FACTORS PREDICTING RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED GASTRIC CANCER

Abstract

Objective: In the treatment of local advanced gastric cancer (LAGC), it is recommended to start with neoadjuvant chemotherapy (NAC). Although the benefits of NAC have been shown, it is still not fully understood which patients respond better. The aim of this study was to investigate the effect of hematological and histopathological parameters on the response to chemotherapy. Material and Method: A retrospective examination was made of 38 patients who underwent surgery for LAGC after receiving NAC. Evaluations were made by comparing the demographic characteristics, histopathological characteristics in an endoscopic biopsy of the tumor, preoperative hemoglobin levels, and neutrophil-lymphocyte ratios with the postoperative pathological response to determine which tumor characteristics gave a better response. Results: In the postoperative histopathological evaluation, there was a pathological complete response to chemotherapy in two patients (6%), grade 1 in 9 patients (24%), grade 2 in 13 patients (34%), and grade 3 in 14 patients (36%). A statistically significant relationship was determined between the histopathological absence of perineural invasion and pathological complete response (p=0.023). Conclusion: A relationship between perineural invasion and poor response to chemotherapy was determined. Although not at a statistically significant level, there was also observed to be a poor response to chemotherapy in the presence of low grade and lymphovascular invasion.

Keywords

• Local advanced gastric cancer
• neoadjuvant chemotherapy response
• pathological complete response
• perineural invasion

LOKAL İLERİ MİDE KANSERİNDE NEOADJUVAN KEMOTERAPİYE YANITI ÖNGÖREN FAKTÖRLER

Abstract

Amaç: Lokal ileri mide kanserinde (LİMK) tedaviye neoadjuvan kemoterapi (NAK) ile başlanması önerilir. Ancak NAK’nin faydaları gösterilmiş olsa da hangi hasta gurubunun tedaviye daha iyi yanıt verdiği tam olarak anlaşılamamıştır. Çalışmamızda hematolojik ve histopatolojik parametrelerin kemoterapi yanıtı üzerine etkisi araştırılmıştır. Yöntem ve Gereç: Bu çalışmada lokal ileri evre mide kanseri nedeni ile neoadjuvan kemoterapi görüp sonrasında ameliyat edilen 38 hasta retrospektif olarak incelendi. Ameliyat sonrası patolojik yanıt ile hastanın demografik özellikleri, tümörün endoskopik biyopsideki histopatolojik özellikleri, preoperatif hemoglobin seviyesi, nötrofil lenfosit oranı karşılaştırılıp hangi özellikteki tümörlerin daha iyi yanıt verdiği değerlendirildi. Bulgular: Ameliyat sonrası yapılan histopatolojik değerlendirmede 2 (%6) hastada patolojik tam yanıt, 9 (%24) hastada grade 1 yanıt, 13 (%34) hastada grade 2 yanıt ve 14 hastada (%36) grade 3 yanıt mevcuttu. Patolojik tam yanıt ile histopatolojik olarak perinöral invazyon olmaması istatistiksel olarak anlamlı ilişki gösterdi (p=0.023). Sonuç: Çalışmamızda NAK alan LİMK’li hastalarda perinöral invazyon varlığının kemoterapiye kötü yanıt ile ilişkisi olduğu görülmüştür. Ayrıca lenfovaskular invazyon ve düşük grade mevcudiyetinde istatistiksel olarak anlamlı olmasa da kemoterapiye kötü yanıt gözlenmiştir.

Keywords

• Lokal ileri mide kanseri
• neoadjuvan kemoterapi yanıtı
• patolojik tam yanıt
• perinöral invazyon

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