The Effectiveness of Postoperative Chemotherapy on pT1bN0 and pT2N0 Gastric Cancer Patients with Risk Factors: An International Dual-Center Analysis

Yang, Kun; Chen, Mo Xi; Choi, Yoon Young; Zhou, Zong Guang; Hyung, Woo Jin; Noh, Sung Hoon; Hu, Jian

doi:10.3349/ymj.2021.62.2.109

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Zheng et al 20 reported that adjuvant CT had no effect on the prognosis in T2N0 patients. Consistent with our ndings, a recent retrospective study comprising only stage IB GC showed that the OS rates in the adjuvant CT group were 95.1% compared with 93.3% in surgery alone group, with no signi cant difference detected 21 .…”

Section: Discussionsupporting

confidence: 91%

Reevaluation of the requirement of adjuvant therapy for T2N0M0 gastric cancer following gastrectomy: a SEER database analysis

Zhang,

Fu,

Leng

et al. 2023

Preprint

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Background Determining the requirement for adjuvant therapy in gastric cancer (GC) patients with stage T2N0M0 remains controversial. Methods An eligible population cohort was identified from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method was used to assess the impact of adjuvant treatment modalities on overall survival (OS) and cause-specific survival (CSS). Multivariate Cox regression and competing risk model were used to investigate the prognostic factors for CSS. Propensity score matching (PSM) analysis was carried out to reduce the selection bias. Results A total of 776 patients were finally included. The 5-year OS for patients receiving surgery alone, adjuvant CRT, and adjuvant CT were 64.0%, 74.3%, and 69.0%, respectively (p = 0.004). The 5-year CSS for patients receiving surgery alone, adjuvant CRT, and CT were 73.0%, 84.3%, and 76.9%, respectively (p = 0.081). After PSM, no significant intergroup difference was observed on OS or CSS. When stratified by the number of lymph node (LN) examined, adjuvant CRT was shown to significantly increase the CSS than surgery alone in patients with LN examined ≤ 15 (p = 0.044), rather than in those with sufficient LN dissected (p = 0.590). Multivariate Cox analysis demonstrated that ethnicity, marital status, and number of LN examined > 15 were independent prognostic factors for CSS, of which number of LN examined > 15 was further validated by the competing risk model (SHR 0.701, p = 0.035). Conclusions Adjuvant therapy is not necessary for T2N0M0 GC patients undergoing standard radical gastrectomy, but adjuvant CRT should be reserved for those who have insufficient LN dissected patients.

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Section: Discussionsupporting

confidence: 91%

Reevaluation of the requirement of adjuvant therapy for T2N0M0 gastric cancer following gastrectomy: a SEER database analysis

Zhang,

Fu,

Leng

et al. 2023

Preprint

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“…Subgroup analyses also demonstrated that postoperative chemotherapy had no survival benefit in the 5-year OS rates of patients with stage ypT1N0 or ypT2N0 gastric cancer ( p = 0.786; p = 0.551). Although adjuvant chemotherapy is not recommended for gastric cancer patients with pT1-2N0 stage in many guidelines, there have been studies drawing conclusions that postoperative chemotherapy could offer survival benefits to these pT2N0 patients with risk factors, such as larger tumor diameter, lymphovascular invasion, suboptimal lymphadenectomy, and poor differentiation [ 28 – 30 ]. Herein, we were inspired by these findings and speculated that whether postoperative chemotherapy could offer survival benefit to stage ypT1-2N0 gastric cancer patients who had risk factors.…”

Section: Discussionmentioning

confidence: 99%

Does postoperative chemotherapy improve overall survival of patients with ypT1-2N0 cancer?

Zhang

Tian

et al. 2022

World J Surg Onc

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Background Perioperative chemotherapy combined with curative gastrectomy has been increasingly represented the standard therapeutic strategy for resectable gastric cancer (GC). However, it is still unclear whether postoperative chemotherapy has a survival benefit for ypT1-2N0 gastric cancer patients who have undergone preoperative chemotherapy followed curative gastrectomy. Methods The data of patients who undergone neoadjuvant chemotherapy followed by gastrectomy and had pathological classification of ypT1–2N0 between March 2016 and December 2020 at Peking Union Medical College Hospital were retrospectively reviewed. Chi-square test was adopted to compare the difference between the patients with postoperative chemotherapy (pCHT) and without postoperative chemotherapy (no pCHT). Survival curves for overall survival (OS) were estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival difference. Univariate and multivariate analyses for prognostic factors were based on the Cox regression. Results A total of 134 patients met the inclusion criteria and 56 (41.8%) of them have undergone postoperative chemotherapy. There were no statistically significant differences in demographic and clinicopathologic characteristics between pCHT group and no pCHT group (all p > 0.05). Postoperative chemotherapy was not associated with a significant improvement in overall survival (OS) (Hazard ratio [HR] 0.815, 95% confidence interval [CI] 0.403–1.650; p = 0.474). Subgroup analyses demonstrated survival was equivalent between pCHT and no CHT group in ypT1N0 patients (HR 0.832, CI 0.222–3.121; p = 0.786) and ypT2N0 patients (HR 1.284, CI 0.564–2.924; p = 0.551). Multivariable analysis identified that clinical T stage independently influenced prognosis (cT3 vs. cT2: HR 2.875, 95% CI 0.998–8.281, p = 0.050; cT4 vs. cT2: HR 7.382, 95% CI 2.569–21.211, p < 0.001). In clinical T3–4 patients, there was an overall survival benefit for postoperative chemotherapy (HR 0.270, 95% CI 0.114–0.634; p = 0.006). No survival benefit of postoperative chemotherapy was identified in clinical T2 patients (HR 0.689, 95% CI 0.200–2.372; p = 0.579). Furthermore, postoperative chemotherapy was proved to be an independently positive prognostic factor for clinical T3–4 patients (HR 0.132, 95% CI 0.051–0.345; p < 0.001). Conclusion Postoperative chemotherapy might offer survival benefit to patients with ypT1-2N0 gastric cancer whose clinical T stage was T3–4 before preoperative chemotherapy.

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“…[ 6 ] and Yang et al . [ 35 ] revealed that stage IB GC patients who received AC did not have prolonged survival. However, in a retrospective analysis of 1,687 patients, In et al .…”

Section: Discussionmentioning

confidence: 99%

Association between adjuvant chemotherapy and survival in stage I gastric cancer patients after curative resection

Chen,

Xiao,

Zhang

et al. 2022

Gastroenterology Report

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Background The efficacy of adjuvant chemotherapy (AC) on survival outcomes of patients with stage I gastric cancer (GC) after curative resection remains controversial. We aimed to determine whether these patients would benefit from AC. Methods This retrospective study included patients with pathologically confirmed stage I GC who underwent curative resection between November 2010 and December 2020. Patients were divided into AC and non-AC groups, then a 1:1 propensity score matching (PSM) analysis was performed to minimize the selection bias. Potential risk factors including age, pN stage, pT stage, lymphovascular invasion, perineural invasion, tumor size, histological type, and carcinoembryonic antigen level were used as matching covariates. The recurrence-free survival (RFS) and disease-specific survival (DSS) were compared between groups using the Kaplan–Meier method. Results A total of 902 consecutive patients were enrolled and 174 (19.3%) patients were treated with AC. PSM created 123 pairs of patients. Before PSM, patients receiving AC had lower 10-year RFS rates (90% vs 94.6%, P = 0.035) than those who did not receive AC; the two groups had similar 10-year DSS rates (93.8% vs 95.0%, P = 0.240). After PSM, there were no statistical differences in the 10-year RFS (90.9% vs 93.0%, P = 0.507) or DSS rates (93.5% vs 93.6%, P = 0.811) between the two groups. Similar results were found in the stage IA and IB subgroups. Moreover, these findings were not affected by AC cycles. Conclusions The addition of AC could not provide survival benefits for patients with stage I GC after surgery and follow-up is thus recommended. However, large-scale randomized clinical trials are required.

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The Effectiveness of Postoperative Chemotherapy on pT1bN0 and pT2N0 Gastric Cancer Patients with Risk Factors: An International Dual-Center Analysis

Cited by 5 publications

References 20 publications

Reevaluation of the requirement of adjuvant therapy for T2N0M0 gastric cancer following gastrectomy: a SEER database analysis

Reevaluation of the requirement of adjuvant therapy for T2N0M0 gastric cancer following gastrectomy: a SEER database analysis

Does postoperative chemotherapy improve overall survival of patients with ypT1-2N0 cancer?

Association between adjuvant chemotherapy and survival in stage I gastric cancer patients after curative resection

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