Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Abstract

Background Perioperative chemotherapy (POC) is one standard approach for the treatment of resectable cancers of the stomach and gastroesophageal junction (GEJ), whereas there has been growing interest in preoperative therapies. The objective of the current study was to compare survival between patients treated with preoperative chemoradiotherapy and adjuvant chemotherapy (PCRT) with those receiving POC using a large database. Methods The National Cancer Data Base was queried for patients diagnosed between 2004 and 2013 with American Joint Committee on Cancer clinical group stage IB to stage IIIC (excluding T2N0 disease) adenocarcinoma of the stomach or GEJ. Patients treated with definitive surgery and POC with or without preoperative radiotherapy of 41 to 54 Gy were included. Overall survival (OS) was defined from the date of definitive surgery and estimated using the Kaplan‐Meier method. A total of 14 patient and treatment variables were used for propensity score matching (PSM). Results A total of 1048 patients were analyzed: 53.2% received POC and 46.8% received PCRT. The primary tumor site was the GEJ in 69.1% of patients and stomach in 30.9% of patients. The median age of the patients was 60 years, and the median follow‐up was 25.8 months. The use of PCRT was associated with a greater pathologic complete response rate of 13.1% versus 8.2% (P = .01). POC was associated with a decreased risk of death in unmatched groups (hazard ratio [HR], 0.83; P = .043). Using PSM cohorts, POC decreased the risk of death with a median OS of 45.1 months versus 31.4 months (HR, 0.70; P = .016). The 2‐year OS rate was 72.9% versus 62.5% and the 5‐year OS rate was 40.7% versus 33.1% for POC versus PCRT, respectively. Survival favored POC in PSM gastric (HR, 0.41; P = .07) and GEJ (HR, 0.77; P = .08) patient subgroups. Conclusions The addition of preoperative radiotherapy to POC appears to be associated with an increased risk of death in patients with resectable gastric and GEJ cancers.

Examining the use of pre‐operative radiation therapy in addition to perioperative chemotherapy: National Cancer Data Base vs. Surveillance, Epidemiology, and End Results

“…As reported by Mokdad et al, the addition of adjuvant chemotherapy conferred a substantial overall survival benefit (median overall survival of 40 months vs 34 months: hazard ratio, 0.79; stratified log‐rank P < .001) . These 3 studies analyzed only patients with cancers of the lower esophagus and GE junction, whereas approximately 31% of the patients in our study had gastric adenocarcinoma primary tumors . Based on the above, we would argue that these studies do not conflict with our findings.…”

“…Xiao et al referenced 3 studies that they argued were inconsistent with the findings of our study . In the 3 retrospective studies, the study investigators compared treatment outcomes between patients treated with neoadjuvant CRT compared with POC.…”

“…We appreciate the interest and efforts taken to conduct a Surveillance, Epidemiology, and End Results (SEER) analysis, the thought‐provoking results, and comments from Xiao et al in regard to our recent report using the National Cancer Data Base (NCDB) to examine combined modality strategies in patients with gastric and gastroesophageal (GE) junction adenocarcinomas . Although both large, US‐based data resources have proven useful in cancer outcomes research, several key differences between SEER and the NCDB in terms of methodology, reporting standards, and available variables merit an in‐depth discussion.…”

“…No patients reportedly received adjuvant chemotherapy after neoadjuvant CRT. However, our study compared outcomes in patients receiving POC with or without preoperative radiotherapy . Thus, our study cohort that included radiation as a modality, also received adjuvant chemotherapy.…”

Patients with gastroesophageal junction adenocarcinomas of an advanced stage may benefit from perioperative chemoradiotherapy: A validation based on the Surveillance, Epidemiology, and End Results database

“…We recently read the article by Tian et al with great interest . In their research, the authors compared the prognosis of patients with gastric and gastroesophageal junction adenocarcinoma who received perioperative chemoradiotherapy (PCRT) with those who received perioperative chemotherapy (POC) alone.…”