title: Effects of preoperative chemotherapy on gastric carcinoma: the relationship between histopathologic response and prognosis.
abstract: To evaluate the efficacy of preoperative chemotherapy in the treatment of gastric carcinoma, 48 previously untreated patients with locoregional advanced gastric carcinoma were consecutively enrolled in this study and received preoperative 5-fluorouracil (5-FU) or 5'-deoxy-5- fluorouridine (5'-DFUR). Histopathologically, 17 patients showed no response, 27 responded slightly, 3 moderately, and 1 had an excellent response to the chemotherapy. Based on clinical cancer staging, the overall 5-year survival rate was 79% in patients with stages IB and II cancer, 44% in patients with stage III cancer, and 14% in those with stage IV cancer. In patients with stages IB, II, and IIIA disease, the 5-year survival rate for those with a positive histopathologic response to the chemotherapy was 74%, whereas that for the nonresponders was 45%. No relationship was seen between the grade of the histopathologic response and the 5-year survival rate of patients with stage IIIB and IV carcinoma. In a second group of 27 patients who received preoperative chemotherapy with 5-FU, the effect of 5-FU was evaluated using thymidylate synthetase (TS) inhibition. Free TS and total TS were measured in the tumor samples, and the thymidylate synthetase inhibition rate (TSIR) was calculated. TSIR ranged from 0% to 90.7%. The mean TSIR was 66.2% in patients with a positive histopathologic response to chemotherapy and 30.3% in those with a negative response. Mild chemotherapy as orally administered 5-FU or 5'-DFUR was found to be useful in patients with resectable gastric cancer. Furthermore, a correlation was found in chemosensitivity, histopathologic response, and TSIR.
authors.affiliation: Department of Surgery, Showa University, Toyosu Hospital, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kumagai
authors.forename: Y
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: A
authors.initials: A
authors.lastname: Yasui
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018279:Carcinoma, Signet Ring Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D005467:Floxuridine; D005472:Fluorouracil; C025034:doxifluridine