Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
Gastric Cancer. 2015 Apr;18(2):314-25. doi: 10.1007/s10120-014-0367-x. Epub 2014 Apr 11.
Neoadjuvant chemotherapy is an accepted standard of care for locally advanced esophagogastric cancer. As only a subgroup benefits, a response-based tailored treatment would be of interest. The aim of our study was the evaluation of the prognostic and predictive value of clinical response in esophagogastric adenocarcinomas.
Clinical response based on a combination of endoscopy and computed tomography (CT) scan was evaluated retrospectively within a prospective database in center A and then transferred to center B. A total of 686/740 (A) and 184/210 (B) patients, staged cT3/4, cN0/1 underwent neoadjuvant chemotherapy and were then re-staged by endoscopy and CT before undergoing tumor resection. Of 184 patients, 118 (B) additionally had an interim response assessment 4-6 weeks after the start of chemotherapy.
In A, 479 patients (70%) were defined as clinical nonresponders, 207 (30%) as responders. Median survival was 38 months (nonresponders: 27 months, responders: 108 months, log-rank, p < 0.001). Clinical and histopathological response correlated significantly (p < 0.001). In multivariate analysis, clinical response was an independent prognostic factor (HR for death 1.4, 95% CI 1.0-1.8, p = 0.032). In B, 140 patients (76%) were nonresponders and 44 (24%) responded. Median survival was 33 months, (nonresponders: 27 months, responders: not reached, p = 0.003). Interim clinical response evaluation (118 patients) also had prognostic impact (p = 0.008). Interim, preoperative clinical response and histopathological response correlated strongly (p < 0.001).
Preoperative clinical response was an independent prognostic factor in center A, while in center B its prognostic value could only be confirmed in univariate analysis. The accordance with histopathological response was good in both centers, and interim clinical response evaluation showed comparable results to preoperative evaluation.
新辅助化疗是局部晚期食管胃腺癌的公认标准治疗方法。由于只有一部分患者从中受益，因此基于反应的个体化治疗将是一个研究方向。本研究的目的是评估食管胃腺癌患者的临床反应的预后和预测价值。
本研究在中心 A 前瞻性数据库中回顾性评估了基于内镜和计算机断层扫描（CT）的临床反应，然后将数据转移到中心 B。共有 686/740 例（A）和 184/210 例（B）cT3/4、cN0/1 期的患者接受了新辅助化疗，然后在内镜和 CT 重新分期后行肿瘤切除。在 184 例患者中，118 例（B）患者在化疗开始后 4-6 周还进行了中期反应评估。
在 A 中，479 例（70%）患者被定义为临床无应答者，207 例（30%）患者为应答者。中位生存期为 38 个月（无应答者：27 个月，应答者：108 个月，对数秩检验，p < 0.001）。临床和组织病理学反应显著相关（p < 0.001）。多变量分析显示，临床反应是独立的预后因素（死亡风险比 1.4，95%CI 1.0-1.8，p = 0.032）。在 B 中，140 例（76%）患者为无应答者，44 例（24%）患者为应答者。中位生存期为 33 个月（无应答者：27 个月，应答者：未达到，p = 0.003）。中期临床反应评估（118 例患者）也具有预后意义（p = 0.008）。中期、术前临床反应和组织病理学反应之间具有很强的相关性（p < 0.001）。
在中心 A，术前临床反应是独立的预后因素，而在中心 B，其预后价值仅在单因素分析中得到证实。两个中心的临床反应与组织病理学反应的一致性良好，中期临床反应评估与术前评估结果相当。
