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Gastroenterology Research and Practice
Volume 2013 (2013), Article ID 502153, 7 pages
Clinical Study

A Pilot Study to Investigate the Role of Thymidylate Synthase as a Marker of Prognosis for Neoadjuvant Chemotherapy in Gastric and Gastro-Oesophageal Junction Adenocarcinoma

1Departments of Gastrointestinal Surgery and Histopathology, University Hospital of South Manchester, Manchester M23 9LT, UK
2Translational Radiobiology Group, School of Cancer and Enabling Sciences, The University of Manchester, Manchester Academic Health Science Centre, Christie Hospital NHS Trust, Manchester M20 4BX, UK
3Departments of Surgery and Histopathology, The University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK

Received 12 October 2012; Accepted 25 January 2013

Academic Editor: D. Fan

Copyright © 2013 A. Mirza et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Aims and Background. Patients in the United Kingdom with operable gastric and gastro-oesophageal junction (GOJ) tumours receive neoadjuvant chemotherapy. Our aim was to study the expression of thymidylate synthase (TS) enzyme in pre-treatment diagnostic biopsy specimens and investigate its clinical usefulness. Methods. A single-centre study was carried out in 45 patients with gastric and GOJ adenocarcinoma treated with neo-adjuvant chemotherapy according to the MAGIC protocol. TS expression was determined using immunohistochemistry. >10% tumour nuclei expression of TS was used as cut-off for positivity. Results. Forty-one (91%) of the 45 tumours expressed TS. There was no association between TS expression and lymph node status (P = 0.80), histological response (P = 0.30), and recurrence (P = 0.55). On univariate analysis, only N-stage (P = 0.02) and vascular invasion (P = 0.04) were associated with a poor prognosis. Patients with negative tumour TS expression had better outcome than those with positive expression. The overall 5-year survival rate was 100% in the TS negative versus 56% in TS positive group, but the difference was not statistically significant (P = 0.17). Conclusion. TS expression should be studied in a larger series of gastro-oesophageal cancers as a potential prognostic marker of prognosis to neo-adjuvant chemotherapy.