Prognostic Analysis of Patients with Operable Gastric Cancer and Tolerability to Adjuvant Radio-Chemo-Therapy

Abstract

The aim of this study is to evaluate the tolerability and toxicity of adjuvant chemoradiotherapy (CRT) and to analyze the prognosis in patients with operable gastric cancer.The retrospective analysis included 723 patients with operable gastric cancer; stage IB-IV (M0), received adjuvant CRT from 8 Medical Centers in Turkey between 2003 and 2010. The patients' age, sex, tumor localization, Lauren classification, grade and stage of the disease, type of dissection, the toxicity and tolerability status and survival rate were analyzed. All patients were divided into two groups as tolerable group to adjuvant CRT and intolerable group to adjuvant CRT .Among the patient, 73.9% had stage III-IVM0 disease; 61.0% had the intestinal type of gastric cancer, 51.1% had the distal type, and 61.4% had undergone D2 dissections. The number of patients who completed the entire course of the adjuvant CRT was 545 (75.4%).The median follow-up period was 20.8 months (range: 1.5-107 months). Overall Survival (OS) rates were 80% and 52%, while the relapse free survival (RFS) rates were 75% and 48% at 1 and 3 years, respectively.In the univariate analysis of the groups based on the the age defined as <65 or ≥65 (p=0.16 / p=0.003), Lauren classification (p=0.004 / p<0.001), localization of tumor (p=0.02 / p=0.04), tumor grade (p=0.06 / p=0.003), disease stage (p<0.001 / p<0.001), type of dissection (p=0.445 / p=0.043), presence or absence of toxicity (p=0.062 / p=0.077) and tolerability of the therapy (p=0.002 / p=0.001). In the cox regression analysis, tumor stage (Hazard Ratio (HR): 0.332; 95% confidence interval (CI): 0.195-0.566; p<0.001), and tolerability (HR: 0.516; 95% CI: 0.305-0.872; p=0.014), were found to be related with the OS. Tumor stage (HR: 0.318; 95% CI: 0.190-0.533; p=<0.001) and tolerability (HR: 0.604; 95% CI: 0.367-0.995; p=0.048) were observed to be statistically significant in terms of the RFS.We have observed that whether a patient can or cannot tolerate adjuvant CRT due to its toxicity is an independent prognostic factor besides the known prognostic factors like tumor stage and Lauren classification. We are of the opinion that the treatment of patients who cannot tolerate adjuvant CRT should be replaced with less toxic adjuvant therapies. Key words: gastric cancer, prognosis, tolerabilityGastric cancer is the fourth most common type of cancer and the second most common cause of cancer-related mortality around the world [1]. As a Eurasian country, the incidence of gastric cancer in Turkey is somewhere between the higher incidence observed in the Eastern world and lower incidence rates in the Western world [2]. In our country, gastric cancer is the fourth most common type of cancer and the third most common cause of cancer-related mortality [3].The prognosis of gastric cancer continues to be poor, with a 5-year survival rate of approximately 20% except for a few countries (e.g. 40%-60% in Japan) [4,5]. This difference between the east and the west is mainly related with the early diagnosis rates resulting from the s...

A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

“…In seven publications, 18 , 20 , 22 , 32 , 38 , 41 , 48 findings from a prospective database were presented. There were 16 retrospective studies, 21 , 24 , 26 , 27 , 29 , 31 , 33 – 35 , 37 , 40 , 45 , 46 , 49 – 51 1 prospective observational study, 23 1 pooled analysis of 2 phase III trials, 44 and 1 RCT. 25 All non-randomized studies, when assessed for quality, were assigned NOS >6 and the randomized study, assessed according to the Cochrane reviewers’ handbook 5.3, scored A (low risk of bias); thereby, all studies were deemed good quality ( online supplemental appendix pp.…”

“…After removal of duplicates and studies that did not fulfil the inclusion criteria, 33 studies remained and the data were extracted. 18 , 20 – 51 Two reviewers (KNW and AB) performed the search and data extraction independently and any discrepancy in the inclusion of a study or in data extraction was reviewed independently by JAS.…”

“…We extracted 23 studies of good quality (NOS above score 7 or quality level A) and performed meta-analysis to determine whether the quality of the studies were influencing our results. 20 , 22 – 26 , 28 – 35 , 37 , 40 – 42 , 45 , 46 , 49 – 51 Additionally, Trim-and-Fill-adjusted analysis was calculated to investigate publication bias for the 33 studies. 18 , 20 – 51 …”

Appraisal of Long-time Outcomes After Curative Surgery in Elderly Patients with Gastric Cancer: A Propensity Score Matching Analysis

“…They reviewed the prognosis of 360 gastric cancer patients aged 65 years or older with non-metastatic gastric cancer who had undergone D2 gastrectomy, and showed that signi cant survival bene ts were achieved with adjuvant chemotherapy in stage III patients but not in stage I or stage II patients. Mustafa et al also reported that the addition of adjuvant chemotherapy after gastrectomy in uenced survival in gastric cancer patients of ≥ 65 years of age [18]. Based on these reports, aggressive adjuvant chemotherapy may be required even in elderly gastric cancer patients with stage III disease.…”

Helicobacter pylori in primary gastric lymphoma and gastric cancer: A clinicopathologic and prognostic assessment

“…20,21 In our region, the high rate H. pylori positivity (57.1%) in stomach cancer was also seen in previous studies. 22 For this reason, H. pylori eradication may be the strategy in the patients with gastric cancer. The strategy of test, treat and screening for H. pylori infection is effective in reducing the incidence and mortality of gastric cancer in communities with a high incidence of gastric cancer.…”