Neoadjuvan kemoterapi alan mide kanseri hastalarında surviye etkili prognostik faktörler: Türkiye’den kesitsel bir çalışma

Abstract

Amaç: Mide kanseri ileri evrede karşımıza çıkar ve kansere bağlı ölümler arasında en üst sıralarda yer almaktadır. Overall sürviyi uzatmak için neoadjuvan kemoterapi alan mide kanseri hastalarında surviye etkili prognostik faktörleri araştırmayı amaçladık. Yöntemler: Kasım 2006 - Eylül 2019 tarihleri arasında mide kanseri nedeniyle ameliyat edilen hastalar retrospektif olarak incelendi. Neoadjuvan kemoterapi alan 46 hasta ile neoadjuvan kemoterapi almayan 194 hasta klinikopatolojik özelliklerine değerlendirildi. Neoadjuvan kemoterapi alan hastaların surviye etki eden prognostik faktörleri Cox regresyon analizi ile değerlendirildi. Bulgular: Neoadjuvan kemoterapi alan hastalar tüm hastaların %19.2’sini oluşturmaktaydı. Bu hastaların tümör yerleşim yeri genellikle üst ve orta yerleşimliydi (%73,9) ve istatistiksel bir farklılık mevcuttu (P=0,001). İki grup arasında sürvi bakımından istatistiksel bir farklılık yoktu. Ancak neoadjuvan kemoterapi alan hastaların pozitif lenf nodu sayısının fazla olması surviye etkili en önemli prognostik faktör olarak bulundu (P<0,01). Sonuç: Neoadjuvan kemoterapi sonrası pozitif lenf nodu sayısının yüksek olması sürvi bakımından en önemli prognostik faktör olup, cerrahi sonrası kemoterapi protokolü değiştirilebilinir veya kemoterapi ile beraber başka yöntemler uygulanabilinir.

Keywords

• Mide kanseri
• Neoadjuvan kemoterapi
• Prognostik faktörler
• Genel sürvi

Prognostic factors for survival among gastric cancer patients receiving neoadjuvant chemotherapy: A cross sectional study from Turkey

Abstract

Aim: Gastric cancer is usually diagnosed once it has reached the advanced stage and is one of the leading causes of cancer-related deaths. We investigated the prognostic factors for survival among gastric cancer patients undergoing neoadjuvant chemotherapy to prolong overall survival. Methods: A retrospective review was made of patients who underwent surgery for gastric cancer between November 2006 and September 2019. Clinicopathological characteristics were assessed in 46 patients receiving neoadjuvant chemotherapy and 194 patients not receiving neoadjuvant therapy. A Cox regression analysis was used to assess the prognostic factors for survival among the patients receiving neoadjuvant chemotherapy. Results: The patients receiving neoadjuvant chemotherapy accounted for 19.2% of the total. The tumors in these patients were located primarily in the upper and middle portions (73.9%), to a statistically significant degree (P=0.001). There was no statistical difference in survival between the two groups, although a high number of positive lymph nodes was identified among the patients receiving neoadjuvant chemotherapy as the most significant prognostic factor for survival (P<0.01). Conclusion: After neoadjuvant chemotherapy, multiple positive lymph nodes are the most important prognostic factor for survival; postoperative chemotherapy protocol can be changed or other methods can be applied together with chemotherapy.

Keywords

• Gastric cancer
• Neoadjuvant therapy
• prognostic factors
• overall survival

References

1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144:1941–53. doi: 10.1002/ijc.31937.
2. 2. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric Cancer: Descriptive Epidemiology, Risk Factors, Screening, and Prevention. Cancer Epidemiol Biomarkers Prev. 2014;23:700–13. doi: 10.1158/1055-9965.EPI-13-1057.
3. 3. Miao Z-F, Liu X-Y, Wang Z-N, Zhao T-T, Xu Y-Y, Song Y-X, et al. Effect of neoadjuvant chemotherapy in patients with gastric cancer: a PRISMA-compliant systematic review and meta-analysis. BMC Cancer. 2018 Jan 31;18(1):118. doi: 10.1186/s12885-018-4027-0.
4. 4. Tokunaga M, Sato Y, Nakagawa M, Aburatani T, Matsuyama T, Nakajima Y, et al. Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives. Surg Today. 1234;50:30–7. doi: 10.1007/s00595-019-01896-5.
5. 5. 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 Jul 6;355(1):11-20. doi: 10.1056/NEJMoa055531.
6. 6. Tian SB, Yu JC, Kang WM, Ma ZQ, Ye X, Yan C, et al. Effect of Neoadjuvant Chemotherapy Treatment on Prognosis of Patients with Advanced Gastric Cancer: a Retrospective Study. Chinese Med Sci J. 2015;30:84–9. doi: 10.1016/S1001-9294(15)30017-1.
7. 7. Sun Y, Yang L, Wang C, Zhao D, Cai J, Li W, et al. Prognostic factors associated with locally advanced gastric cancer patients treated with neoadjuvant chemotherapy followed by surgical resection. Oncotarget. 2017 Sep 6;8(43):75186-75194. doi: 10.18632/oncotarget.20660.
8. 8. Kodera Y, Sano T. Japanese gastric cancer treatment guidelines 2014 (ver. 4) Japanese Gastric Cancer Association 1. Gastric Cancer. 2017 Jan;20(1):1-19. doi: 10.1007/s10120-016-0622-4.

9. 9. Marano L, D’Ignazio A, Cammillini F, Angotti R, Messina M, Marrelli D, et al. Comparison between 7th and 8th edition of AJCC TNM staging system for gastric cancer: Old problems and new perspectives. Transl Gastroenterol Hepatol. 2019;4:2–5. doi: 10.21037/tgh.2019.03.09.
10. 10. Al-Batran S-E, Homann N, Pauligk C, Illerhaus G, Martens UM, Stoehlmacher J, et al. Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer The AIO-FLOT3 Trial Supplemental content. JAMA Oncol. 2017;3:1237–44. doi: 10.1001/jamaoncol.2017.0515.
11. 11. 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. 2014;12:1061–9. doi: 10.1016/j.ijsu.2014.08.349.
12. 12. 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;29:1715–21. doi: 10.1200/JCO.2010.33.0597.
13. 13. Xu A-M, Huang L, Liu W, Gao S, Han W-X, Wei Z-J. Neoadjuvant Chemotherapy Followed by Surgery versus Surgery Alone for Gastric Carcinoma: Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One. 2014 Jan 30;9(1):e86941. doi: 10.1371/journal.pone.0086941.
14. 14. Coccolini F, Nardi M, Montori G, Ceresoli M, Celotti A, Cascinu S, et al. Neoadjuvant chemotherapy in advanced gastric and esophago-gastric cancer. Meta-analysis of randomized trials. Int J Surg. 2018;51:120–7. doi: 10.1016/j.ijsu.2018.01.008.
15. 15. Liao Y, Yang ZL, Peng JS, Xiang J, Wang JP. Neoadjuvant chemotherapy for gastric cancer: A meta-analysis of randomized, controlled trials. J Gastroenterol Hepatol. 2013;28:777–82. doi: 10.1111/jgh.12152.
16. 16. Cats A, Jansen EPM, van Grieken NCT, Sikorska K, Lind P, Nordsmark M, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. Lancet Oncol. 2018;19:616–28. doi: 10.1016/S1470-2045(18)30132-3.