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2. Recurrence and survival after pathologic complete response to preoperative therapy followed by surgery for gastric or gastrooesophageal adenocarcinoma.

Author

Fields, R. C., Strong, V. E., Gönen, M., Goodman, K. A., Rizk, N. P., Kelsen, D. P., Ilson, D. H., Tang, L. H., Brennan, M. F., Coit, D. G., Shah, M. A., and Gönen, M

Subjects
STOMACH cancer, CANCER chemotherapy, CANCER relapse, CANCER patients, PREOPERATIVE care, FIBROSIS, THERAPEUTICS, CANCER treatment, ADENOCARCINOMA, BRAIN tumors, COMBINED modality therapy, COMPARATIVE studies, ESOPHAGUS, ESOPHAGEAL tumors, RESEARCH methodology, MEDICAL cooperation, RESEARCH, STOMACH tumors, EVALUATION research, RETROSPECTIVE studies, TUMOR treatment
Abstract

Background: To characterise recurrence patterns and survival following pathologic complete response (pCR) in patients who received preoperative therapy for localised gastric or gastrooesophageal junction (GEJ) adenocarcinoma.Methods: A retrospective review of a prospective database identified patients with pCR after preoperative chemotherapy for gastric or preoperative chemoradiation for GEJ (Siewert II/III) adenocarcinoma. Recurrence patterns, overall survival, recurrence-free survival, and disease-specific survival were analysed.Results: From 1985 to 2009, 714 patients received preoperative therapy for localised gastric/GEJ adenocarcinoma, and 609 (85%) underwent a subsequent R0 resection. There were 60 patients (8.4%) with a pCR. Median follow-up was 46 months. Recurrence at 5 years was significantly lower for pCR vs non-pCR patients (27% and 51%, respectively, P=0.01). The probability of recurrence for patients with pCR was similar to non-pCR patients with pathologic stage I or II disease. Although the overall pattern of local/regional (LR) vs distant recurrence was comparable (43% LR vs 57% distant) between pCR and non-pCR groups, there was a significantly higher incidence of central nervous system (CNS) first recurrences in pCR patients (36 vs 4%, P=0.01).Conclusion: Patients with gastric or GEJ adenocarcinoma who achieve a pCR following preoperative therapy still have a significant risk of recurrence and cancer-specific death following resection. One third of the recurrences in the pCR group were symptomatic CNS recurrences. Increased awareness of the risk of CNS metastases and selective brain imaging in patients who achieve a pCR following preoperative therapy for gastric/GEJ adenocarcinoma is warranted. [ABSTRACT FROM AUTHOR]

Published
2011
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3. Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment

Author

Mithat Gönen, Firas Abdollah, Felix K.-H. Chun, Richard K. Lee, Yair Lotan, Alberto Briganti, M. Graefen, Pierre I. Karakiewicz, Andreas Becker, Alexander Bachmann, Douglas S. Scherr, F. Montorsi, Harun Fajkovic, Maxine Sun, Karl Pummer, Alessandro Nonis, Michael Herman, Wolfgang Loidl, S.F. Shariat, Evanguelos Xylinas, Sascha Ahyai, A. Tewari, Luis A. Kluth, Paul Schramek, Jens Hansen, Malte Rieken, Behfar Ehdaie, Daniel Seiler, Christian Seitz, Kluth, La, Abdollah, F, Xylinas, E, Rieken, M, Fajkovic, H, Seitz, C, Sun, M, Karakiewicz, Pi, Schramek, P, Herman, Mp, Becker, A, Hansen, J, Ehdaie, B, Loidl, W, Pummer, K, Lee, Rk, Lotan, Y, Scherr, D, Seiler, D, Ahyai, Sa, Chun, Fk, Graefen, M, Tewari, A, Nonis, A, Bachmann, A, Montorsi, Francesco, Gönen, M, Briganti, A, and Shariat, Sf

Subjects
Oncology, Male, Cancer Research, Lymphatic metastasis, medicine.medical_specialty, nodal yield, medicine.medical_treatment, Preoperative risk, Nodal staging, extended lymph node dissection, Risk Assessment, Cohort Studies, Prostate cancer, Internal medicine, Medicine, Humans, Aged, Neoplasm Staging, Aged, 80 and over, Prostatectomy, lymph node metastasis, business.industry, Prostatic Neoplasms, Lymphatic Metastasi, lymph node metastasi, Middle Aged, medicine.disease, prostate cancer, pelvic lymph node dissection, Lymphatic Metastasis, Prostatic Neoplasm, Clinical Study, Lymph Node Excision, Neoplasm staging, Cohort Studie, business, Risk assessment, Human, Cohort study
Abstract

Background:Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status.Methods:We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes.Results:In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively.Conclusions:Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis. © 2014 Cancer Research UK.

Published
2014

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