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PURPOSE To compare overall survival (OS) in patients with baseline metastatic gastric adenocarcinoma (GA) with and without ovarian metastasis (OM). Furthermore, within the group that had ovarian metastases, we aimed to assess whether there was a survival benefit (SB) with palliative oophorectomy (PO). PATIENTS AND METHODS This is a single-institution retrospective analysis of the clinicopathological features of women diagnosed with metastatic GA with a comparison of outcomes based on PO status. We identified 240 women with baseline metastatic GAs who were treated at MD Anderson Cancer Center between February 2003 and September 2022. Among these women, we categorized a subgroup of 102 women who had OM from their primary GA. Patients were analyzed whether they underwent PO. RESULTS Patients who developed OM were most often non-Caucasian, had peritoneal involvement, and had tumors that were both human epidermal growth factor receptor 2–negative and PD-L1–negative, with signet ring cell features and diffuse histological type. Among patients with ovarian metastases, those who had PO had an Eastern Cooperative Oncology Group = 0, more comprehensive molecular and immunohistochemical profiling, lower percentage of family history of gastroesophageal malignancies, and lower interval between diagnosis of the GA primary and the OM. PO was associated with significantly improved OS in this subgroup (hazard ratio, 0.5 [95% CI, 0.31 to 0.81]; P = .005). CONCLUSION To our knowledge, this is the largest multiethnic population study assessing SB of PO in patients with GA with OM. Additionally, it is the largest study analyzing survival in this population according to the patient's multiethnic characteristics and metastasis timing and growth patterns. PO presents as a therapeutic option for women with GAs with OM if the patient is clinically suitable for surgical resection.

Objective: To discern recurrence risk stratification and investigate its influence on postoperative surveillance in patients with esophageal adenocarcinoma (EAC) after neoadjuvant chemoradiotherapy (CRT). Background: Reports documenting recurrence risk stratification in EAC after neoadjuvant CRT are scarce. Methods: Between 1998 and 2014, 601 patients with EAC who underwent neoadjuvant CRT followed by esophagectomy were included for analysis. The pattern, site, timing, and frequency of the first recurrence and potential prognostic factors for developing recurrences were analyzed. This cohort was used as the training set to propose a recurrence risk stratification system, and the stratification was further validated in another cohort of 172 patients. Results: A total of 150 patients (25.0%) achieved pathologic complete response (pCR) after neoadjuvant CRT and the rest were defined as the non-pCR group (n = 451) in the training cohort. After a median follow-up of 63.6 months, the pCR group demonstrated a significantly lower locoregional (4.7% vs 19.1%) and distant recurrence rate (22.0% vs.44.6%) than the non-pCR group (P < 0.001). Based on independent prognostic factors, patients were stratified into 4 recurrence risk categories: pCR with clinical stage I/II, pCR with clinical stage III, non-pCR with pN0, and non-pCR with pN+, with corresponding 5-year recurrence-free survival rates of 88.7%, 65.8%, 55.3%, and 33.0%, respectively (P < 0.001). The risk stratification was reproducible in the validation cohort. Conclusions: We proposed a recurrence risk stratification system for EAC patients based on pathologic response and pretreatment clinical stage. Risk-based postoperative surveillance strategies could be developed for different risk categories.