Correlation of the histological effects and survival after neoadjuvant chemotherapy on gastric cancer patients

The surgical results for patients with stage IV gastric cancer are very poor. This study was performed to clarify the morphologic changes and survival after neoadjuvant chemotherapy for the stage IV gastric cancer patients.

Forty-three patients with stage advanced gastric cancer were treated with preoperative PMUE therapy by a combination use of cisplatin 75 mg/m2, mitomycin C 10 mg/body, etoposide 150 mg/body and UFT 400 mg/day. Among them, 32 patients underwent gastrectomy. Resected specimens were precisely examined histologically, and the histologic changes were correlated with clinical response and survival.

Histologic manifestations of neoadjuvant chemotherapy included coagulation necrosis of cancer cell, appearance of the giant cell with foamy degeneration, extracellular mucin pools, aggregates of foamy histiocytes and/or stromal fibrosis. Histological responses were obtained in 24 (75%) of 32 primary tumors, 13 (81%) of 16 liver metastases, 20 (76%) of 28 lymph node metastases and 3 (18%) of 17 peritoneal disseminations, respectively. Clinical responses were observed in 21 (49%), but there was no statistical survival difference between clinical responders and nonresponders. In contrast, histologic responders survived significantly longer than non-responders.

These results indicate that the grading of the histologic changes is a good prognosticator of patients treated with neoadjuvant chemotherapy, and yields an important information for the selection of postoperative chemotherapy.