Validating a nodal regression system for gastric cancer: An ancillary cohort study of the GASTRODOC trial
Luca Saragoni1, Leonardo Solaini, Daniele Marrelli
1Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy Unit of Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy Pathology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy General and Upper GI Surgery Division, University of Verona, Verona, Italy Department of Pathology, Ospedale G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy Department of Oncology, San Giuseppe Hospital, Empoli, Italy Pathology Unit,San Giuseppe Hospital, Empoli, Italy Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili di Brescia, Brescia, Italy Institute of Pathology, ASST Spedali Civili, Brescia, Italy Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy General and Oncologic Surgery, Department of Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy.
Background:
To validate a nodal regression system for gastric cancer and to verify its impact on prognosis.
Methods:
This is an ancillary study which included 47 patients of the GASTRODOC trial. The dedicated pathologists of each Institute were invited to revise all the lymph nodes included in the surgical specimens in order to classify the regression according to the grading system proposed by Tsekrekos et al. The association of the nodal regression system and the clinico-pathological characteristics and prognosis were investigated.
Results:
According to the classification of Tsekrekos et al., there were 19 (40.4%) patients with grade a, 14 (29.8%) with grade b and 14 (29.8%) with grade c nodal regression. This regression system showed significant statistical associations with pathological N status (p < 0.001), residual tumor classification (p = 0.003) and Becker regression system (p = 0.011). At multivariable analysis only Tsekrekos' grading regression system was significantly associated with the PFS (HR 10.1, 95% CI 1.3-75.5; p = 0.025).
Conclusions:
The analyzed nodal regression system is significantly associated with Becker's regression system and it has a strong correlation with prognosis.
