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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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).

Results

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]; p = 0.01).

Conclusions

In gastric cancer patients who underwent preoperative therapy, we found similar OS in cN0/ypN0 and cN+/ypN0 patients. Because ypN+ patients had poor OS, achieving ypN0 status is an important hallmark demonstrating the effectiveness of preoperative therapy for gastric cancer.

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Disclosures

The authors have no conflicts of interest to disclose. Supported by the NIH/NCI under award number P30CA016672 and used the Clinical Trials Support Resource.

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Authors and Affiliations

  1. Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Naruhiko Ikoma MD, MS, Keith F. Fournier MD, Paul Mansfield MD & Brian D. Badgwell MD, MS

  2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeannelyn S. Estrella MD

  3. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wayne Hofstetter MD

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das MD, MPH & Bruce D. Minsky MD

  5. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jaffer A. Ajani MD

Authors
  1. Naruhiko Ikoma MD, MS
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  2. Jeannelyn S. Estrella MD
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  3. Wayne Hofstetter MD
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  4. Prajnan Das MD, MPH
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  5. Bruce D. Minsky MD
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  6. Jaffer A. Ajani MD
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  7. Keith F. Fournier MD
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  8. Paul Mansfield MD
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  9. Brian D. Badgwell MD, MS
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Corresponding author

Correspondence to Brian D. Badgwell MD, MS.

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Ikoma, N., Estrella, J.S., Hofstetter, W. et al. Nodal Downstaging in Gastric Cancer Patients: Promising Survival if ypN0 is Achieved. Ann Surg Oncol 25, 2012–2017 (2018). https://doi.org/10.1245/s10434-018-6471-0

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  • DOI: https://doi.org/10.1245/s10434-018-6471-0

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