Abstract
Background: There is no global consensus on adjuvant chemotherapy (ACT) for pT2N0M0 gastric cancer. We conducted a retrospective study to reveal the role of ACT in such patients. Methods: Patients with pT2N0M0 gastric cancer who underwent radical resection with D2 lymphadenectomy for primary gastric cancer between January 2012 and May 2016 were included. Kaplan–Meier and Cox regression were used to evaluate overall survival (OS), disease-specific survival (DSS) and predictors of prognosis. Stratified analysis based on high-risk factors was conducted. Results: Of enrolled 307 patients, 111 patients underwent surgery alone and 196 patients received ACT. Surgery alone (HR = 2.913, 95% CI: 1.494-5.682, p = 0.002) and total gastrectomy (HR = 2.445, 95% CI: 1.279-4.675, p = 0.007) were independently associated with decreased OS. With the median follow-up of 73.1 months, the 5-year OS rate was 87.9% and 5-year DSS rate was 91.8%. Patients receiving ACT showed a better 5-year OS rate (92.9 vs. 79.3%, p < 0.001) and DSS rate (96.8 vs. 83.0%, p < 0.001) than patients underwent surgery alone. Patients receiving monotherapy (n = 130) had a relatively poor prognosis compared to patients receiving dual-drug (n = 66) without a significant difference (92.3 vs. 93.9%, p = 0.637). In patients without high-risk factors based on the Chinese Society of Clinical Oncology (CSCO) Guidelines, ACT also provided survival benefit (96.0 vs 82.9%, p = 0.038). Conclusions: ACT was accompanied with higher 5-year OS and DSS rates of patients with pT2N0M0 gastric cancer. Patients with pT2N0M0 gastric cancer, regardless of high-risk factors based on the CSCO guidelines, might be considered candidates for ACT. In regard to the therapy regimen, monotherapy might be the optimal choice, considering the adverse events.
Highlights
Gastric cancer is the fourth leading cause of death from malignant tumors worldwide and the third main cause of cancer death in China (Cao et al, 2021; Navashenaq et al, 2021; Sun et al, 2021; Zeng and Jin, 2021)
Considering the number of patients with stage I gastric cancer is increasing, several retrospective studies focused on the role of Adjuvant chemotherapy (ACT) in patients with pT2N0M0 gastric cancer and evaluated the high-risk factors of relapse and death; they reported diverse opinions on the effect of ACT on pT2N0M0 gastric cancer. Since it was an open question whether ACT would benefit patients with pT2N0M0 gastric cancer, we aimed to determine the effect of ACT after curative resection in this study
Tubular adenocarcinoma; Por, poorly differentiated adenocarcinoma; Sig, signet ring cell carcinoma; Muc, mucinous adenocarcinoma; sMP, superficial muscularis propria layer; dMP, deep muscularis propria layer; LNs, lymph nodes; PNI, perineural invasion; LVI, lymphovascular invasion; ACT, adjuvant chemotherapy; SA, surgery alone; Hazard ratio (HR), hazard ratio; 95% CI, 95% confidence interval
Summary
Gastric cancer is the fourth leading cause of death from malignant tumors worldwide and the third main cause of cancer death in China (Cao et al, 2021; Navashenaq et al, 2021; Sun et al, 2021; Zeng and Jin, 2021). PT2N0M0 gastric cancer is defined as tumors infiltrating the muscularis propria without regional lymph node metastasis or distant metastasis based on the 8th edition of the AJCC TNM staging system for gastric cancer (Amin et al, 2017; Brierley et al, 2017). Adjuvant chemotherapy (ACT) or chemoradiotherapy has been demonstrated to be beneficial in numerous clinical trials worldwide (Macdonald et al, 2001; Sasako et al, 2011; Noh et al, 2014; Park et al, 2015). These trials did not report whether patients with less advanced disease would benefit from adjuvant therapy. We conducted a retrospective study to reveal the role of ACT in such patients
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