Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer

Background and Objectives It is unknown whether the degree of response to preoperative therapy correlates with locoregional recurrence (LR) or distant recurrence (DR) after resection of gastric cancer. Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chem...

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Published in:Journal of surgical oncology 2020-09, Vol.122 (3), p.422-432
Main Authors: Stark, Alexander P., Estrella, Jeannelyn S., Chiang, Yi‐Ju, Das, Prajnan, Minsky, Bruce D., Blum Murphy, Mariela A., Ajani, Jaffer A., Mansfield, Paul, Badgwell, Brian D., Ikoma, Naruhiko
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Language:English
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Gastric cancer
neoadjuvant
radiation therapy
recurrence
tumor regression grade
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cited_by cdi_FETCH-LOGICAL-c4434-a28c4e0ebc29c57302ef2987c5301ade64dff8029a8976dbfb3af0eda074f43f3
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container_title Journal of surgical oncology
container_volume 122
creator Stark, Alexander P.
Estrella, Jeannelyn S.
Chiang, Yi‐Ju
Das, Prajnan
Minsky, Bruce D.
Blum Murphy, Mariela A.
Ajani, Jaffer A.
Mansfield, Paul
Badgwell, Brian D.
Ikoma, Naruhiko
description Background and Objectives It is unknown whether the degree of response to preoperative therapy correlates with locoregional recurrence (LR) or distant recurrence (DR) after resection of gastric cancer. Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chemoradiation (1995‐2015) were reviewed. The tumor regression grade (TRG) was defined by the percentage of viable tumor cells in the specimen (TRG0 = 0%; TRG1 = 1%‐2%; TRG2 = 3%‐50%; TRG3 ≥ 50%). The relationships among TRG, recurrence‐free survival (RFS), LR, and DR were examined. Results Two hundred forty‐seven patients met the inclusion criteria (TRG0, 52 [21%]; TRG1, 49 [20%]; TRG2, 98 [40%]; TRG3, 48 [19%]). LR and DR occurred in 6.1% and 32.0% of patients, respectively. No patient with TRG0 experienced LR. R1 resection (6%‐15%) and LR (6%‐8%) rates were similar among TRG1‐3 patients. R1 resection was associated with LR (hazard ratio [HR], 17.85; P 
doi_str_mv 10.1002/jso.25984
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Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chemoradiation (1995‐2015) were reviewed. The tumor regression grade (TRG) was defined by the percentage of viable tumor cells in the specimen (TRG0 = 0%; TRG1 = 1%‐2%; TRG2 = 3%‐50%; TRG3 ≥ 50%). The relationships among TRG, recurrence‐free survival (RFS), LR, and DR were examined. Results Two hundred forty‐seven patients met the inclusion criteria (TRG0, 52 [21%]; TRG1, 49 [20%]; TRG2, 98 [40%]; TRG3, 48 [19%]). LR and DR occurred in 6.1% and 32.0% of patients, respectively. No patient with TRG0 experienced LR. R1 resection (6%‐15%) and LR (6%‐8%) rates were similar among TRG1‐3 patients. R1 resection was associated with LR (hazard ratio [HR], 17.85; P &lt; .001). ypN status (HR, 2.44; P = .004) and linitis plastica (HR, 2.90; P &lt; .001) were associated with DR. TRG was not independently associated with RFS, LR, or DR. Conclusions TRG0 imparted excellent local control. However, TRG1‐3 patients had similar R1 resection rates and therefore similar LR. DR is associated with ypN status and linitis plastica, not TRG.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.25984</identifier><identifier>PMID: 32462681</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Gastric cancer ; neoadjuvant ; radiation therapy ; recurrence ; tumor regression grade</subject><ispartof>Journal of surgical oncology, 2020-09, Vol.122 (3), p.422-432</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4434-a28c4e0ebc29c57302ef2987c5301ade64dff8029a8976dbfb3af0eda074f43f3</citedby><cites>FETCH-LOGICAL-c4434-a28c4e0ebc29c57302ef2987c5301ade64dff8029a8976dbfb3af0eda074f43f3</cites><orcidid>0000-0003-3705-5964 ; 0000-0001-8463-5414 ; 0000-0002-9825-9234 ; 0000-0002-9915-8355</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32462681$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stark, Alexander P.</creatorcontrib><creatorcontrib>Estrella, Jeannelyn S.</creatorcontrib><creatorcontrib>Chiang, Yi‐Ju</creatorcontrib><creatorcontrib>Das, Prajnan</creatorcontrib><creatorcontrib>Minsky, Bruce D.</creatorcontrib><creatorcontrib>Blum Murphy, Mariela A.</creatorcontrib><creatorcontrib>Ajani, Jaffer A.</creatorcontrib><creatorcontrib>Mansfield, Paul</creatorcontrib><creatorcontrib>Badgwell, Brian D.</creatorcontrib><creatorcontrib>Ikoma, Naruhiko</creatorcontrib><title>Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer</title><title>Journal of surgical oncology</title><addtitle>J Surg Oncol</addtitle><description>Background and Objectives It is unknown whether the degree of response to preoperative therapy correlates with locoregional recurrence (LR) or distant recurrence (DR) after resection of gastric cancer. Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chemoradiation (1995‐2015) were reviewed. The tumor regression grade (TRG) was defined by the percentage of viable tumor cells in the specimen (TRG0 = 0%; TRG1 = 1%‐2%; TRG2 = 3%‐50%; TRG3 ≥ 50%). The relationships among TRG, recurrence‐free survival (RFS), LR, and DR were examined. Results Two hundred forty‐seven patients met the inclusion criteria (TRG0, 52 [21%]; TRG1, 49 [20%]; TRG2, 98 [40%]; TRG3, 48 [19%]). LR and DR occurred in 6.1% and 32.0% of patients, respectively. No patient with TRG0 experienced LR. R1 resection (6%‐15%) and LR (6%‐8%) rates were similar among TRG1‐3 patients. R1 resection was associated with LR (hazard ratio [HR], 17.85; P &lt; .001). ypN status (HR, 2.44; P = .004) and linitis plastica (HR, 2.90; P &lt; .001) were associated with DR. TRG was not independently associated with RFS, LR, or DR. Conclusions TRG0 imparted excellent local control. However, TRG1‐3 patients had similar R1 resection rates and therefore similar LR. DR is associated with ypN status and linitis plastica, not TRG.</description><subject>Gastric cancer</subject><subject>neoadjuvant</subject><subject>radiation therapy</subject><subject>recurrence</subject><subject>tumor regression grade</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kU1LxDAQhoMoun4c_AMS8OShmiZp01wEET8RPKjnkE0na5dtUyetsv_e6KrowVMyzDPPDLyE7OfsOGeMn8xjOOaFruQameRMl5lmulonk9TjmVSabZHtGOeMMa1LuUm2BJclL6t8QuJN21s30ODpMLYBKcIMIcYmdHSGtgaaPghuRITOAbV-AKQ9QugB7dC8AnXPkAZt3aQywbar6czGIQ0NoV1Sn6SfdeOos8mBu2TD20WEva93hzxdXjyeX2d391c352d3mZNSyMzyyklgMHVcu0IJxsFzXSlXCJany0pZe18xrm2lVVlP_VRYz6C2TEkvhRc75HTl7cdpC7WDbkC7MD02rcWlCbYxfztd82xm4dUoJfK8KJLg8EuA4WWEOJh5GLFLNxsuuRaiUqVK1NGKchhiRPA_G3JmPvIxKR_zmU9iD36f9EN-B5KAkxXw1ixg-b_J3D7cr5Tv0SGeXg</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Stark, Alexander P.</creator><creator>Estrella, Jeannelyn S.</creator><creator>Chiang, Yi‐Ju</creator><creator>Das, Prajnan</creator><creator>Minsky, Bruce D.</creator><creator>Blum Murphy, Mariela A.</creator><creator>Ajani, Jaffer A.</creator><creator>Mansfield, Paul</creator><creator>Badgwell, Brian D.</creator><creator>Ikoma, Naruhiko</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3705-5964</orcidid><orcidid>https://orcid.org/0000-0001-8463-5414</orcidid><orcidid>https://orcid.org/0000-0002-9825-9234</orcidid><orcidid>https://orcid.org/0000-0002-9915-8355</orcidid></search><sort><creationdate>20200901</creationdate><title>Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer</title><author>Stark, Alexander P. ; Estrella, Jeannelyn S. ; Chiang, Yi‐Ju ; Das, Prajnan ; Minsky, Bruce D. ; Blum Murphy, Mariela A. ; Ajani, Jaffer A. ; Mansfield, Paul ; Badgwell, Brian D. ; Ikoma, Naruhiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4434-a28c4e0ebc29c57302ef2987c5301ade64dff8029a8976dbfb3af0eda074f43f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Gastric cancer</topic><topic>neoadjuvant</topic><topic>radiation therapy</topic><topic>recurrence</topic><topic>tumor regression grade</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stark, Alexander P.</creatorcontrib><creatorcontrib>Estrella, Jeannelyn S.</creatorcontrib><creatorcontrib>Chiang, Yi‐Ju</creatorcontrib><creatorcontrib>Das, Prajnan</creatorcontrib><creatorcontrib>Minsky, Bruce D.</creatorcontrib><creatorcontrib>Blum Murphy, Mariela A.</creatorcontrib><creatorcontrib>Ajani, Jaffer A.</creatorcontrib><creatorcontrib>Mansfield, Paul</creatorcontrib><creatorcontrib>Badgwell, Brian D.</creatorcontrib><creatorcontrib>Ikoma, Naruhiko</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stark, Alexander P.</au><au>Estrella, Jeannelyn S.</au><au>Chiang, Yi‐Ju</au><au>Das, Prajnan</au><au>Minsky, Bruce D.</au><au>Blum Murphy, Mariela A.</au><au>Ajani, Jaffer A.</au><au>Mansfield, Paul</au><au>Badgwell, Brian D.</au><au>Ikoma, Naruhiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J Surg Oncol</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>122</volume><issue>3</issue><spage>422</spage><epage>432</epage><pages>422-432</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>Background and Objectives It is unknown whether the degree of response to preoperative therapy correlates with locoregional recurrence (LR) or distant recurrence (DR) after resection of gastric cancer. Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chemoradiation (1995‐2015) were reviewed. The tumor regression grade (TRG) was defined by the percentage of viable tumor cells in the specimen (TRG0 = 0%; TRG1 = 1%‐2%; TRG2 = 3%‐50%; TRG3 ≥ 50%). The relationships among TRG, recurrence‐free survival (RFS), LR, and DR were examined. Results Two hundred forty‐seven patients met the inclusion criteria (TRG0, 52 [21%]; TRG1, 49 [20%]; TRG2, 98 [40%]; TRG3, 48 [19%]). LR and DR occurred in 6.1% and 32.0% of patients, respectively. No patient with TRG0 experienced LR. R1 resection (6%‐15%) and LR (6%‐8%) rates were similar among TRG1‐3 patients. R1 resection was associated with LR (hazard ratio [HR], 17.85; P &lt; .001). ypN status (HR, 2.44; P = .004) and linitis plastica (HR, 2.90; P &lt; .001) were associated with DR. TRG was not independently associated with RFS, LR, or DR. Conclusions TRG0 imparted excellent local control. 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subjects Gastric cancer
neoadjuvant
radiation therapy
recurrence
tumor regression grade
title Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer
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