Adjuvant chemotherapy provided survival benefit for stage T2N0 gastric cancer with high-risk factors

Abstract

The value of adjuvant chemotherapy in T2N0 gastric cancer (GC) remains controversial. The aim of this retrospective study is to define a high-risk subgroup of pathological T2N0 GC patients and examine the impact of adjuvant chemotherapy on overall survival (OS). A total of 225 patients underwent R0 resection for T2N0 gastric adenocarcinoma between 2002 and 2012 and 51/225 (22.7%) of these received adjuvant chemotherapy. Multivariate Cox regression identified tumor location in the Upper1/3 of the stomach (peast one of the independent risk factor listed above, and we found that adjuvant chemotherapy significantly improved OS for this subgroup.

Challenges surrounding postoperative adjuvant chemotherapy for T2N0 gastric cancer (Review)

“…A separate retrospective assessment of 225 patients with GC, who had received R0 resection, determined that lymphovascular (P=0.001) and perineural (P<0.001) invasion were independent predictors of reduced OS time (23). In addition, the study also found that adjuvant chemotherapy was associated with significant improvements in the OS time of patients with these invasive phenotypes (P<0.001) (23). Consistent with these results, Araki et al (27) found that in a retrospective assessment of 130 patients with stage IB node-negative (T2N0) GC venous invasion was independently predictive of reduced patient RFS and OS times (HR, 3.00; P=0.035 and HR, 5.00; P=0.006, respectively).…”

“…Further randomized trials would be important to adequately evaluate the benefits of adjuvant therapy in patients with stage T2N0 GC. These patients typically have a favorable prognosis; however, several retrospective studies suggested that specific subgroups of high-risk patients with T2N0 GC had poorer prognosis (7,8,(23)(24)(25). Therefore, prognostic markers should be identified to assist with identifying which patients with stage T2N0 GC would benefit from adjuvant chemotherapy.…”

“…Tumors in the upper third of the stomach were associated with an 81.8% 5-year OS time, whereas tumors in the middle or low third of the stomach were associated with a 95.5% 5-year OS time (P=0.0093). A separate retrospective analysis identified a high-risk subgroup among 225 patients with stage T2N0 GC, who would benefit from adjuvant chemotherapy (23). The study observed that tumor location within the upper third of the stomach was independently associated with a decrease in the OS time of these patients (P<0.001), and the patients were also reported to benefit from adjuvant chemotherapy treatment (23).…”

Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Gastric Cancer

“…The results of several studies indicated worse outcome in the young, whereas other studies showed comparable or better outcome relative to patients diagnosed with later-onset disease ( 5 , 6 , 8 – 10 ). Because prognosis of young patients with GC is not very clear, it is not easy to give advice on chemotherapy, and the therapeutic regimen for these patients is not well known ( 6 , 11 – 13 ). Whether younger patients gain survival benefit from chemotherapy remains unknown.…”

“…Among patients with stage II and stage III disease, adjuvant chemotherapy is recommended as the routine treatment after surgery; however, not every patient could benefit from chemotherapy, and some patients may even be harmed ( 14 , 15 , 19 – 22 ). In addition, little is known on the survival benefits of chemotherapy in patients with earlier-stage cancers, as several studies have reported no significant improvement in the outcome ( 11 , 23 ). Therefore, routine chemotherapy after surgery is currently not recommended as the routine treatment for all patients, and its use in cases of earlier-stage GC is still controversial ( 24 ).…”