Dados do Trabalho

Título

PATHOLOGICAL STAGING AFTER METASTASECTOMY AND SURVIVAL IN GASTRIC/GASTROESOPHAGEAL CANCER PATIENTS

Introdução

Pathological staging is a major prognostic factor for survival in locally advanced gastric/gastroesophageal junction cancer(GC/GEJC). Metastasectomy (mtsec) appears to be interesting for selected cases of advanced GC/GEJC, increasing survival in observational trials. Data on the prognostic value of pathological findings after mtsec is lacking.

Objetivo

To evaluate the correlation of pathological findings after mtsec and overall survival(OS) in GC/GEJC patients(pts). Secondarily, to evaluate the impact of pathological staging on progression-free survival(PFS) and of response to preoperative chemotherapy (PreOp chemo) on OS and PFS.

Método

Metastatic GC/GEJC pts who underwent mtsec in our center were retrospectively recruited. Data was retrieved from medical records. OS was defined by the time of the start of treatment (PeriOp chemo or mtsec) to death by any cause. PFS was defined by mtsec to disease progression or death by any cause. Descriptive statistics were used to evaluate population characteristics. Time-to-event variables were analyzed by Kaplan-Meier curves and the Log-rank test. Cox regression was used for multivariate analysis.

Resultado

From September 2007 to January 2020, 69 pts were included. Median follow-up was 37 months(m). Median age was 54 years; most were men (55.1%), with GC (82.6%) and diffuse subtype (65.2%),78.5% de novo metastatic. The prevailing metsec sites: peritoneum(62.3%), liver(15.9%), lymph nodes (14.5%). Perioperative chemo was given to 94.2%: 43.5% pre+postoperative, 34.8% PreOp, 15.9% postoperative. Main regimens used were FOLFOX/CAPOX (30.7%), FLOT (16.9%) and mDCF(13.8%). Amid 54pts exposed to PreOp chemo, 57.4% had pathological response (7.4% complete; 50.0% partial). Median OS for responders or not to PreOp chemo was 26m (HR 0.84,95%CI 0.41-1.73). Most pts had a pT4 (44.9%), node positive (pN+; 71%) after mtsec + primary tumor excision. The metastatic lesion (pM1) was found in 69.6%. Pts with pT4 and pN+ had an inferior OS (27m vs 16m,p=0.01 and 59m vs 17m, p=0.001,respectively). Those with pT4 (9m vs 8m; p=0.03), pN+ (17m vs 7m; p<0.001), pM1 (15m vs 8m; p=0.01) and >50% viable cells (9m vs 8m; p=0.04) had an inferior PFS. Absence of PreOp chemo, pT4 and pM1 were independently associated with worse OS in multivariate analysis; and male sex, GEJ location and pM1 with worse PFS.

Conclusão

Pathological T4 or M1 after metastasectomy were independently associated with worse survival. Although the pathological response to PreOp chemo has not influenced OS, to offer this therapy prolonged PFS and OS.

Palavras-chave

Gastric/gastroesophageal cancer, Metastasectomy, Perioperative chemotherapy, Pathological response