Pode a regressão tumoral e ganglionar induzida pela quimioterapia perioperatória no carcinoma gástrico relacionar-se com os outcomes pós-operatórios?

Abstract

Introduction: Gastric cancer is an aggressive neoplasm with a poor prognosis. The multimodal approach with perioperative chemotherapy is currently the recommended treatment for patients with locally advanced gastric cancer. This method induces a histopathological response expressed either through the degree of regression of the primary tumor or of the lymph nodes and through yTNM staging. Despite its advantages, there are still doubts regarding the effects of chemotherapy on postoperative morbidity and mortality. The main goal of this study is to evaluate the impact of perioperative chemotherapy and its effect on anatomopathological results and operative morbidity, and secondly to evaluate its effect on patient survival. Materials and methods: Observational retrospective study with 134 patients with advanced gastric cancer, who underwent perioperative chemotherapy and curative radical surgery. The degree of histological regression of the primary tumor was evaluated according to Becker's criteria; the proportion of regressed lymph nodes was determined and postoperative complications were evaluated according to Clavien-Dindo's classification. Survival times were compared between the groups using Kaplan-Meier curves and the Mantel-Cox Log Rank test. Simple associations between categorical variables were evaluated using Pearson's Chi-square test. Results: 22.2% of patients undergoing perioperative chemotherapy were classified as good responders and 75.9% as poor responders. This variable and operative morbidity were not related (p=1.68). 64.2% of patients had invaded lymph nodes and 46.3% had regressed lymph nodes, 49.4% had no lymphatic invasion and 61.9% had no signs of venous invasion after perioperative chemotherapy. Postoperative complications occurred in 30.6% of the patients. The group of good responders had an average survival of 56.0 months and the group of poor responders of 34.0 months, p=0.17. Conclusion: Our study corroborated that perioperative chemotherapy induces regression both on the primary tumor and lymph nodes. The results of operative morbidity were similar to those described in the literature. However, although the group of good responders showed better survival, this value was not significant. Therefore, further studies are needed to evaluate the importance of the degree of lymph node regression and its impact on the survival of these patients.