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Application of Gross Tissue Response System in Gastric Cancer after Neoadjuvant Chemotherapy: A Primary Report of a Prospective Cohort Study
58 Pages Posted: 10 Mar 2020
More...Abstract
Objective: We previously have established the gross tissue response (GTR) system to evaluate the intraoperative perigastric tissue response after neoadjuvant chemotherapy of gastric cancers. This prospective cohort study aims to confirm the relationship among gross tissue response, postoperative complications, and pathological tumor regression.
Methods: A total of 156 gastric cancer cases from January 2018 to December 2019 were enrolled in the study. The fibrosis, edema, and effusion degree of perigastric tissues was intraoperative assessed according to the GTR system. We systematically analyzed relations among the GTR system, clinicopathological characteristics, and postoperative 30-day complications.
Results: Finally, the study had included 107 males and 49 female patients. The overall incidence rate of postoperative 30-day complications was 26.28% (41/156). Fibrosis, edema and the total score of the GTR system were significantly related to operation time and postoperative 30-day complications (p<0.05). Edema, effusion and the total score of the GTR system were significantly related to intraoperative blood loss (p<0.05). The AUC of total score of GTR system in the prediction of the postoperative 30-day complications and tumor regression grade were 0.701 and 0.818, respectively. The logistic regression analysis identified that the total score of the GTR system (score: 4-6, OR 2.651, 95% CI: 1.172-7.007, p = 0.024) was independent risk factors for the postoperative 30-day complications. The total score of the GTR system (scores 4-6, OR 0.349, 95%CI 0.138-0.829, p = 0.020) was good risk factors, whereas the cN stage (Nodes positive, OR 4.616, 95%CI 2.027-10.934, p<0.001) was poor risk factor for pathological tumor regression (TRS 2-3).
Conclusion: The gross tissue response system can help the operator to assess the difficulty of operation and incidence risk of postoperative complications for gastric cancer patients with neoadjuvant chemotherapy. Besides, the grade of gross tissue response grade not only reflect the normal tissue reaction by chemotherapy, but also related to the grade of tumor regression.
Trial Registration: ClinicalTrials.gov Identifier: NCT03791268
Funding Statement: 1. National Natural Science Foundation of China (81372344, 81772547, 81902437); 2. Ten Thousand Talent Program of Sichuan Province (No. TJZ201906); 3. 135 project for disciplines of excellence, West China Hospital, Sichuan University; 4. Fund for Fostering Academic and Technical Leaders of Sichuan Province ([2017]919).
Declaration of Interests: There are no conflicts of interest.
Ethics Approval Statement: The performing of this study was approved by the Ethics Committee of West China Hospital, Sichuan University (2018(No.34)).
Keywords: Gastric cancer, neoadjuvant chemotherapy, tissue response, complications, tumor regression
Suggested Citation: Suggested Citation