J Cancer 2021; 12(6):1669-1677. doi:10.7150/jca.49673

Research Paper

Histologic Lymph Nodes Regression after Preoperative Chemotherapy as Prognostic Factor in Non-metastatic Advanced Gastric Adenocarcinoma

Augustinas Bausys, MD1✉, Veslava Senina, MD2, Martynas Luksta, MD1, Giedre Anglickiene, MD3, Greta Molnikaite, MD4, Bernardas Bausys, MD4*, Andrius Rybakovas, MD, PhD1, Edita Baltruskeviciene, MD, PhD3, Arvydas Laurinavicius, MD, PhD5, Tomas Poskus, MD, PhD1, Rimantas Bausys, MD, PhD1, Dmitrij Seinin, MD5, Kestutis Strupas, MD, PhD1

1. Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
2. National Centre of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
3. Department of Medical Oncology, National Cancer Institute, Vilnius, Lithuania.
4. Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
5. Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
* undergraduate at the time of submission.

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Citation:
Bausys A, Senina V, Luksta M, Anglickiene G, Molnikaite G, Bausys B, Rybakovas A, Baltruskeviciene E, Laurinavicius A, Poskus T, Bausys R, Seinin D, Strupas K. Histologic Lymph Nodes Regression after Preoperative Chemotherapy as Prognostic Factor in Non-metastatic Advanced Gastric Adenocarcinoma. J Cancer 2021; 12(6):1669-1677. doi:10.7150/jca.49673. Available from https://www.jcancer.org/v12p1669.htm

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Abstract

Background: The study aims to evaluate the lymph node (LN) response to preoperative chemotherapy and its impact on long-term outcomes in advanced gastric cancer (AGC).

Methods: Histological specimens retrieved at gastrectomy from patients who received preoperative chemotherapy were evaluated. LN regression was graded by the adapted tumor regression grading system proposed by Becker. Patients were classified as node-negative (lnNEG) in the case of all negative LN without evidence of previous tumor involvement. Patients with LN metastasis were classified as nodal responders (lnR) in case of a regression score 1a-2 was detected in the LN. Nodal non-responders (lnNR) had a regression score of 3 in all of the metastatic nodes. Survival was compared using Kaplan-Meier and Cox regression analysis.

Results: Among 87 patients included in the final analysis 29.9 % were lnNEG, 21.8 % were lnR and 48.3 % were lnNR. Kaplan-Meier curves showed a survival benefit for lnR over lnNR (p=0.03), while the survival of lnR and lnNEG patients was similar. Cox regression confirmed nodal response to be associated with decreased odds for death in univariate (HR: 0.33; 95 % CI 0.11-0.96, p=0.04) and multivariable (HR 0.37; 95 CI% 0.14-0.99, p=0.04) analysis.

Conclusions: Histologic regression of LN metastasis after preoperative chemotherapy predicts the increased survival of patients with non-metastatic resectable AGC.

Keywords: gastric cancer, preoperative chemotherapy, histological regression, nodal regression.