title: Tumor regression and survival after perioperative MAGIC-style chemotherapy in carcinoma of the stomach and gastroesophageal junction.
abstract: BACKGROUND
  We assessed the effectiveness of perioperative MAGIC-style chemotherapy in our series focused on the tumor regression grade and survival rate.
  
  
  METHODS
  We conducted a retrospective study of 53 patients following a perioperative regimen of epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/X). Forty-four (83 %) neoplasias were located in the stomach and 9 (17 %) were located at the esophagogastric junction. Perioperative chemotherapy completion, resection, TNM staging, the tumor regression grade (Becker's classification) and survival were analyzed.
  
  
  RESULTS
  Forty-five patients (85 %) completed the 3 preoperative cycles. R0 resection was achieved in 42 (79 %) patients. Thirty-five (66 %) patients completed the 3 postoperative cycles. Nine carcinomas (17 %) were considered major responders after preoperative chemotherapy. With multivariate analysis, only completion of perioperative chemotherapy (HR: 0.25; 95%CI: 0.08 - 0.79; p = 0.019) was identified as an independent prognostic factor for disease-specific survival. However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029). The tumor regression grade (major vs minor responders) was at the limit of significance only with univariate analysis. The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively.
  
  
  CONCLUSIONS
  The percentage of major responder tumors after preoperative chemotherapy was low. Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.
authors.affiliation: Surgery Department, Elche University Hospital, Elche, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mingol
authors.affiliation: Medical Oncology Department, Elche University Hospital and Vega Baja Hospital, Elche, Spain.|Pathology and Surgery Department, Miguel Hernandez University of Elche, Elche, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gallego
authors.affiliation: Pathology Department, Elche University Hospital, Elche, Spain.
authors.forename: Albina
authors.initials: A
authors.lastname: Orduña
authors.affiliation: Surgery Department, Elche University Hospital, Elche, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Martinez-Blasco
authors.affiliation: Gastroenterology Department, Elche University Hospital, Elche, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sola-Vera
authors.affiliation: Surgery Department, Elche University Hospital, Elche, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moya
authors.affiliation: Surgery Department, Vega Baja Hospital, Elche, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Morcillo
authors.affiliation: Pathology Department, Vega Baja Hospital, Elche, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Ruiz
authors.affiliation: Surgery Department, Elche University Hospital, Elche, Spain.|Pathology and Surgery Department, Miguel Hernandez University of Elche, Elche, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
authors.affiliation: Surgery Department, Elche University Hospital, Elche, Spain. fj.lacueva@umh.es.|Pathology and Surgery Department, Miguel Hernandez University of Elche, Elche, Spain. fj.lacueva@umh.es.
authors.forename: Francisco-Javier
authors.initials: FJ
authors.lastname: Lacueva
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D015251:Epirubicin; D000069287:Capecitabine; D002945:Cisplatin; D005472:Fluorouracil