YPT AND YPN STAGING IMPACT ON GASTRIC CANCER PATIENT’S SURVIVAL COMPARED TO PT AND PN STAGING AFTER UPFRONT SURGERY (A SINGLE CENTER ANALYSIS)

The American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) Manual 8th ed. has developed a different stage grouping for patients receiving neoadjuvant therapy (ypTNM), with a significant prognostic impact, as demonstrated in some studies. What remains unclear is how these stages compare to the ones in patients treated with upfront surgery (pT and pN), and if that would favor one treatment strategy over the other. Objective: We aimed to compare the overall survival between the ypTNM and pTNM groups of gastric cancer patients treated with perioperative chemotherapy, versus those treated with upfront surgery. Method: This was a retrospective cohort study that included 666 patients with non-metastatic gastric or gastroesophageal (GE) junction adenocarcinoma treated with curative surgery with or without neoadjuvant chemotherapy (CTX) in the Department of Abdominal Surgery, from 2002 to 2016. Results: Among the study population, 230 received neoadjuvant CTX and 436 were treated with upfront surgery. Most patients were male (55.9%), with a mean age of 61.4 years and 65.9% were classified as ASA 2. Total gastrectomy was performed in 44.4% and a subtotal one in 55.6%, with D2 lymphadenectomy in 87.5%. Postoperative morbidity was 35.3%. Regarding pathological group staging, stage I subjects in the neoadjuvant group had overall 5-year survival of 95.2%, versus 82.5% in the upfront surgery one (p <0.017). In stages II and III, survival differences were not statistically significant (p values of 0.471 and 0.099, respectively), but among stage III individuals the perioperative CTX group had worse survival numbers (34.6% vs. 41.0%). When ypT and ypN stages were analyzed separately, the ypT0-2 group had increased overall survival compared to the pT0-2 one (87.9% vs 78.9%, p <0.046). In lymph node staging, pN0 patients had equivalent results to ypN0 (76% vs 80%). Conclusion: the comparison between ypN vs pN groups did not differ in survival regardless of the extent of lymph node involvement. Regarding staging groups, the post-CTX stage I subjects had better survival results when compared to the upfront surgery group, but stage III ones (non-responders) seemed to do worse than patients who had resection first.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019