Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer.
BACKGROUND
The objective of the current study was to assess the staging accuracy and prognostic role of preoperative endoscopic ultrasound (EUS) and computed tomography (CT) in patients with locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy.


METHODS
Presurgical LAGC patients underwent EUS and CT before and after 3 cycles of neoadjuvant chemotherapy. Chemotherapy was comprised of docetaxel (at a dose of 36 mg/m(2)) and cisplatin (at a dose of 40 mg/m(2)) on Days 1 and 8 of a 3-week cycle.


RESULTS
Forty patients were enrolled in the study. After chemotherapy, the accuracy of EUS and CT was found to be 47% and 57%, respectively for T classification (P = .22) and 39% and 37%, respectively for N classification (P > .99). The 3-year overall survival (OS) rate for patients downstaged with EUS for T and/or N classification was greater than that for nondownstaged patients (69% vs 41%; P = .05). The 2-year recurrence-free survival (RFS) rate was also better for the EUS-downstaged patients than for the nondownstaged patients (77% vs 47%; P = .04). On multivariate analysis, EUS downstaging was found to be correlated with OS (hazards ratio [HR] of 0.12; P = .04), and was correlated with RFS with borderline statistical significance (HR of 0.27; P = .07). The differences in OS and RFS between the patients downstaged with CT and those not downstaged were not found to be statistically significant.


CONCLUSIONS
Restaging by EUS and CT after neoadjuvant chemotherapy in patients with LAGC was found to be inaccurate. However, T and/or N downstaging by EUS was found to be correlated with better OS and RFS. Thus, downstaging by EUS may be a useful clinical parameter with which to predict a better outcome for LAGC patients.
Park
Sook Ryun
SR
Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Lee
Jong Seok
JS
Kim
Chan Gyoo
CG
Kim
Hark Kyun
HK
Kook
Myeong-Cherl
MC
Kim
Young-Woo
YW
Ryu
Keun Won
KW
Lee
Jun Ho
JH
Bae
Jae-Moon
JM
Choi
Il Ju
IJ
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin