Pathologic Evaluation For The Efficacy Of Neoadjuvant Chemotherapy In Advanced Gastric

Objective:To investigate the association between pathological factors and prognosis neoadjuvant chemotherapy in advanced gastric cancer patients and establish a new pathological standard to select a postoperative chemotherapy regimen.Methods:Eigthty-seven patients with T2–T4 or N+ were enrolled in the period from April 2007 to December 2015.All patients received neoadjuvant chemotherapy and R0 resection surgery and D2 lymphadenectomy were performed by one team.Clinical and pathological features were reviewed.Univariate and multivariate analysis were performed to identify the association between these factors and overall survival,A new pathological standard were established to select a postoperative chemotherapy regimen.Results:Sixty-eight male(75.9%)and 21 female(24.1%)were enrolled and the median age was 56 years old.Three to four cycles neoadjuvant chemotherapy were perfomed in all patients(Folfox 67/77.0%,Xelox 15/17.2% and Sox 5/5.8%)and postoperative chemotherapy were performed in 79 patients(median cycle: 5 cycles).Grade histologic regresion(GHR)were demonstrated in all patients(GHR≥50%: 50.6%,GHR≥2/3: 34.5% and GHR≥90%: 17.2%)and four cases had pathological complete remission(CR).All patients were followed up and median time was 45 months(5-117 months).41 patients(47.1%)died and 39 cases dued to recurrence during following time.The median time of overall survival(OS)in all 87 cases was 97.5 months and 1-,2-,3-,5-and 7-years survival rate was 86.2%、68.5%、63.5%、54% and 47.5% respectively.The median time of disease-specific survival(DSS)in 85 cases was 73 months and 1-,2-,3-,5-and 7-years DSS was 87.1%、69%、63.4%、、54% and 51.3% respectively.In univariate analysis,primary location of tumor(p=0.009),Lauren’s classification(p=0.002),ypTNM(p=0.001),GHR≥50%/<50%(p=0.022,)、GHR≥66.7%/<66.7%(p=0.013)、GHR≥90%/<90%(p=0.028)were associated with OS.In multivariate analysis,ypTNM(HR 3.533,95%CI 1.886-6.617)and Lauren classification(HR 3.843,95%CI 1.443-10.237;HR 2.624,95%CI 0.698-9.863)were associated with OS significantly.Conclusion:The yp TNM stage and Lauren classification were independent predictor of OS.GHR≥50% could be a potential standard in prediction of postoperational chemotherapy efficacy.