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Tumor Regression Grade and Overall Survival following Gastrectomy with Preoperative Therapy for Gastric Cancer

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

Abstract

Background

Pre-/perioperative chemotherapy is well-established for management of locoregional gastric cancer (LRGC). The American Joint Committee on Cancer advocates histopathologic assessment of tumor regression grade (TRG) but does not endorse a specific schema. We sought to examine the prognostic value of the recently revised National Comprehensive Cancer Network (NCCN) definition of TRG specifying TRG0 as no disease in primary tumor or lymph nodes.

Patients and Methods

Patients with clinical-stage T2+/N+/M0 LRGC receiving preoperative chemotherapy and curative-intent gastrectomy were identified (2000–2020). TRG using the current NCCN definition was retrospectively assigned. Factors associated with TRG were examined using ordinal logistic regression and overall survival (OS) was assessed using the Kaplan–Meier method and Cox regression.

Results

Among 117 patients, the most common chemotherapy regimen was epirubicin, cisplatin, plus fluorouracil or capecitabine (ECF/ECX) (n = 48, 41%), followed by folinic acid, fluorouracil, and oxaliplatin (FOLFOX) (n = 30, 26%), and fluorouracil, leucovorin, oxaliplatin, plus docetaxel (FLOT) (n = 13, 11%). TRG3 was the most common histopathologic response (n = 68, 58%), followed by TRG2 (n = 25, 21%), TRG1 (n = 18, 15%), and, lastly, TRG0 (n = 6, 5.1%). The only preoperative factor independently associated with lower TRG was gastroesophageal junction tumor location (OR 0.24, p = 0.012). Higher TRG was independently associated with worse OS in a stepwise fashion (HR 1.49, p = 0.026). Posttreatment pathologic lymph node status was the strongest prognostic factor (HR 1.93, p = 0.026). Independent prognostic value of TRG and ypT stage could not be shown due to substantial overlap.

Conclusions

TRG using the contemporary NCCN definition is associated with OS in LRGC. TRG0 is uncommon but with excellent prognosis. ypN status is the strongest prognostic factor and the revised NCCN definition acknowledging this is appropriate.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Andrew J. Sinnamon MD, MSCE, Rutika Mehta MD, Sean P. Dineen MD, Luis R. Peña MD, Gregory Y. Lauwers MD & Jose M. Pimiento MD

  2. University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Michelle Savoldy BS

Authors
  1. Andrew J. Sinnamon MD, MSCE
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  2. Michelle Savoldy BS
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  3. Rutika Mehta MD
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  4. Sean P. Dineen MD
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  5. Luis R. Peña MD
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Corresponding author

Correspondence to Andrew J. Sinnamon MD, MSCE.

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Disclosures

Rutika Mehta: Consulting—Eli Lilly, Astellas; advisory board—Eli Lilly, Astellas, Novartis, BMS, Guardant Health, Boston Gene; speakers bureau—Natera, Daiichi Sankyo. This study was reviewed and approved by the institutional review board at Moffitt Cancer Center.

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Sinnamon, A.J., Savoldy, M., Mehta, R. et al. Tumor Regression Grade and Overall Survival following Gastrectomy with Preoperative Therapy for Gastric Cancer. Ann Surg Oncol 30, 3580–3589 (2023). https://doi.org/10.1245/s10434-023-13151-w

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