The addition of chemoradiation to adjuvant chemotherapy is associated with improved survival in lymph node-positive gastric cancer |
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| Affiliation: | 1. Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA;2. Medical College of Georgia, Augusta, GA;3. Georgia Cancer Center, Augusta, GA;4. Department of Urology, Vanderbilt University Medical Center, Nashville, TN;1. Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada;2. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;3. ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Urology Unit, Radiological Science and Public Health, University of Brescia, Italy;4. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy;5. Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy;6. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;7. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;9. Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;1. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;4. Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy;5. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy;6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;7. Departments of Urology, Weill Cornell Medical College, New York, NY;8. Department of Urology, University of Texas Southwestern, Dallas, TX;9. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic;10. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;1. Department of Urology, Brigham and Women''s Hospital, Boston, MA;2. Center for Surgery and Public Health, Brigham and Women''s Hospital, Boston, MA;3. Genitourinary Lank Center, Dana-Farber Cancer Institute, Boston, MA;4. Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA;1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;2. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;3. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;4. Department of Urology, University of Naples Federico II, Naples, Italy;5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;7. Departments of Urology, Weill Cornell Medical College, New York, NY;8. Department of Urology, University of Texas Southwestern, Dallas, TX;9. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic;10. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan |
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| Abstract: | BackgroundIn the ARTIST trial, chemoradiation did not improve disease-free survival (DFS) in gastric cancer patients treated with curative-intent surgery and adjuvant chemotherapy. Subgroup analysis suggested chemoradiation improved DFS in patients with lymph node (LN) metastases, but the role of adjuvant chemoradiation remains uncertain. This study sought to determine the role of adjuvant chemoradiation using population-based methods.MethodsSurveillance, Epidemiology and End Results-Medicare linked data from 2004 to 2013 was used to identify patients aged 66 and older with LN-positive gastric adenocarcinoma. Multivariable logistic regression evaluated factors associated with receipt of chemoradiation. The Kaplan-Meier method and Cox proportional hazards modeling were used to evaluate overall survival (OS).ResultsA total of 2409 patients with LN-positive gastric adenocarcinoma who underwent upfront surgical resection were identified; 309 (13%) received adjuvant chemotherapy and 407 (17%) received adjuvant chemotherapy and chemoradiation. Among all patients, median OS was 15 months. Median OS was 20 months for patients who received chemotherapy alone and 27 months for patients who received chemotherapy and chemoradiation (p < 0.05). Recent diagnosis, older age, tumor stage T3 or T4, and Charleston Comorbidity Index were associated with an increased hazard ratio for death (p < 0.05). Receipt of chemoradiation was associated with a decreased hazard ratio for death (p < 0.05).ConclusionsIn patients with LN-positive gastric adenocarcinoma, the addition of chemoradiation to adjuvant chemotherapy after upfront surgical resection was associated with improved survival irrespective of the extent of lymphadenectomy. These data suggest chemoradiation should be considered in patients with LN-positive gastric adenocarcinoma. |
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| Keywords: | Gastric cancer Lymphadenectomy Adjuvant therapy Chemotherapy Chemoradiation Overall survival |
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