Histological indications of a favorable prognosis with far-advanced gastric carcinomas after preoperative chemotherapy

Purpose: Although preoperative chemotherapy for advanced gastric cancer is now commonly applied with favorable results, convincing evidence for life p rolongation and predictive markers for a good prognosis are both lacking. W e report here 5 cases that have shown a distinct positive effect of preoper ative chemotherapy together with the results of a precise histological exam ination of materials indicating features predicting a favorable outcome. Pa tients and methods: A total of 18 patients with a far-advanced gastric carc inoma subjected to gastrectomy after FLEP (5-fluorouracil, leucovorin, etop oside, cisplatin) in the Cancer Institute Hospital of the Japanese Foundati on for Cancer Research, Tokyo, could be divided into two distinct groups: 5 surviving over 5 years (group A) and 13 who died within 13 months (group B ). Histological features (subtypes) of the carcinomas and chemotherapeutic effects were studied with reference to biopsy materials and resected stomac hs and lymph nodes. Results: In group A, 3 of 5 patients had solid-type poo rly differentiated adenocarcinomas. In contrast, in group B, 9 had tubular adenocarcinomas (well or moderately differentiated) and 3 non-solid or diff use-type poorly differentiated adenocarcinomas and there was only one solid -type tumor. In group A, remarkable therapeutic effects were apparent histo logically in 4 of the 5 patients with almost complete disappearance of canc er cells from metastases in lymph nodes, whereas no such changes were evide nt in group B. Conclusion: FLEP is distinctly beneficial for certain types of advanced gastric carcinoma, especially solid-type poorly differentiated adenocarcinomas, and favorable results can be predicted, to a certain exten t, on the basis of findings for the material resected after chemotherapy.