Long term survival after R0 resection in locally advanced gastric cancer
date: 15 – 17 September 2010
topic: Esophageal and Gastric Cancer
organizer: ESSO
location: Bordeaux, France
Methods: 47 patients with LAGC, staged by laparoscopy, underwent D2-gastrectomy after preoperative chemotherapy.
The effects of preoperative treatment has been evaluated by a ‘‘quantitative analysis’’, which determines the percentage of residual vital tumor cells in the surgical specimens and by a ‘‘qualitative analysis’’, which evaluates the achievement of tumor-downstaging (T/dwn) induced by any grade of pathologic response.
T/dwn after preoperative chemotherapy was assessed comparing pre-treatment clinical and laparoscopic staging with post-operative pathologic staging. The χ2 test was used to evaluate the significance of statistical differences among sub-groups. Survival was calculated by Kaplan–Meier method and the prognostic significance of prognostic factors was determined by means of univariate analysis (log-rank test). Multivariate analysis was performed using the Cox proportional hazard model in backward stepwise regression.
Results: “Quantitative analysis” of pathologic response was unable to show a clear prognostic significance.
T/dwn was obtained in 25 out of 47 patients. T/dwn was associated with a smaller tumor diameter (mean=34 mm. in T/dwn group versus 55 mm. in non-T/dwn group, p=0.002) and a higher R0-resection rate (96% in T/dwn group versus 72% in no-T/dwn group, p=0.04).
Overall survival at 5 years was 55%. In those patients who benefited from a R0-resection (40/47 patients: R0-resection rate = 85%) overall survival reached up to 63%. At univariate and multivariate analysis, R0-resection was found to be an independent prognostic factor (R1-2/R0: HR 6.250/1, p=0.002).
Conclusions: In this study, R0-resection was the most important prognostic factor for LAGC selected to be treated by preoperative chemotherapy. Patients who obtained T/dwn had a definitely better chance of cure, mainly through the achievement of a true R0-resection.