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Evidence from Europe shows that perioperative chemotherapy may be beneficial for the treatment of locally advanced gastric cancer, but reliable and robust data is lacking. To rectify this, the phase 3 RESONANCE trial investigated the efficacy and safety of S-1 plus oxaliplatin (SOX) as a perioperative chemotherapy regimen for gastric cancer. This randomized, open-label trial enrolled patients from 19 medical centers with stage II/III resectable gastric cancer who were centrally randomly assigned to either perioperative chemotherapy (PC) arm or adjuvant chemotherapy (AC) arm. Patients in the PC arm received two to four cycles of SOX followed by surgery and four to six cycles of SOX. Patients in the AC arm received upfront surgery and eight cycles of SOX. 386 patients in each group were enrolled and 756 (382 in PC and 374 in AC) were included in the mITT population. The three-year DFS rate was 61.7% in the PC arm and 53.8% in the AC arm (log-rank p = 0.019). The R0 resection rate in the PC arm was significantly higher than that in the AC arm (94.9% vs. 83.7%, p < 0.0001). There was no difference between two arms in surgical outcomes or postoperative complications. Safety-related data were like the known safety profile. In conclusion, from a clinical perspective, this trial indicated a trend towards higher three-year disease-free survival rate with perioperative SOX in stage II/III resectable gastric cancer with well-tolerated toxicity compared to adjuvant SOX, which might provide a theoretical basis for applying perioperative SOX in advanced gastric cancer patients. (ClinicalTrials.gov NCT01583361) [ABSTRACT FROM AUTHOR]

Background: Long-term outcome of patients with locally advanced gastric cancer (LAGC) who achieved a pathological complete response (pCR) was scarcely discussed, and never had the factors affecting the prognosis of pCR patients been investigated. Methods: We retrospectively reviewed all patients who achieved a pCR to neoadjuvant chemotherapy (NAC) in Jinling Hospital. The 3- and 5-year overall survival (OS) and progression-free survival (PFS) were calculated with the Kaplan–Meier method. Meanwhile, univariate and multivariate COX regression analysis was applied to identify prognostic factors affecting patients' survival. Results: A total of 37 consecutive LAGC patients with pCR were included. The 3- and 5-year OS rates were 88.8% and 78.6%, and the 3- and 5-year PFS rates were 86.5% and 75.8%. In the multivariate COX model, NAC duration of more than 3 cycles (HR 0.11 [0.02–0.62], P = 0.013) and poorly differentiated tumor at diagnosis (HR 0.17 [0.03–0.95], P = 0.043) were detected as protective factors for patients OS. Whereas for PFS, NAC duration (HR 0.12 [0.02–0.67], P = 0.015) was the only protective factor confirmed, with tumor differentiation at diagnosis exhibiting marginal significance (HR 0.21 [0.04–1.09], P = 0.063). Conclusions: Patients with LAGC who achieved a pCR displayed favorable long-term survival outcome, especially those with adequate cycles (≥ 3) of NAC. Besides, poor differentiation at diagnosis might also predict the better OS when pCR achieved. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the body composition score (BCS) impact on 3-year survival after radical gastrectomy in patients with gastric cancer. This retrospective study included patients with gastric cancer from September 2015 to June 2017. The patients were divided into three groups: BCS0 (having normal skeletal muscle or adipose mass), BCS1 (having low skeletal muscle mass only), and BCS2 (having low skeletal muscle and adipose mass) according to their third lumbar vertebra skeletal muscle index and fat index calculated using abdominal computed tomography. The clinicopathological indicators, postoperative complications, 3-year over survival (OS) rate after radical gastrectomy, and cause of death among the three groups were compared. A total of 187 patients were enrolled in the study, in which 102 patients (54.6%) had BCS0, 76 (40.6%) had BCS1 and 9 (4.8%) had BCS2. There was no significant difference in postoperative complications among the groups. 3-year OS was significantly shortened with each 1-score increase in BCS (Log-rank p < 0.001). Multivariate Cox regression analyses showed that no neoadjuvant chemotherapy, tumor stage III, BCS1, and BCS2 were independent prognostic factors for 3-year OS after radical gastrectomy. The main cause of death was cancer-related. We demonstrated that BCS1 and BCS2 were strongly associated with poor 3-year survival for patients with gastric cancer who underwent radical gastrectomy, suggesting that special attention may be required for nutritional support while determining therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: The incidence of the para-aortic lymph node metastasis (PALM) in patients with advanced gastric cancer is 6 to 33 %. The prognosis is poor and the 5-year survival rate is only 12 to 23 % after gastrectomy with super-extended lymph node dissection. We applied an individualized comprehensive treatment for affected patients including neoadjuvant chemotherapy via intra-arterial and intravenous administration, surgery and radiotherapy, to investigate the safety and prognostic value.Methods: Between January 2005 and December 2010, 47 advanced gastric cancer patients with PALM received 5-Fu (370 mg/m(2)) and leucovorin (200 mg/m(2)) intravenously on days 1-5, and intra-arterial infusion of etoposide (80 mg/m(2)) and oxaliplatin (80 mg/m(2)) on days 6 and 20, repeated 2 cycles. Patients achieved PR or CR of the para-aortic lymph node (PAL) were performed D2 dissection, followed by 6 cycles chemotherapy with XELOX regimen, oxaliplatin (130 mg/m(2)) on day 1 and xeloda (1000 mg/m(2)) on days 1 to 14 of a 28-day cycle, and radiotherapy to the region of PALM.Results: Forty-six patients completed 2 cycles of neoadjuvant chemotherapy. The overall response rate of the primary tumor was 80.4 % (37/46). The response rate of PAL was 76.1 % (35/46). Thirty-two patients underwent D2 dissection and six cases achieved pathological complete response (pCR). The toxicity profile was well tolerable and there was no treatment-related death. The median survival time for all patients was 23 months, and for nonsurgical and surgical patients were 12 and 29 months (p < 0.001), respectively. The 1-year, 2-year and 3-year survival rate was 70.96, 43.27 and 35.48 % for all patients, and for surgical patients was 96.875, 68.75, and 40.63 %.Conclusion: Advanced gastric cancer patients with PALM can obtain a survival benefit from neoadjuvant chemotherapy, subsequent surgery and radiotherapy.Trial Registration: Current Controlled Trials ChiCTR-TRC-12002046 . [ABSTRACT FROM AUTHOR]

Background: Tumor response to chemotherapy has traditionally been assessed by using Response Evaluation Criteria in Solid Tumors (RECIST) based on changes in tumor size alone. However, adapted Choi criteria, which incorporate volumetric tumor attenuation in addition to tumor size, have been reported more predictive of chemotherapeutic efficacy than RECIST in some studies. Purpose: To examine the usefulness of adapted Choi criteria in predicting clinical survival in locally advanced gastric cancer patients treated with cytotoxic drugs. Material and Methods: A total of 48 histologically proven gastric cancer patients who received neoadjuvant chemotherapy and surgery were involved. Pre- and post-chemotherapy short-axis diameter and volumetric mean tumor attenuation of target lymph nodes on contrast-enhanced CT images were measured. Tumor response was assessed by using both RECIST and adapted Choi criteria, and was correlated with progression-free survival (PFS) and overall survival (OS). Results: Significant decrease was observed in the sum of short-axis diameters and tumor attenuation of metastatic lymph nodes between baseline and post-chemotherapy CT images. The inter-observer agreement for both parameters was good. The PFS and OS of 17 RECIST responders were identical with that of 28 adapted Choi responders (P = 0.855 and 0.913, respectively). PFS and OS of 31 RECIST non-responders were significantly prolonged compared to that of 20 adapted Choi non-responders (P = 0.018 and 0.042, respectively). To the 11 RECIST stable disease (SD) but adapted Choi partial response (PR) patients, the PFS and OS were similar to the survival of 17 RECIST PR patients (P = 0.785 and 0.838, respectively), but significantly prolonged compared to that of the 12 both RECIST and adapted Choi criteria SD patients (P < 0.001 and P = 0.004, respectively). Conclusion: Adapted Choi criteria might be helpful to predict PFS and OS in locally advanced gastric cancer patients following chemotherapy. [ABSTRACT FROM AUTHOR]

Summary: Overexpression of the Eph receptor tyrosine kinases in cancers is related to malignant transformation, metastasis, tumor differentiation, and prognosis. Down-regulation of EphA7 secondary to hypermethylation has been reported in colorectal cancer. In the present study, expression of EphA7 in gastric cancer cell lines and gastric carcinoma specimens was determined by quantitative real-time reverse transcriptase–polymerase chain reaction. The expression of EphA7 was reduced in all tested gastric cancer cell lines; however, there is marked variability in expression among gastric carcinoma specimens. Overexpression was observed more often in younger patients (aged ≤65 years) (P = .03) and in patients with advanced cancer (P = .031). Hypermethylation of the EphA7 promoter–associated CpG island was found using methylation-specific polymerase chain reaction. Down-regulation of EphA7 was significantly related to hypermethylation (P = .001), and the level of hypermethylation was greater in moderately differentiated tumors than in poorly differentiated ones (P = .03). We also performed immunohistochemical staining for EphA7 in 52 gastric carcinoma specimens and found that expression of the protein was consistent with its transcript expression, with the protein being significantly overexpressed in younger patients (P = .016) and in patients with advanced tumors (P = .033). Our data indicate that EphA7 may have roles in the pathogenesis and development of gastric carcinomas. [Copyright &y& Elsevier]