Comparison of efficacy in adjuvant chemotherapy regimens in patients with radically resected gastric cancer: a propensity-matched analysis

Ren, Qian; Huang, Jia Xing; Chen, Hong Tao; Liao, Yi; Lv, Wei; Chen, Nan; Liu, Jing; Zhang, Hong Yu; Xu, Da

doi:10.18632/oncotarget.11783

Cited by 1 publication

(1 citation statement)

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“…12 Several studies have sought to evaluate the efficacy and safety of adjuvant chemotherapy (CTx) or chemoradiation therapy (cXRT) among patients with gastric cancer. 12,16–19,31,32,33,34,35 The results of these studies have been controversial as well as limited by small sample size and lack of a cohort receiving contemporary chemotherapy regimens. The current study is important, because it reports the outcomes of adjuvant CTx / cXRT among a contemoporary cohort of patients with gastric cancer using one of the largest, multi-institutional experiences on the surgical management of gastric cancer in the United States.…”

Section: Discussionmentioning

confidence: 99%

Impact of lymph node ratio in selecting patients with resected gastric cancer for adjuvant therapy

Kim

Squires

Poultsides

et al. 2017

Surgery

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Background: The impact of adjuvant chemotherapy (CTx) and chemo-radiation therapy (cXRT) in the treatment of resectable gastric cancer remains varied. We sought to define the clinical impact of lymph node ratio (LNR) on the relative benefit of adjuvant CTx or cXRT among patients having undergone curative-intent resection for gastric cancer. Methods: Using the multi-institutional U.S. Gastric Cancer Collaborative database, 719 patients with gastric adenocarcinoma who underwent curative-intent resection between 2000 and 2013 were identified. Patients with metastasis or an R2 margin were excluded. The impact of LNR on overall survival (OS) among patients who received CTx or cXRT was evaluated. Results: Median patient age was 65 years, and the majority of patients were male (56.2%). The majority of patients underwent either subtotal (40.6%) or total gastrectomy (41.0%), with the remainder undergoing distal gastrectomy or wedge resection (18.4%). On pathology, median tumor size was 4 cm; most patients had a T3 (33.0%) or T4 (27.9%) lesion with lymph node metastasis (59.7%). Margin status was R0 in 92.5% of patients. A total of 325 (45.2%) patients underwent resection alone, 253 (35.2%) patients received 5-FU or capecitabine-based cXRT, whereas the remaining 141 (19.6%) received CTx. Median OS was 40.9 months, and 5-year OS was 40.3%. According to LNR categories, 5-year OS for patients with a LNR of 0, 0.1–0.10, >0.10–0.25, >0.25 were 54.1%, 53.1 %, 49.1 % and 19.8 %, respectively. Factors associated with worse OS included involvement of the gastroesophageal junction (hazard ratio [HR] 1.8), T-stage (3–4: HR 2.1), lymphovascular invasion (HR 1.4), and LNR (>0.25: HR 2.3) (all P<0.05). In contrast, receipt of adjuvant cXRT was associated with an improved OS in the multivariable model (vs. resection alone: HR 0.40; vs. CTx: HR 0.45, both P<0.001). The benefit of cXRT for resected gastric cancer was noted only among patients with LNR >0.25 (vs. resection alone: HR 0.34; vs. CTx: HR 0.45, both P<0.001). In contrast, there was no noted OS benefit of CTx or cXRT among patients with LNR ≤0.25 (all P>0.05). Conclusion: Adjuvant CTx or cXRT was utilized in over one-half of patients undergoing curative-intent resection for gastric cancer. LNR may be a useful tool to select patients for adjuvant cXRT, because the benefit of cXRT therapy was isolated to patients with greater degrees of lymphatic spread (i.e., LNR >0.25).

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