Prognostic Factors and the Role of Adjuvant Chemotherapy in Pathological Node-Negative T3 Gastric Cancer

Abstract

The role of adjuvant chemotherapy in pathological T3N0M0 (pT3N0M0) gastric cancer (GC) remains unclear. The aim of this study was to analyze the prognostic factors of patients with pT3N0M0 GC and to clarify which ones could benefit from adjuvant chemotherapy. A total of 137 patients with pT3N0M0 GC were recruited between 1994 and 2020. Clinicopathological factors and adjuvant chemotherapy regimens were retrospectively collected. Prognostic factors of disease-free survival (DFS) and cancer-specific survival (CSS) were determined using univariate and multivariate analyses. The chemotherapy group was younger (p = 0.012), had had more lymph nodes retrieved (p = 0.042) and had higher percentages of vascular invasion (p = 0.021) or perineural invasion (p = 0.030) than the non-chemotherapy group. There were no significant differences in DFS (p = 0.222) and CSS (p = 0.126) between patients treated with or without adjuvant chemotherapy. Stump cancer, tumor size and perineural invasion were associated with higher rates of recurrence. Tumor size was an independent prognostic factor for DFS (hazard ratio, 4.55; confidence interval, 1.59–12.99; p = 0.005) and CSS (hazard ratio, 3.97; confidence interval, 1.38–11.43; p = 0.011). Tumor size independently influenced survival outcomes in pT3N0M0 patients who underwent radical surgery with and without adjuvant chemotherapy.

Rationale in the Use of Adjuvant Chemotherapy in pT3N0M0 Gastric Cancer Resected Patients. Comment on Chen et al. Prognostic Factors and the Role of Adjuvant Chemotherapy in Pathological Node-Negative T3 Gastric Cancer. J. Pers. Med. 2023, 13, 553

“…I read with great interest the well-written and well-made study by Yi-Fu Chen et al recently published in the “ Journal of Personalized Medicine ” [ 1 ].…”

Reply to Graziosi et al. Rationale in the Use of Adjuvant Chemotherapy in pT3N0M0 Gastric Cancer Resected Patients. Comment on “Chen et al. Prognostic Factors and the Role of Adjuvant Chemotherapy in Pathological Node-Negative T3 Gastric Cancer. J. Pers. Med. 2023, 13, 553”

“…We appreciate the authors very much for their interest in our article “Prognostic factors and the role of adjuvant chemotherapy in pathological node-negative T3 gastric cancer” [ 1 ]. We also greatly agree with their comments that to identify clinical and molecular predictive and prognostic factors in patients at high risk of recurrence who could benefit from the adjuvant chemotherapy is important [ 2 ].…”

“…We also greatly agree with their comments that to identify clinical and molecular predictive and prognostic factors in patients at high risk of recurrence who could benefit from the adjuvant chemotherapy is important [ 2 ]. The patients enrolled during 1994 and 2020 in our study did not receive neoadjuvant chemotherapy [ 1 ]. In this regard, recent randomized controlled studies recruiting resectable advanced gastric cancer have indicated that neoadjuvant chemotherapy (NAC) downstages the tumor and increases pathological complete response rate, with significantly longer progression-free survival in the NAC group [ 3 , 4 ].…”