SSO 2018: Improved Survival With Nodal Downstaging in Gastric Cancer if ypN0 Is Achieved
A team of researchers led by Naruihiko Ikoma, MD, MS, of The University of Texas MD Anderson Cancer Center in Houston, analyzed outcomes in 316 patients with gastric cancer to determine whether patients who had clinically positive nodal disease before preoperative therapy have similar survival to those with node-negative disease before neoadjuvant treatment. Their findings were presented at the 2018 Society for Surgical Oncology (SSO) Annual Cancer Symposium (Abstract 4).
The American Joint Committee on Cancer 8th edition Cancer Staging Manual introduced yp stage for patients with gastric cancer due to the increasing use of preoperative therapy. It is known that patients with ypN0 disease have better survival than those with ypN+ disease. However, whether patients with clinically positive nodal disease before preoperative therapy (cN+ ypN0) have similar survival to those with “natural N0” disease (cN0 ypN0) is unknown.
Major Findings
Dr. Ikoma’s team reviewed an institutional database to identify patients with gastric adenocarcinoma who underwent surgery after preoperative chemotherapy or chemoradiotherapy. Patients were categorized into three groups based on nodal status: natural N0 (cN0 ypN0), downstaged N0 (cN+ ypN0), and ypN+. Ninety-four (30%) had natural N0, 93 (29%) had downstaged N0, and 129 (41%) had ypN+ disease. Univariable and multivariable Cox regressions were performed to determine associations with overall survival.
In patients with gastric cancer who underwent preoperative therapy, the researchers found similar overall survival in patients with natural N0 and those with downstaged N0 disease—but it was shorter in ypN+ patients. As ypN+ patients had poor overall survival, the investigators concluded, achieving ypN0 status is an important hallmark demonstrating the effectiveness of preoperative therapy.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
