title: A pilot study to investigate the role of thymidylate synthase as a marker of prognosis for neoadjuvant chemotherapy in gastric and gastro-oesophageal junction adenocarcinoma.
abstract: Aims and Background. Patients in the United Kingdom with operable gastric and gastro-oesophageal junction (GOJ) tumours receive neoadjuvant chemotherapy. Our aim was to study the expression of thymidylate synthase (TS) enzyme in pre-treatment diagnostic biopsy specimens and investigate its clinical usefulness. Methods. A single-centre study was carried out in 45 patients with gastric and GOJ adenocarcinoma treated with neo-adjuvant chemotherapy according to the MAGIC protocol. TS expression was determined using immunohistochemistry. >10% tumour nuclei expression of TS was used as cut-off for positivity. Results. Forty-one (91%) of the 45 tumours expressed TS. There was no association between TS expression and lymph node status (P = 0.80), histological response (P = 0.30), and recurrence (P = 0.55). On univariate analysis, only N-stage (P = 0.02) and vascular invasion (P = 0.04) were associated with a poor prognosis. Patients with negative tumour TS expression had better outcome than those with positive expression. The overall 5-year survival rate was 100% in the TS negative versus 56% in TS positive group, but the difference was not statistically significant (P = 0.17). Conclusion. TS expression should be studied in a larger series of gastro-oesophageal cancers as a potential prognostic marker of prognosis to neo-adjuvant chemotherapy.
authors.affiliation: Departments of Gastrointestinal Surgery and Histopathology, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mirza
authors.forename: M
authors.initials: M
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: McNulty
authors.forename: J
authors.initials: J
authors.lastname: Valentine
authors.forename: A
authors.initials: A
authors.lastname: Annesley
authors.forename: S
authors.initials: S
authors.lastname: Galloway
authors.forename: I
authors.initials: I
authors.lastname: Welch
authors.forename: C M
authors.initials: CM
authors.lastname: West
authors.forename: S
authors.initials: S
authors.lastname: Pritchard