Use of a combination of computed tomography and endoscopy to assess the response to 5-fluorouracil/cisplatin and predict survival in gastric cancer.
BACKGROUND
Response of metastatic sites on computed tomography (CT) has been used to assess response in metastatic gastric carcinoma (MGC); however, the role of endoscopy to evaluate the response of the primary gastric lesion is unclear. We undertook a prospective study to compare prognostic values of endoscopy-based response criteria with those of CT-based response criteria in MGC patients treated with 5-fluorouracil (5-FU) and cisplatin.


METHODS
MGC patients naïve to chemotherapy were treated with 5-FU (1000 mg/m(2), days 1-5) and cisplatin (60 mg/m(2), day 1) (FP) every 21 days. Response was assessed by CT [World Health Organization (WHO) criteria/Response Evaluation Criteria In Solid Tumors (RECIST)] every three cycles and/or endoscopy after the third cycle.


RESULTS
With a median follow-up of 26.2 months, 103 patients were assessed by CT and endoscopy. There was good concordance between the WHO and RECIST criteria (kappa = 0.91; P = 0.0001), but poor agreement between CT and endoscopic assessments (kappa = 0.17; P = 0.01). On multivariate analysis, both CT (WHO/RECIST) (hazard ratio, 5.20; P < 0.0001) and endoscopic response (hazard ratio, 2.78; P < 0.0001) were significantly associated with survival. The combination of CT and endoscopy defined patients into four groups with distinct prognoses according to chemotherapy response: responders on both tests, responders on CT alone, responders on endoscopy alone, and nonresponders on both tests (hazard ratio, 1.00 versus 2.87 versus 5.35 versus 12.3; P < 0.0001).


CONCLUSIONS
The use of endoscopy together with CT provides a better prognostic tool than CT alone in MGC patients treated with FP.
Park
Sook Ryun
SR
Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi 410-769, Republic of Korea.
Choi
Il Ju
IJ
Kim
Chan Gyoo
CG
Kim
Young-Woo
YW
Ryu
Keun Won
KW
Lee
Jun Ho
JH
Lee
Jong Seok
JS
Bae
Jae-Moon
JM
Kim
Hark Kyun
HK
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D002945:Cisplatin; D005472:Fluorouracil