Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy.
Published: 13th June 2019
Authors: J. X. Lin, C. Yoon, J. Desiderio, B. C. Yi, P. Li, C. H. Zheng et al.
Neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy is commonly used for patients with locally advanced gastric adenocarcinoma. The eighth AJCC ypTNM staging system was validated based on patients undergoing more limited lymphadenectomy (less than D2). The aim of this study was to develop a system for accurate staging of patients with locally advanced gastric adenocarcinoma who receive neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy.
A modified system of ypTNM was developed, based on overall survival (OS) of patients receiving neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy at Memorial Sloan Kettering Cancer Center, and validated using data from an international cohort of patients who had similar treatment.
Of 325 patients in the derivation cohort, 33 (10·2 per cent) had ypT0 N0/+ tumours, which are not classifiable under the AJCC system. The 5‐year OS rate for modified ypTNM stages I, II, IIIA and IIIB was 89, 71, 42·3 and 10 per cent respectively, compared with 82, 65·2 and 24·1 for AJCC stages I, II and III respectively. The concordance index (0·730 versus 0·709), estimated area under the curve (0·765 versus 0·740) and time‐dependent receiver operating characteristic (ROC) curve throughout the observation period were all superior for modified ypTNM staging. For the validation cohort of 186 patients, the modified system was again better at separating patients into prognostic groups for OS.
The modified ypTNM staging system improves the accuracy of OS prediction for patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy.Full text
You may also be interested in
Effect of neoadjuvant chemoradiation on preoperative pulmonary physiology, postoperative respiratory complications and quality of life in patients with oesophageal cancer.
Authors: J. A. Elliott, L. O'Byrne, G. Foley, C. F. Murphy, S. L. Doyle, S. King et al.
Quality assurance of surgery in the randomized ST03 trial of perioperative chemotherapy in carcinoma of the stomach and gastro‐oesophageal junction.
Authors: W. H. Allum, E. C. Smyth, J. M. Blazeby, H. I. Grabsch, S. M. Griffin, S. Rowley et al.
Meta‐analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis.
Authors: N. Moody, A. Adiamah, F. Yanni, D. Gomez
Authors: Y. Y. Broza, S. Khatib, A. Gharra, A. Krilaviciute, H. Amal, I. Polaka et al.
Authors: S. Ahlin, C. Cefalù, I. Bondia‐Pons, E. Capristo, L. Marini, A. Gastaldelli et al.
Hepatectomy for hepatocellular carcinoma after perioperative management of portal hypertension. BJS 2019; 106: 1066-1074.
Authors: N. Takemura, T. Aoki, K. Hasegawa, J. Kaneko, J. Arita, N. Akamatsu et al.
Meta‐analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy. BJS 2019; 106: 534-547.
Authors: D. Schizas, M. Kosmopoulos, S. Giannopoulos, S. Giannopoulos, D. G. Kokkinidis, N. Karampetsou et al.
Changes in gut hormones, glycaemic response and symptoms after oesophagectomy. BJS 2019; 106: 735-746.
Authors: J. A. Elliott, N. G. Docherty, C. F. Murphy, H.‐G. Eckhardt, S. L. Doyle, E. M. Guinan et al.
Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer. BJS 2019; 106: 596-605.
Authors: S. E. Vollenbrock, F. E. M. Voncken, J. M. van Dieren, D. M. J. Lambregts, M. Maas, G. J. Meijer et al.
Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. BJS 2019; 106: 626-635.
Authors: T. Mizuno, T. Ebata, Y. Yokoyama, T. Igami, J. Yamaguchi, S. Onoe et al.
Meta‐analysis of clinical outcome after treatment for achalasia based on manometric subtypes. BJS 2019; 106: 332-341.
Authors: C. Andolfi, P. M. Fisichella