title: Role of histological regression grade after two neoadjuvant approaches with or without radiotherapy in locally advanced gastric cancer.
abstract: The degree of histopathological response after neoadjuvant therapy in locally advanced gastric cancer (GC) is a key determinant of patients' long-term outcome. We aimed to assess the pattern of histopathological regression after two neoadjuvant approaches and its impact on survival times.
  
  
  
  Regression grade of the primary tumour (Becker criteria) and the degree of nodal response by a 4-point scale (grades A-D) were assessed. Grade A-true negative lymph nodes (LNs); grade B and C-infiltrated LNs with any or little evidence of nodal response; and grade D-complete pathological response in a previously infiltrated LN. A favourable pathological response was defined as Becker Ia-b and grade D.
  
  
  
  From 2004 to 2014, 80 patients with GC (cT3-4/N+ by CT-scan/EUS) were treated with either preoperative chemotherapy (ChT, n=34) or chemoradiation (CRT, n=46). Patients in the CRT group had a higher likelihood of achieving a Becker Ia-b response (58 vs 32%, P=0.001), a grade D nodal regression (30 vs 6%, P=0.009) and a favourable pathological response (23 vs 3%; P=0.019). Patients with a grade D nodal response had a longer 5-year PFS and OS compared with those with a grade B or C response. Patients with a baseline negative LN status had similar outcomes irrespective of the preoperative therapy received (5-year OS; ChT vs CRT, 58 vs 51%, P=0.92).
  
  
  
  Preoperative chemoradiation increases the likelihood of achieving favourable histopathological features that correlate with a 5-year OS>70% in GC patients.
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martin-Romano
authors.affiliation: Department of Pathology, Hospital San Pedro, Logroño 26006, Spain.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Sola
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Diaz-Gonzalez
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Chopitea
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Yohana
authors.initials: Y
authors.lastname: Iragorri
authors.affiliation: Department of Surgical Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martínez-Regueira
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Ponz-Sarvise
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Leire
authors.initials: L
authors.lastname: Arbea
authors.affiliation: Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Subtil
authors.affiliation: Department of Radiology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Cano
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ceniceros
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Jairo
authors.initials: J
authors.lastname: Legaspi
authors.affiliation: Department of Surgical Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Hernandez
authors.affiliation: Department of Oncology, Clínica Universidad de Navarra, Pamplona 31008, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Rodríguez
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology* / Q000556:secondary / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001247:Asthenia / Q000139:chemically induced; D000069287:Capecitabine / Q000008:administration & dosage; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005743:Gastrectomy; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D060787:Neoplasm Grading; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000008:administration & dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D043823:Taxoids; D000077150:Oxaliplatin; D000077143:Docetaxel; D000069287:Capecitabine; D017239:Paclitaxel; D005472:Fluorouracil