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A real-life analysis on the indications and prognostic relevance of perioperative chemotherapy in locally advanced resectable gastric adenocarcinoma

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Abstract

Background and purpose

Perioperative chemotherapy (periCTX) based on the “MAGIC” scheme has become a standard treatment in Europe for locally advanced oesophagogastric cancer. We assessed implementation and long-term oncological outcomes of MAGIC periCTX for locally advanced gastric cancer.

Methods

Population-based cohort study of all patients with locally advanced gastric cancer undergoing surgical resection with curative intent in Catalonia and Navarra (the first two autonomous communities included in the EURECCA Upper GI Spanish Working Group) between January 2011 and December 2013. The main variable was the percentage of patients treated with MAGIC periCTX. Kaplan–Meier analysis and Cox proportional hazards model were used to assess the survival benefit of periCTX.

Results

Among 814 patients, 217 (26.6%) received periCTX (especially patients more likely to receive it: aged < 70 years, with proximal tumors, low anesthetic risk, and cT3–4/cN+ clinical stage). 35% did not complete perioperative chemotherapy, with no relationship with age. PeriCTX showed no effect on postoperative morbimortality. Histological tumor regression was more often absent or poor (38.2%) than total or almost total (27.8%), although clinico-pathological lymph-node downstaging was higher than expected by staging inaccuracy (38.7% vs. 24.2%). PeriCTX was associated with a better survival only in cT3–4 and cN+ patients, showing less prognostic relevance than optimal oncological surgery with D2 lymphadenectomy.

Conclusions

Only 26.6% of locally advanced resectable gastric cancer patients received PeriCTX. Pathological response was poor, although some degree of nodal downstaging was observed. Survival benefit of periCTX was limited to cT3–4 and cN+ patients, being less relevant than D2 lymphadenectomy.

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Acknowledgements

The authors thank all members of the Spanish EURECCA Oesophago-Gastric Cancer Group for their contribution to the study; Xabier García-Albéniz, epidemiologist, Harvard School of Public Health; Joan Maurel, medical oncologist, Hospital Clínic, Barcelona, for his useful comments; Marta Gimeno, data manager of the Spanish EURECCA register, for her dedication in supervising the register; Marta Pulido, MD, for editing the manuscript and editorial assistance; and Ana Aguilar for her linguistic assistance. Spanish EURECCA Oesophago-Gastric Cancer Group: Maite Santamaria, Hospital Arnau de Vilanova, Lleida; Eva Artigau and Josep Roig, Hospital Josep Trueta, Girona; Juan José Sanchez-Cano, Hospital de Reus, Reus, Tarragona; Aurora Aldeano, Hospital de Granollers, Granollers, Barcelona; Mercè GÚell, Hospital Althaia, Manresa, Barcelona, Josep Feliu, Hospital del Maresme, Mataró, Barcelona; Carles Olona, Hospital Joan XXIII, Tarragona; and Carme Balagué, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Funding

The authors received no specific funding for this work.

Author information

Author notes

  1. F. Pardo and J. Osorio have contributed equally to the study and share first authorship.

Authors and Affiliations

  1. Service of Digestive Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain

    F. Pardo & E. Garsot

  2. Service of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain

    J. Osorio & J. Rodríguez-Santiago

  3. Esophagogastric Surgery Unit, Complejo Hospitalario de Navarra, Pamplona, Spain

    C. Miranda

  4. Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    S. Castro

  5. Service of General and Digestive Surgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    M. Miró

  6. Department of General Surgery, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain

    A. Luna

  7. Service of Gastrointestinal Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

    D. Momblán

  8. Department of Surgery, Hospital de Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, Spain

    G. Galofré

  9. Section of Gatrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain

    M. Pera

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Consortia

The Spanish EURECCA Oesophago-Gastric Cancer Group

  • Maite Santamaria
  • , Eva Artigau
  • , Josep Roig
  • , Juan José Sanchez-Cano
  • , Aurora Aldeano
  • , Mercè GÚell
  • , Josep Feliu
  • , Carles Olona
  •  & Carme Balagué

Corresponding author

Correspondence to F. Pardo.

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The authors have no conflicts of interest to declare.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Members of the Spanish EURECCA Oesophago-Gastric Cancer Group are listed in Acknowledgments section.

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Pardo, F., Osorio, J., Miranda, C. et al. A real-life analysis on the indications and prognostic relevance of perioperative chemotherapy in locally advanced resectable gastric adenocarcinoma. Clin Transl Oncol 22, 1335–1344 (2020). https://doi.org/10.1007/s12094-019-02261-1

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  • DOI: https://doi.org/10.1007/s12094-019-02261-1

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