Perioperative chemotherapy versus postoperative chemoradiotherapy in patients with resectable gastric/gastroesophageal junction adenocarcinomas: A survival analysis of 5058 patients

Fitzgerald, Timothy L.; Efird, Jimmy T.; Bellamy, N.; Russo, Suzanne; Jindal, Charulata; Mosquera, Catalina; Holliday, Elizabeth G.; Biswas, Tithi

doi:10.1002/cncr.30692

Cited by 30 publications

(14 citation statements)

References 30 publications

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“…An analysis of >5000 patients with esophageal and GEJ adenocarcinomas diagnosed between 2004 and 2013 demonstrated a substantially decreased risk of death with the receipt of POC over postoperative chemoradiation (adjusted HR, 0.58; P < .001). 20 Others have found no survival gain with the addition of preoperative RT to neoadjuvant chemotherapy and surgery (HR, 1.08; P = .23). 21 Last, Mokdad et al reported on >10,000 patients in the NCDB with locally advanced esophageal and GEJ adenocarcinomas who were treated with preoperative chemoradiation, and reported a significant benefit to the addition of adjuvant chemotherapy (HR, 0.79; P < .001).…”

Section: Discussionmentioning

confidence: 97%

“…The value of RT in addition to surgery with or without chemotherapy has been unclear when explored using other large data sets. An analysis of >5000 patients with esophageal and GEJ adenocarcinomas diagnosed between 2004 and 2013 demonstrated a substantially decreased risk of death with the receipt of POC over postoperative chemoradiation (adjusted HR, 0.58; P < .001) . Others have found no survival gain with the addition of preoperative RT to neoadjuvant chemotherapy and surgery (HR, 1.08; P = .23) .…”

Section: Discussionmentioning

confidence: 99%

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Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Tian

Jiang

Madden

et al. 2019

Cancer

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Background Perioperative chemotherapy (POC) is one standard approach for the treatment of resectable cancers of the stomach and gastroesophageal junction (GEJ), whereas there has been growing interest in preoperative therapies. The objective of the current study was to compare survival between patients treated with preoperative chemoradiotherapy and adjuvant chemotherapy (PCRT) with those receiving POC using a large database. Methods The National Cancer Data Base was queried for patients diagnosed between 2004 and 2013 with American Joint Committee on Cancer clinical group stage IB to stage IIIC (excluding T2N0 disease) adenocarcinoma of the stomach or GEJ. Patients treated with definitive surgery and POC with or without preoperative radiotherapy of 41 to 54 Gy were included. Overall survival (OS) was defined from the date of definitive surgery and estimated using the Kaplan‐Meier method. A total of 14 patient and treatment variables were used for propensity score matching (PSM). Results A total of 1048 patients were analyzed: 53.2% received POC and 46.8% received PCRT. The primary tumor site was the GEJ in 69.1% of patients and stomach in 30.9% of patients. The median age of the patients was 60 years, and the median follow‐up was 25.8 months. The use of PCRT was associated with a greater pathologic complete response rate of 13.1% versus 8.2% (P = .01). POC was associated with a decreased risk of death in unmatched groups (hazard ratio [HR], 0.83; P = .043). Using PSM cohorts, POC decreased the risk of death with a median OS of 45.1 months versus 31.4 months (HR, 0.70; P = .016). The 2‐year OS rate was 72.9% versus 62.5% and the 5‐year OS rate was 40.7% versus 33.1% for POC versus PCRT, respectively. Survival favored POC in PSM gastric (HR, 0.41; P = .07) and GEJ (HR, 0.77; P = .08) patient subgroups. Conclusions The addition of preoperative radiotherapy to POC appears to be associated with an increased risk of death in patients with resectable gastric and GEJ cancers.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Tian

Jiang

Madden

et al. 2019

Cancer

View full text Add to dashboard Cite

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“…However, such patient selection is unlikely to account for the difference in conclusions between that study and the current one, as institution was not a prognostic factor even when patients receiving preoperative chemotherapy were eliminated from the analysis. Furthermore, preoperative chemotherapy has been associated with enhanced survival compared with postoperative chemotherapy, 18 The current study has several limitations. This is a retrospective study comparing data from two different institutions in disparate regions of the world, so the analysis is vulnerable to both confounding factors and selection bias despite our best efforts to adjust for differences between the two groups.…”

Section: Discussionmentioning

confidence: 87%

Comparison of gastric cancer survival after R0 resection in the US and China

Huang

Zheng

et al. 2018

Journal of Surgical Oncology

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Background and Objectives: Gastric cancer outcomes differ between Asian and Western countries, even when controlling for contributing factors, but whether this difference holds true for China remains inadequately studied. We sought to compare the presentation, treatment, and outcomes of patients with gastric cancer (GC) undergoing curative intent (R0) resection between the U.S. and China, and to ascertain whether geography/ institution is an independent predictor of DSS. Methods: Data were analyzed from patients with GC undergoing R0 resection at high-volume cancer centers in the U.S. (Memorial Sloan Kettering Cancer Center [MSKCC], n=1,378) and China (Fujian Medical University Union Hospital [FMUUH], n=4,262) between 2000 and 2014. Factors associated with disease-specific survival (DSS) were examined by multivariate analysis. Results: The 5-year DSS (p < 0.001) for all patients was better at MSKCC than at FMUUH, even among patients not receiving preoperative chemotherapy (p < 0.001), but stratification by sub-stage eliminated this difference (p > 0.05). Factors independently associated with DSS included age, histology, tumor size, T category, N category, gastrectomy type, and preoperative chemotherapy, but not institution. Conclusions: Although the presentation of GC patients between MSKCC and FMUUH differs, survival of patients with curatively resected GC, when matched for clinical stage, is comparable.

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“…One study demonstrated a survival advantage for perioperative chemotherapy, especially in patients who were down-staged from lymph node-positive to lymph node-negative disease after neoadjuvant chemotherapy. 12 Another study found an improved overall survival with adjuvant chemoradiation, particularly in patients with margin positive resections. 13 Another study using a California cancer registry found similar outcomes between perioperative chemotherapy and adjuvant chemoradiation for clinically node-positive patients, though chemoradiation resulted in better survival for node-negative patients or those with signet ring cell histology.…”

Section: Discussionmentioning

confidence: 99%

Lack of National Adoption of Evidence-Based Treatment for Resectable Gastric Adenocarcinoma

Lee

Wima

Morris

et al. 2021

Journal of Gastrointestinal Surgery

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Background Level 1 evidence for multimodal treatment of resectable gastric adenocarcinoma from the Intergroup 0116 (2001) and MAGIC (2006) trials demonstrated survival benefit of adjuvant chemoradiation (CRT) and perioperative chemotherapy, respectively. We evaluated the adoption of evidence-based treatment in the post-MAGIC era and its impact on survival. Methods A total of 7058 patients with resectable gastric adenocarcinoma undergoing definitive surgical resection between 2004 and 2015 were analyzed using the National Cancer Database. Results Over the study period, the proportion of patients receiving adjuvant CRT decreased from 19.1% to 9.1%, while perioperative chemotherapy increased from 1.9% to 28.6%. Utilization of perioperative chemotherapy surpassed adjuvant CRT in 2011. Evidence-based treatment (either perioperative chemotherapy or adjuvant CRT) had better overall survival (OS) than other treatments for clinical stage II–III patients ( p < 0.05). On multivariate analysis of the whole study period, evidence-based treatments were associated with better OS (HR 0.67 [0.60–0.74], p < 0.05). Only 360/1262 (28.5%) patients in the perioperative chemotherapy group completed postoperative therapy, which was associated with improved OS ( p < 0.05). For clinical stage III patients ( n = 2402), only 806 (33.6%) received evidence-based treatment, while 487 (22.2%) underwent surgery alone. On multivariate analysis of these patients between 2010 and 2015, both perioperative chemotherapy (HR 0.49 [0.35–0.68]) and adjuvant CRT (HR 0.31 [0.21–0.44]) were associated with better OS than surgery alone ( p < 0.05). Conclusions Since the INT-0116 and MAGIC trials, utilization of evidence-based treatments for resectable gastric adenocarcinoma has increased, with perioperative chemotherapy surpassing adjuvant CRT as the preferred practice. However, overall utilization of these regimens remains quite low nationally despite association with improved OS.

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Perioperative chemotherapy versus postoperative chemoradiotherapy in patients with resectable gastric/gastroesophageal junction adenocarcinomas: A survival analysis of 5058 patients

Cited by 30 publications

References 30 publications

Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Comparison of gastric cancer survival after R0 resection in the US and China

Lack of National Adoption of Evidence-Based Treatment for Resectable Gastric Adenocarcinoma

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