Response to neoadjuvant chemotherapy best predicts survival after curativeresection of gastric cancer

Objective In Western populations, long-term survival rates after curative resection o f gastric cancer remain extremely poor. The lack of effective adjuvant ther apy has prompted the evaluation or neoadjuvant approaches. Since 1988, we h ave conducted three separate phase II trials using neoadjuvant chemotherapy to treat patients with potentially resectable gastric cancer. The present study was conducted to evaluate whether response to neoadjuvant chemotherap y is predictive of survival in patients with resectable gastric cancer. Methods Eighty-three patients with pathologically confirmed gastric adenocarcinoma were treated with neoadjuvant chemotherapy before planned surgical resectio n. Response was assessed by upper gastrointestinal series, endoscopy, compu ted tomography scan, and pathologic examination. Results For the three phase II trials, clinical response rates ranged from 24% to 3 8%. Three patients (4%) had a complete pathologic response. Sixty-one patie nts (73%) underwent a curative resection, Median follow-up was 26 months, U nivariate analysis revealed T stage, number of positive nodes, and response to chemotherapy to be significant predictors of overall survival, However, on multivariate analysis, response to chemotherapy was found to be the onl y independent prognostic factor. Conclusions Response to neoadjuvant chemotherapy is the single most important predictor of overall survival after neoadjuvant chemotherapy for gastric cancer. The se findings support further evaluation of neoadjuvant approaches in the tre atment of this disease.