Nodal Downstaging in Gastric Cancer Patients: Promising Survival if ypN0 is Achieved

Annals of Surgical Oncology
Naruhiko IkomaBrian D Badgwell

Abstract

The American Joint Committee on Cancer's 8th edition introduced ypStage, a separate staging system for patients with gastric cancer having undergone preoperative therapy. Overall, ypN0 patients have better survival outcomes than ypN+ patients. However, whether patients with cN+/ypN0 disease ("downstaged N0") and those with cN0/ypN0 disease ("natural N0") have similar survival is unknown. An institutional database was reviewed to identify gastric adenocarcinoma patients who underwent potentially curative R0 resection after induction chemotherapy or chemoradiation. Patients were categorized into three groups based on nodal status: cN0/ypN0, cN+/ypN0, and ypN+. Univariable and multivariable Cox regression models were used to identify clinicopathologic factors associated with overall survival (OS). We identified 316 patients who met the study criteria. Ninety-four patients (30%) had cN0/ypN0 disease, 93 (29%) had cN+/ypN0 disease, and 129 (41%) had ypN+ disease. The median OS was 7.7 years, and the 5-year OS was 60.3%. In the multivariate analysis, OS did not differ between the cN0/ypN0 and cN+/ypN0 patients (hazard ratio, 0.90 [95% CI 0.54-1.48]; p = 0.666), but it was shorter in ypN+ patients (hazard ratio, 1.82 [95% CI 1.15-2.87...Continue Reading

References

Apr 25, 2009·Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association·Robert Michael Kwee, Thomas Christian Kwee
Aug 3, 2016·Annals of Surgical Oncology·Andrea ZanoniGiovanni de Manzoni
Oct 5, 2016·Journal of the National Comprehensive Cancer Network : JNCCN·Brian Badgwell
Mar 24, 2017·Annals of Surgical Oncology·Naruhiko IkomaBrian D Badgwell
Jun 24, 2017·Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association·Naruhiko IkomaBrian D Badgwell
Dec 28, 2017·International Journal of Radiation Oncology, Biology, Physics·Naruhiko IkomaBrian D Badgwell

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Citations

Oct 26, 2018·Annals of Surgical Oncology·Naruhiko Ikoma, Brian D Badgwell
Sep 26, 2019·Annals of Surgical Oncology·Casey J AllenBrian D Badgwell
Jul 28, 2019·Annals of Surgical Oncology·Alexander P StarkBrian D Badgwell
Jun 17, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Naruhiko IkomaBrian D Badgwell
Dec 24, 2020·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Masato HayashiHisayuki Matsushita

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