Effect of Pathologic Tumor Response and Nodal Status on Survival in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial

• DOI: 10.1200/jco.2015.65.7692
• Publication Date: 2016-06-14T03:09:08Z
• Authors: Elizabeth C. Smyth; Matteo Fassan; David Cunningham; William H. Allum; Alicia F.C. Okines; Andrea Lampis; Jens C. Hahne; Massimo Rugge; Clare Peckitt; Matthew Nankivell; Ruth Langley; Michele Ghidini; Chiara Braconi; Andrew Wotherspoon; Heike I. Grabsch; Nicola Valeri
• Keywords: Epirubicin; Univariate analysis

Purpose The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification at risk relapse remains challenging. We evaluated whether pathologic response lymph node status after neoadjuvant are prognostic in treated the MAGIC trial. Materials Methods Pathologic regression was assessed resection specimens by two independent pathologists using Mandard tumor grading system (TRG). Differences overall survival (OS) according to TRG were Kaplan-Meier method compared log-rank test. Univariate multivariate analyses Cox proportional hazards relationships among TRG, clinical-pathologic variables, OS. Results Three hundred thirty analyzed. In chemotherapy-treated 1 or 2, median OS not reached, whereas 3, 4, 5, 20.47 months. On univariate analysis, high metastases negatively related (Mandard 5: hazard ratio [HR], 1.94; 95% CI, 1.11 3.39; P = .0209; metastases: HR, 3.63; 1.88 7.0; < .001). only independently predictive (HR, 3.36; 1.70 6.63; Conclusion Lymph predictor plus Prospective evaluation omitting postoperative and/or switching noncross-resistant regimen node-positive disease whose did respond preoperative may be appropriate.