Comparison of treatment strategies based on clinical and pathological nodal status in resectable gastric adenocarcinoma

To determine the optimal multimodal treatment strategy between perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), and postoperative chemotherapy (POC) in resected gastric cancer (GC) patients based on nodal status. In this retrospective analysis, the National Cancer Datab...

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Bibliographic Details
Published in:Journal of surgical oncology 2024-10, Vol.130 (5), p.1078-1091
Main Authors: Ajay, Pranay S, Mavani, Parit T, Sok, Caitlin P, Goyal, Subir, Switchenko, Jeffery M, Gillespie, Theresa W, Kooby, David A, Kennedy, Timothy J, Shah, Mihir M
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adenocarcinoma - therapy
Aged
Chemotherapy
Chemotherapy, Adjuvant
Combined Modality Therapy
Female
Follow-Up Studies
Gastrectomy
Humans
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Male
Middle Aged
Retrospective Studies
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Stomach Neoplasms - therapy
Survival Rate
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Summary:To determine the optimal multimodal treatment strategy between perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), and postoperative chemotherapy (POC) in resected gastric cancer (GC) patients based on nodal status. In this retrospective analysis, the National Cancer Database was used to identify resected non-metastatic GC (2006-2016). Patients were stratified by clinical nodal status-negative (cLN-) and positive (cLN+). In patients with cLN- disease who underwent upfront resection and were upstaged to pathological LN+, overall survival (OS) was compared between POC and POCR. In patients with cLN- and cLN+ disease, OS was compared between PEC, POCR, and POC. Kaplan-Meier survival estimate, log-rank test, and multivariable Cox proportional hazards analysis were performed. We identified 7827 patients (cLN- 4828; cLN+ 2999). On multivariable analysis in patients with cLN- disease who underwent upfront resection (n = 4314) and were upstaged to pLN+ disease (70%), POCR (n = 2300, aHR 0.78, 95% CI 0.70-0.87, p 
ISSN:0022-4790
1096-9098
1096-9098
DOI:10.1002/jso.27835