The value of restaging CT following neoadjuvant chemotherapy for resectable gastric cancer. A population-based study

World Journal of Surgical Oncology

Alina Desiree Sandø¹  Jon Erik Grønbech¹  Erling Audun Bringeland¹  Reidun Fougner² 

[1] Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006, Trondheim, Norway;Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Department of Radiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;

关键词: Gastric cancer;    Response evaluation;    Neoadjuvant chemotherapy;    Downstaging;   

DOI  :  10.1186/s12957-021-02313-3

来源: Springer

【 摘 要 】

BackgroundResponse evaluation following neoadjuvant chemotherapy (NAC) in gastric cancer is debated. The aim of this study was to investigate the value of UICC-downstaging as mode of response evaluation following a MAGIC-style regimen of NAC.MethodsRetrospective, population-based study on consecutive patients with resectable gastric adenocarcinoma receiving NAC from 2007 to 2016. CT-scan was obtained at diagnosis (rTNM) and repeated following NAC (yrTNM) to evaluate response in terms of downstaging. Further, yrTNM stage was crosstabulated to pathologic stage (ypTNM) to depict correlation between radiologic and pathologic assessment.ResultsOf 171 patients receiving NAC, 169 were available for response evaluation. For TNM-stages, 43% responded, 50% had stable disease and 7% progressed at CT. Crosstabulating yrTNM stage to ypTNM stage, 24% had concordant stages, with CT overstaging 38% and understaging 38% of the tumours, Cohen kappa ƙ = 0,06 (95%CI 0.004–0.12). Similar patterns of discordance were found for T-stages and N-stages separately. For M-category, restaging CT detected 12 patients with carcinomatosis, with an additional 14 diagnosed with carcinomatosis only at operation. No patient developed parenchymal or extra abdominal metastases, and none developed locally non-resectable tumour during delivery of NAC. Restaging CT with response evaluation was not able to stratify patients into groups of different long-term survival rates based on response mode.ConclusionsRoutine CT-scan following NAC is of limited value. Accuracy of CT staging compared to final pathologic stage is poor, and radiologic downstaging as measure of response evaluation is unreliable and unable to discriminate long-term survival rates based on response mode.

【 授权许可】

CC BY