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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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| Published in: | Journal of surgical oncology 2024-10, Vol.130 (5), p.1078-1091 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1002/jso.27835 |
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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 < 0.001) was associated with improved OS compared to POC (n = 907). No significant difference was noted between POCR (n = 766, aHR 1.11, 95% CI 0.88-1.40, p = 0.39) and POC (n = 341) in patients with pLN- disease. On multivariable analysis in all patients with cLN- disease, POCR (n = 3066) was significantly associated with improved OS (aHR 0.84, 95% CI 0.75-0.92, p < 0.01) compared to POC (n = 1248). No significant difference was noted between POCR (aHR 1.0, 95% CI 0.70-1.01, p = 0.958) and PEC (n = 514). These results remained consistent in patients with cLN+ disease (POCR = 1602, POC = 720, PEC = 677).
Postoperative chemoradiation is associated with improved survival in GC patients upstaged from clinically node-negative disease to pathologically node-positive disease. Negative clinical nodal disease status is not a reliable indicator of pathological nodal disease.</description><identifier>ISSN: 0022-4790</identifier><identifier>ISSN: 1096-9098</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.27835</identifier><identifier>PMID: 39190495</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>Journal of surgical oncology, 2024-10, Vol.130 (5), p.1078-1091</ispartof><rights>2024 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c238t-64963541122fba04e43ef0d62834ed833cb7ebc4f7e971dc1423077f8ba284253</cites><orcidid>0000-0003-3968-1205 ; 0000-0001-8694-0455 ; 0000-0002-4665-5534 ; 0000-0002-9292-8345</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39190495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ajay, Pranay S</creatorcontrib><creatorcontrib>Mavani, Parit T</creatorcontrib><creatorcontrib>Sok, Caitlin P</creatorcontrib><creatorcontrib>Goyal, Subir</creatorcontrib><creatorcontrib>Switchenko, Jeffery M</creatorcontrib><creatorcontrib>Gillespie, Theresa W</creatorcontrib><creatorcontrib>Kooby, David A</creatorcontrib><creatorcontrib>Kennedy, Timothy J</creatorcontrib><creatorcontrib>Shah, Mihir M</creatorcontrib><title>Comparison of treatment strategies based on clinical and pathological nodal status in resectable gastric adenocarcinoma</title><title>Journal of surgical oncology</title><addtitle>J Surg Oncol</addtitle><description>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 < 0.001) was associated with improved OS compared to POC (n = 907). No significant difference was noted between POCR (n = 766, aHR 1.11, 95% CI 0.88-1.40, p = 0.39) and POC (n = 341) in patients with pLN- disease. On multivariable analysis in all patients with cLN- disease, POCR (n = 3066) was significantly associated with improved OS (aHR 0.84, 95% CI 0.75-0.92, p < 0.01) compared to POC (n = 1248). No significant difference was noted between POCR (aHR 1.0, 95% CI 0.70-1.01, p = 0.958) and PEC (n = 514). These results remained consistent in patients with cLN+ disease (POCR = 1602, POC = 720, PEC = 677).
Postoperative chemoradiation is associated with improved survival in GC patients upstaged from clinically node-negative disease to pathologically node-positive disease. Negative clinical nodal disease status is not a reliable indicator of pathological nodal disease.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Adenocarcinoma - therapy</subject><subject>Aged</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy</subject><subject>Humans</subject><subject>Lymph Nodes - pathology</subject><subject>Lymph Nodes - surgery</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - mortality</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Stomach Neoplasms - therapy</subject><subject>Survival Rate</subject><issn>0022-4790</issn><issn>1096-9098</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkUtr3TAQhUVpSG7SLvoHiqCbZOFUL1vSslzSJhDIJl2bsTy-1cWWbiSZkH8f5dEuupmBmY_D4RxCvnB2yRkT3_c5XgptZPuBbDizXWOZNR_Jpv5Eo7RlJ-Q05z1jzNpOHZMTabllyrYb8riNywGSzzHQONGSEMqCodBcEhTcecx0gIwjrYCbffAOZgphpAcof-Icd6-HEMc6c4GyZuoDTZjRFRhmpDuoUt5RGDFEB8n5EBf4RI4mmDN-ft9n5PfPq_vtdXN79-tm--O2cUKa0nTKdrJVnAsxDcAUKokTGzthpMLRSOkGjYNTk0ar-ei4EpJpPZkBhFGilWfk_E33kOLDirn0i88O5xkCxjX3klltlDVcVvTbf-g-rilUd73kqjphrdaVunijXIo5J5z6Q_ILpKees_6ljb620b-2Udmv74rrsOD4j_wbv3wGcLGGSA</recordid><startdate>202410</startdate><enddate>202410</enddate><creator>Ajay, Pranay S</creator><creator>Mavani, Parit T</creator><creator>Sok, Caitlin P</creator><creator>Goyal, Subir</creator><creator>Switchenko, Jeffery M</creator><creator>Gillespie, Theresa W</creator><creator>Kooby, David A</creator><creator>Kennedy, Timothy J</creator><creator>Shah, Mihir M</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3968-1205</orcidid><orcidid>https://orcid.org/0000-0001-8694-0455</orcidid><orcidid>https://orcid.org/0000-0002-4665-5534</orcidid><orcidid>https://orcid.org/0000-0002-9292-8345</orcidid></search><sort><creationdate>202410</creationdate><title>Comparison of treatment strategies based on clinical and pathological nodal status in resectable gastric adenocarcinoma</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c238t-64963541122fba04e43ef0d62834ed833cb7ebc4f7e971dc1423077f8ba284253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Adenocarcinoma - therapy</topic><topic>Aged</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy</topic><topic>Humans</topic><topic>Lymph Nodes - pathology</topic><topic>Lymph Nodes - surgery</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - mortality</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Stomach Neoplasms - therapy</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ajay, Pranay S</creatorcontrib><creatorcontrib>Mavani, Parit T</creatorcontrib><creatorcontrib>Sok, Caitlin P</creatorcontrib><creatorcontrib>Goyal, Subir</creatorcontrib><creatorcontrib>Switchenko, Jeffery M</creatorcontrib><creatorcontrib>Gillespie, Theresa W</creatorcontrib><creatorcontrib>Kooby, David A</creatorcontrib><creatorcontrib>Kennedy, Timothy J</creatorcontrib><creatorcontrib>Shah, Mihir M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ajay, Pranay S</au><au>Mavani, Parit T</au><au>Sok, Caitlin P</au><au>Goyal, Subir</au><au>Switchenko, Jeffery M</au><au>Gillespie, Theresa W</au><au>Kooby, David A</au><au>Kennedy, Timothy J</au><au>Shah, Mihir M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of treatment strategies based on clinical and pathological nodal status in resectable gastric adenocarcinoma</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J Surg Oncol</addtitle><date>2024-10</date><risdate>2024</risdate><volume>130</volume><issue>5</issue><spage>1078</spage><epage>1091</epage><pages>1078-1091</pages><issn>0022-4790</issn><issn>1096-9098</issn><eissn>1096-9098</eissn><abstract>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 < 0.001) was associated with improved OS compared to POC (n = 907). No significant difference was noted between POCR (n = 766, aHR 1.11, 95% CI 0.88-1.40, p = 0.39) and POC (n = 341) in patients with pLN- disease. On multivariable analysis in all patients with cLN- disease, POCR (n = 3066) was significantly associated with improved OS (aHR 0.84, 95% CI 0.75-0.92, p < 0.01) compared to POC (n = 1248). No significant difference was noted between POCR (aHR 1.0, 95% CI 0.70-1.01, p = 0.958) and PEC (n = 514). These results remained consistent in patients with cLN+ disease (POCR = 1602, POC = 720, PEC = 677).
Postoperative chemoradiation is associated with improved survival in GC patients upstaged from clinically node-negative disease to pathologically node-positive disease. Negative clinical nodal disease status is not a reliable indicator of pathological nodal disease.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>39190495</pmid><doi>10.1002/jso.27835</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0003-3968-1205</orcidid><orcidid>https://orcid.org/0000-0001-8694-0455</orcidid><orcidid>https://orcid.org/0000-0002-4665-5534</orcidid><orcidid>https://orcid.org/0000-0002-9292-8345</orcidid><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Comparison of treatment strategies based on clinical and pathological nodal status in resectable gastric adenocarcinoma |
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