title: Evaluations of primary lesions by endoscopy clearly distinguishes prognosis in patients with gastric cancer who receive chemotherapy.
abstract: BACKGROUND
  Chemotherapy may improve outcomes in gastric cancer (GC), especially for the patients with advanced stage. To explore useful predictive factor for GC performing chemotherapy, we compared the tumor responses assessed using computed tomography (CT) with endoscopy based criteria.
  
  
  METHODS
  192 GC patients performing chemotherapy were retrospectively studied. CT based response assessment was performed after 2 courses of treatment. Endoscopic evaluation according to The Japanese classification of gastric carcinoma was also performed at same period. Data were correlated with overall survival (OS) and progression-free survival (PFS).
  
  
  RESULTS
  Majority of the cases (n = 178, 93%) received S-1 based chemotherapy as the first line treatment. 55 (29%) and 91 (47%) cases were considered to be CT and endoscopic responders. Endoscopic responder was more clearly associated with better OS and PFS compared to CT based responder by the log-rank test (P<0.0001 vs. 0.01 and P<0.0001 vs. 0.008, respectively). The association was more striking among patients performing neoadjuvant chemotherapy (P<0.0001 vs. 0.15 and P<0.0001 vs. 0.1, respectively). Multivariate survival analysis using Cox's regression model revealed that endoscopic non-responder was the independent predictive factor, being more strongly associated with worse OS when compared to CT non-responder (hazard ratio: 4.60 vs. 1.77, 95% confidence interval: 2.83-7.49 vs.1.08-2.89, P<0.0001 vs. 0.02). More advanced T, N stage and cases who had peritoneal dissemination were significantly associated with endoscopic non-responder (all P values <0.01).
  
  
  CONCLUSIONS
  Endoscopy based evaluation of primary lesions are clearly associated with prognosis in patients with GC who perform chemotherapy.
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tomomitsu
authors.identifier: http://orcid.org/0000-0002-3474-8274
authors.initials: T
authors.lastname: Tahara
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Shibata
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Okubo
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Horiguchi
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Ishizuka
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Nagasaka
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome