Adjuvant Chemotherapy for Advanced Gastric Cancer in Elderly and Non-elderly Patients: Meta-Analysis of Randomized Controlled Trials

Chang, Shih-Chieh; Kim, Soo-Nyung; Choi, Hye Jung; Park, Misuk; Kim, Rock Bum; Go, Se‐Il; Lee, Won Sup

doi:10.4143/crt.2016.054

Cited by 17 publications

(15 citation statements)

References 26 publications

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“…Our results also indicated that chemotherapy or radiotherapy had limited benefits in this elderly group, regardless if used in neoadjuvant or adjuvant setting if they received a curative surgical resection. This result was consistent with previous small cohort studies which demonstrated that elderly patients did not benefit from neoadjuvant or adjuvant treatment [45][46][47][48], especially for patients older than 80 years [49]. There are a limited number of studies that have reported a survival benefit for adjuvant chemoradiation therapy [50,51].…”

Section: Discussionsupporting

confidence: 91%

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Wang

Zhao

Fairweather

et al. 2019

Preprint

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Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001). However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P=0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P=0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P=0.002) was a significant independent prognostic factor, while extensive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P=0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P=0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P<0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P<0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P<0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with resectable PGC.

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Section: Discussionsupporting

confidence: 91%

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Wang

Zhao

Fairweather

et al. 2019

Preprint

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“…These results suggested that S-1 treatment was insufficient in eliminating micrometastatic cancer cells in cases with high p-TNM stage. Furthermore, in their subgroup analysis, S-1 treatment was shown to be not beneficial in elderly patients (≥ 60 years) and could not be sustained up to one year, with a 12-mo completion rate of only 65.8%[ 16 ]. In the CLASSIC study, only 67% received the planned eight cycles of adjuvant capecitabine and oxaliplatin chemotherapy; 56% experienced grade 3 or 4 adverse events; and 90% needed dose modifications because of adverse events[ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy with S-1 plus oxaliplatin improves survival of patients with gastric cancer after D2 gastrectomy: A multicenter propensity score-matched study

Ren

Zheng

Zhao

et al. 2018

WJCC

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AIMTo investigate the safety and efficacy of S-1 plus oxaliplatin (SOX) as an adjuvant chemotherapy regimen in gastric cancer (GC) after D2 dissection.METHODSGC Patients who underwent D2 gastrectomy from September 2009 to December 2011 in four Chinese institutions were enrolled. Patients with stage IB-IIIC GC, who received adjuvant SOX treatment were matched by propensity scores with those who underwent surgery alone and those who conducted capecitabine plus oxaliplatin (XELOX) regimen. Disease-free survival (DFS) and overall survival (OS) were compared among the groups. In addition, adverse events in SOX patients were analyzed.RESULTSOf 1944 GC patients who underwent D2 dissection, 867 were included for analysis. One hundred and seventeen patients treated with SOX were matched to 234 patients who conducted surgery alone. Fifty-seven patients treated with SOX were matched to 57 patients who received XELOX. The estimated five-year DFS was 57.5% in the adjuvant SOX group which was higher than that (44.6%) in the surgery alone group (P = 0.001); and the estimated five-year OS was 68.3% which was higher than that (45.8%) of surgery alone group (P < 0.001). Survival benefit was also revealed in stage III and > 60 years old subgroups (P < 0.001 and P = 0.015, respectively). Compared with XELOX regimen, SOX showed no significant difference in DFS (P = 0.340) and OS (P = 0.361). The most common ≥ 3 grade adverse events of SOX regimen were neutropenia (22.6%), leukopenia (8.9%) and thrombocytopenia (5.6%).CONCLUSIONCompared with surgery alone, SOX regimen significantly improves the long-term survival and has acceptable toxicity in patients with stage IB-IIIC GC after D2 dissection. It may be a novel adjuvant chemotherapy regimen in GC patients.

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“…For example, a recent metaanalysis of adjuvant therapy for gastric cancer reported no benefit of adjuvant chemotherapy among the elderly population. 36 In contrast, in a separate study by Jo et al, the authors reported that adjuvant chemotherapy may confer a potential survival benefit in elderly patients with stages II or III gastric cancer after a D2 resection. 37 These data suggest that a different strategy and risk stratification may be needed for the elderly patients that considers their functional, social, and mental conditions.…”

Section: Discussionmentioning

confidence: 92%

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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Adjuvant Chemotherapy for Advanced Gastric Cancer in Elderly and Non-elderly Patients: Meta-Analysis of Randomized Controlled Trials

Cited by 17 publications

References 26 publications

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Adjuvant chemotherapy with S-1 plus oxaliplatin improves survival of patients with gastric cancer after D2 gastrectomy: A multicenter propensity score-matched study

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

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