. Helsinki Bildirgesi'nin etik ilkelerine uygun olarak yürütülmüştür.
Destekleyen Kurum
Yoktur
Kaynakça
- 1. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021.
- 2. National Cancer Institute. Cancer of the Stomach - Cancer Stat Facts [Available from: https://seer.cancer.gov/statfacts/html/stomach.html.
- 3. Cunningham D, Allum WH, Stenning SP, et al; MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20.
- 4. Ychou M, Boige V, Pignon JP, 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(13):1715-21.
- 5. Al-Batran SE, Homann N, Pauligk C, et al; FLOT4-AIO Investigators. 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(10184):1948-57.
- 6. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26(5):778-85.
- 7. Hellmann MD, Chaft JE, William WN Jr, et al; University of Texas MD Anderson Lung Cancer Collaborative Group. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet Oncol. 2014;15(1):e42-50.
- 8. Maas M, Nelemans PJ, Valentini V, 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.
- 9. Sun Y, Zhang Y, Wu X, et al. Prognostic significance of neoadjuvant rectal score in locally advanced rectal cancer after neoadjuvant chemoradiotherapy and construction of a prediction model. J Surg Oncol. 2018;117(4):737-44.
- 10. Derieux S, Svrcek M, Manela S, et al. Evaluation of the prognostic impact of pathologic response to preoperative chemotherapy using Mandard's Tumor Regression Grade (TRG) in gastric adenocarcinoma. Dig Liver Dis. 2020;52(1):107-14.
- 11. Sandø AD, Fougner R, Røyset ES, et al. Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer. Cancers (Basel). 2023;15(8):2318.
- 12. George TJ Jr, Allegra CJ, Yothers G. Neoadjuvant Rectal (NAR) Score: a New Surrogate Endpoint in Rectal Cancer Clinical Trials. Curr Colorectal Cancer Rep. 2015;11(5):275-80.
- 13. Mukai T, Uehara K, Aiba T, et al. Importance of the neoadjuvant rectal (NAR) score to the outcome of neoadjuvant chemotherapy alone for locally advanced rectal cancer. Surg Today. 2020;50(8):912-9.
- 14. Shah S, Asawa P, Abel S, Wegner RE. Validation of the Neoadjuvant Rectal Cancer (NAR) Score for Prognostication Following Total Neoadjuvant Therapy (TNT) for Locally Advanced Rectal Cancer. J Gastrointest Cancer. 2023;54(3):829-36.
- 15. Ucar G, Acikgoz Y, Ergun Y, et al. Prognostic and Predictive Value of NAR Score in Gastric Cancer. J Gastrointest Cancer. 2021;52(3):1054-60.
- 16. Wehrle CJ, Seavey CN, Chang J, et al. Neoadjuvant Gastric Score: How Response to Neoadjuvant Chemotherapy Affects Overall Survival and Adjuvant Benefit. Ann Surg Oncol. 2023;30(12):7240-50.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Ağustos 2025 |
| Gönderilme Tarihi | 24 Mayıs 2025 |
| Kabul Tarihi | 12 Ağustos 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 24 Sayı: 2 |
test-5