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Radiological criteria for selecting candidates for neoadjuvant chemotherapy for gastric cancer: an exploratory analysis from the PRODIGY study

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Author(s)
Hyung-Don KimJong Seok LeeJeong Hwan YookMin-Hee RyuYoung-Kyu ParkJin Young KimYoung-Woo KimSang Cheul OhJong Gwang KimJae-Ho CheongOh JeongSung Hoon NohYoon-Koo Kang
Keimyung Author(s)
Kim, Jin Young
Department
Dept. of Internal Medicine (내과학)
Journal Title
Gastric Cancer
Issued Date
2022
Volume
25
Issue
1
Keyword
Gastric cancerNeoadjuvant chemotherapyLymph node stagingRadiological criteria
Abstract
Background:
In this exploratory analysis from the PRODIGY study, we aimed to define the radiological criteria to identify patients with gastric cancer who may derive maximal clinical benefit from neoadjuvant chemotherapy.

Patients and methods:
There were 246 patients allocated to receive surgery followed by adjuvant S-1 (SC group) and 238 allocated to receive neoadjuvant chemotherapy (CSC group). As the PRODIGY's radiological method of lymph node (LN) evaluation considers short diameter and morphology (the size and morphology method), a method considering only short diameter was also employed. In the SC group, the correlation between radiologic and pathologic findings was analyzed. The hazard ratio (HR) for the progression-free survival (PFS) of the CSC group was analyzed in subgroups with different cT/N stages.

Results:
cT4 disease showed a sensitivity of 85.6% for detecting pT4 and had a low proportion of pathologic stage (pStage) I disease (4.5%). Among the criteria determined by different cT/N stages by each method of LN positivity, those involving cT4Nany or cT4N + by both methods had a minimal proportion of pStage I disease (≤ 5%), while cT4Nany by both methods and cT4N + by the size and morphology method exhibited ≥ 75.9% sensitivity for detecting pStage III disease. The relative risk reduction in PFS of the CSC group was greatest in patients meeting the cT4Nany criterion defined by both methods (HR 0.67, 95% confidence interval 0.48–0.93).

Conclusions:
The cT4Nany criterion, regardless of the radiological method used for LN evaluation, may help select patients with resectable gastric cancer for neoadjuvant chemotherapy.
Keimyung Author(s)(Kor)
김진영
Publisher
School of Medicine (의과대학)
Citation
Hyung-Don Kim et al. (2022). Radiological criteria for selecting candidates for neoadjuvant chemotherapy for gastric cancer: an exploratory analysis from the PRODIGY study. Gastric Cancer, 25(1), 170–179. doi: 10.1007/s10120-021-01243-z
Type
Article
ISSN
1436-3305
Source
https://link.springer.com/article/10.1007/s10120-021-01243-z
DOI
10.1007/s10120-021-01243-z
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44027
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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