Gastric cancer: high recurrence rates point to need for multimodal therapy

  • Mokadem I & al.
  • Gastric Cancer
  • 4 Apr 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Gastric cancers treated with curative intent (perioperative chemotherapy, surgery) tend to recur, with most recurrences manifesting as distant metastases.
  • This multicenter European study found that more than a third of patients had recurrence, 90% distant metastasis.

Why this matters

  • These authors say that multimodal treatment approaches are needed to prevent distant recurrence.

Key results

  • 36.8% of patients had a recurrence at median follow-up of 27.8 months.
  • 90% of recurrences were distant metastases.
  • 1-year recurrence-free survival, 71.8%.
  • Factors affecting recurrence (HRs; 95% CIs):
    • ypN+ stage: 4.92 (3.35-7.24);
    • Partial/no tumor regression: 2.63 (1.22-5.64);
    • 3 vs ≥6 chemotherapy cycles: 3.04 (1.99-4.63);
    • R1 resection: 1.52 (1.02-2.26); and
  • Less recurrence seen with antrum tumors, intestinal tumor type, complete pathological regression after preoperative chemotherapy.
  • Type of preoperative chemotherapy was not associated with recurrence-free survival. 

Study design

  • 408 patients with gastric adenocarcinoma, 2010-2015, treated with a minimum of preoperative chemotherapy, gastrectomy with curative intent, 18 Dutch hospitals.
  • Funding: None disclosed; 1 author cites several industry funding sources.

Limitations

  • Many values missing for some variables (e.g., tumor regression, chemotherapy type, and cycle number).

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