Benefit of adjuvant chemoradiotherapy in patients with pathological stage III gastric cancer
Received 11 February 2019
Accepted for publication 20 May 2019
Published 2 July 2019 Volume 2019:11 Pages 6029—6041
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Dr Kenan Onel
Gui-Fen Ma,1,* Hai-Ge Zhang,1,* Juan Liu,1 Yi-Xing Chen,1 Han Xiao,1 Xue-Fei Wang,2 Jian He,1 Zhao-Chong Zeng,1 Jing Sun,1 Tian-Shu Liu3,4
1Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of China; 2Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of China; 3Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of China; 4Center of Evidence-Based Medicine, Fudan University, Shanghai 200032, People’s Republic of China
*These authors contributed equally to this work
Background: For patients with locally advanced gastric cancer (LAGC) after D2 gastrectomy, the survival benefits of receiving adjuvant chemoradiotherapy versus adjuvant chemotherapy are unclear. This study aimed to compare the 5- and 7-year overall survival (OS) in the two groups and to identify which patients can benefit more from adjuvant chemoradiotherapy.
Methods: Retrospective data were collected from January 2009 to December 2014. The 5- and 7-year OS and disease-free survival (DFS) were compared between the two groups using the Chi-square test. The association of OS with prognostic factors was identified using the Cox’s proportional hazard model, which was then adjusted for survival coparison using propensity score-matching (PSM) analysis. The association of OS with each clinical/demographic factor was compared between the two groups using the Kaplan–Meier analysis.
Results: A total of 415 eligible patients were identified (135 adjuvant chemoradiotherapy, 280 adjuvant chemotherapy). Significant 5- and 7-year OS and DFS benefits were found in the adjuvant chemoradiotherapy group versus chemotherapy group. Multivariate analysis showed that age, TNM stage, lymph node (LN) ratio, tumor deposits, and total/subtotal gastrectomy were independent prognostic factors. When the PSM analysis was adjusting by these factors, 135 patients were matched with an improved survival benefit from adjuvant chemoradiotherapy. Patients in the adjuvant chemoradiotherapy group had a lower locoregional relapse. Subset analysis also identified significant OS benefits of adjuvant chemoradiotherapy in patients with LN ratio <50%, pIIIA, and pIIIB stage disease, while OS benefits were not observed in patients with tumor deposits, pN3b classification, or pIIIC stage disease.
Conclusion: Adjuvant chemoradiotherapy was shown to be superior in improving the OS in a certain population of patients compared with adjuvant chemotherapy. This finding may help to better guide the individualized treatments of patients with stage III LAGC after D2 gastrectomy.
Keywords: adjuvant chemoradiotherapy, adjuvant chemotherapy, local advanced gastric cancer, overall survival, propensity score-matching analysis, tumor deposits
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