Impact of adjuvant therapy on outcomes of cancer of the stomach and gastroesophageal junction in the real-world.

IF 6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastric Cancer Pub Date : 2025-05-16 DOI:10.1007/s10120-025-01624-8

Steffen M Heckl, Hans-Michael Behrens, Ulrike Ebert, Dita Ulase, Florian Richter, Thomas Becker, Anne Letsch, Christoph Röcken

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Abstract

Background: Since the FLOT4 gastric cancer (GC) trial, the use of adjuvant chemotherapy has been perceived as limited and its added value questioned. We wanted to objectify this perception and reassess the value of adjuvant chemotherapy in a real-world setting.

Methods: In our retrospective cohort study we analyzed real-world data from 147 patients with GC or cancer of the gastroesophageal junction (AEG) who received perioperative FLOT. Data originated from clinical care at the university hospital, local hospitals and medical practices. Clinicopathologic data, survival outcomes, and targetable biomarkers were analyzed.

Results: Median overall survival (OS) and tumor specific survival (TSS) were 19.4 ± 2.9 and 19.9 ± 3.1 months, respectively. 84.4% completed all cycles of neoadjuvant chemotherapy. The pathological complete response rate was 11.8%. Adjuvant chemotherapy was initiated in only 42.9%. Survival rates of patients with marked tumor regression (TRG1) were not improved by adjuvant chemotherapy. Conversely, patients with partial histopathologic response (TRG2) showed a marked trend and those with minimal histopathologic response (TRG3) showed a significantly longer survival with any number of adjuvant chemotherapy cycles (OS: 22.3 ± 2.6 months versus 8.7 ± 2.4 months, p = 0.005; TSS: 22.3 ± 4.5 months versus 8.7 ± 2.4 months, p = 0.016). Targetable biomarkers PD-L1, Claudin 18.2, HER2 and microsatellite instability were detected in 53.4%, 26.2%, 7.8%, and 3.9% of the TRG2/3 patient subset, respectively.

Conclusions: In the real-world setting, adjuvant chemotherapy proved to be a critical turning point of the FLOT regimen. It should be sought-even in a reduced form-in patients with TRG2/3.

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在现实世界中，辅助治疗对胃癌和胃食管交界处癌症预后的影响。

背景：自FLOT4胃癌（GC）试验以来，辅助化疗的使用一直被认为是有限的，其附加价值受到质疑。我们想客观地看待这种看法，并重新评估辅助化疗在现实世界中的价值。方法：在我们的回顾性队列研究中，我们分析了147例接受围手术期FLOT的胃癌或胃食管交界癌（AEG）患者的真实数据。数据来源于大学医院的临床护理、当地医院和医疗实践。分析了临床病理数据、生存结果和可靶向的生物标志物。结果：中位总生存期（OS）为19.4±2.9个月，肿瘤特异性生存期（TSS）为19.9±3.1个月。84.4%的患者完成了所有周期的新辅助化疗。病理完全缓解率为11.8%。辅助化疗仅为42.9%。有明显肿瘤消退（TRG1）的患者的生存率没有得到辅助化疗的改善。相反，在任何辅助化疗周期中，部分组织病理反应（TRG2）的患者表现出明显的趋势，而最低组织病理反应（TRG3）的患者表现出明显更长的生存期(OS: 22.3±2.6个月vs 8.7±2.4个月，p = 0.005；TSS: 22.3±4.5个月和8.7±2.4个月,p = 0.016)。可靶向生物标志物PD-L1、Claudin 18.2、HER2和微卫星不稳定性分别在53.4%、26.2%、7.8%和3.9%的TRG2/3患者亚群中检测到。结论：在现实环境中，辅助化疗被证明是FLOT方案的关键转折点。应该在TRG2/3患者中寻找它，即使是以减少的形式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastric Cancer 医学-胃肠肝病学

CiteScore

14.70

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide. The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics. Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field. With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.