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Abstract
Introduction. Data from various studies on the impact of a complete pathological response (pCR) following neoadjuvant therapy on long-term oncological outcomes in gastric cancer remain inconsistent. Furthermore, there is no consensus regarding the influence of different neoadjuvant therapy regimens on patient survival or the efficacy of adjuvant chemotherapy in this setting.
Aim. To analyze the treatment outcomes in patients with locally advanced gastric cancer who achieved a complete morphological response after various neoadjuvant therapy regimens.
Materials and Methods. More than 300 patients with locally advanced gastric cancer (adenocarcinoma) received combined modality treatment within protocol studies and routine clinical practice at the A.F. Tsyb Medical Radiological Research Center. Neoadjuvant (perioperative) therapy included FLOT chemotherapy, chemoradiotherapy (total dose of 45–46 Gy with concurrent capecitabine and oxaliplatin), or a combination thereof. A subset of patients was selected from the database for whom pathomorphological examination confirmed ypT0N0M0 or ypT0N+M0 staging.
Results. The analysis included 38 patients with a pathological stage of ypT0N0M0 and 4 patients with ypT0N+M0. In the ypT0N0M0 group, with a median follow-up of 43 months (range: 4–120 months), tumor progression was recorded in only one case. The overall survival rates for all patients (n=38) were: 1-year survival, 94.7 ± 3%; 3- and 5-year survival, 86.5 ± 6%. When postoperative mortality was excluded (n=36), these rates were 100% and 91.3 ± 6%, respectively. There were no differences in disease outcomes based on the neoadjuvant therapy method used, and the administration of adjuvant chemotherapy did not affect treatment results. Patients with complete primary tumor regression but persistent regional metastases (ypT0N+M0) had an unfavorable prognosis; tumor progression in the form of hematogenous and lymphogenous metastases was observed in three of the four patients.
Conclusion. A complete morphological response (complete therapeutic pathomorphosis) should be strictly defined as ypT0N0M0. Long-term outcomes for gastric cancer patients who achieve a pCR are highly favorable and appear to be independent of the specific neoadjuvant therapy technique. The use of adjuvant chemotherapy does not improve survival rates in this patient category.
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