Published online Jan 15, 2019. doi: 10.4251/wjgo.v11.i1.48
Peer-review started: September 28, 2018
First decision: October 15, 2018
Revised: November 26, 2018
Accepted: December 24, 2018
Article in press: December 24, 2018
Published online: January 15, 2019
Processing time: 109 Days and 22.4 Hours
Neoadjuvant chemotherapy has been applied to improve the long-term survival of patients with gastric adenocarcinoma (GAC). Although the regression change of primary tumors may affect the prognosis of GAC patients, it is controversial whether evaluation of lymph node (LN) regression change would help predict the outcomes of GAC patients.
Our previous study revealed that the grading of primary tumor regression was valuable for predicting the prognosis of GAC patients. However, the role of regression change in LNs for prognosis remains questionable.
We analyzed the prognostic effect of LN regression change in GAC patients after neoadjuvant chemotherapy, and tried to explore the necessity of LN regression evaluation.
We evaluated the histological regression of resected LNs from 192 GAC patients, and classified regression change and residual tumor in LNs into four groups: (A) true negative LNs with no evidence of a preoperative therapy effect, (B) no residual metastasis but the presence of regression change in LNs, (C) residual metastasis with regression change in LNs, and (D) metastasis with minimal or no regression change in LNs. The effects of regression change and residual tumor groups in LNs on overall survival and progression-free survival were evaluated by Cox regression analysis.
The patients who had no residual tumor in LNs (Groups A+B) had a significantly better outcome than the patients who had residual tumors in LNs (Groups C+D) (P < 0.01), no matter whether they had LN regression change or not. No significant differences in survival were found between Groups A and B, or between Groups C and D.
Our study revealed that patients who had residual tumors in LNs had significantly worse outcomes than patients who had no residual tumors in LNs, independent of whether LN regression change existed or not. Therefore, it may not be necessary to evaluate LN regression change in GAC patients.
This was a single center retrospective study, and the preoperative therapeutic strategies were not uniform. Prospective studies are needed for further investigation.