title: Long-term survival outcomes of advanced gastric cancer patients who achieved a pathological complete response with neoadjuvant chemotherapy: a systematic review of the literature.
abstract: BACKGROUND
  A pathologic complete response (pCR) can sometimes be induced by intensive or long-term neoadjuvant chemotherapy (NAC). This prognostic research study based on a systematic review of the literature evaluated the impact of a pCR on the long-term survival of gastric cancer (GC) patients.
  
  
  METHODS
  Articles were extracted from PubMed and the Japanese medical search engine "Ichu-shi," using the terms "GC," "NAC," and "pCR." Articles were selected based on the following criteria: (1) full-text case report, (2) R0 resection following NAC for locally advanced GC, and (3) pathological complete response in both the primary stomach and in the lymph nodes. A questionnaire regarding the patients' prognoses was sent to the corresponding authors of the articles selected in July 2013.
  
  
  RESULTS
  Twenty-four articles met the criteria. Twenty authors responded to the questionnaire. Finally, 22 patients from 20 articles were entered into the present study. The median follow-up time (range) of the survivors was 76 (range 13-161) months. Tumors that were stage III/IV (86%: 19/22) and of an undifferentiated histology (61.9%: 13/21) were dominant. An S1-based regimen was frequently selected for the NAC. All patients underwent R0 resection and D2/D3 lymphadenectomy. The overall survival and recurrence-free survival rates at 3 and 5 years were 96% and 85% and 91% and 75%, respectively.
  
  
  CONCLUSIONS
  Although a pCR was a relatively rare event, a high pCR rate would be helpful to select the regimen and courses of NAC, especially when the pathological response rates are similar.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakamura
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Asaumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yabusaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sakon
authors.forename: Naoki
authors.initials: N
authors.lastname: Takasu
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Taro
authors.initials: T
authors.lastname: Aoki
authors.forename: Osamu
authors.initials: O
authors.lastname: Shiraishi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kishimoto
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Shinji
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suda
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Ueshima
authors.forename: Satoru
authors.initials: S
authors.lastname: Matono
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Tatsumi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Seya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate