Abstract
BackgroundThe types of patients with gastric adenocarcinoma (GA) for whom postoperative radiotherapy can improve the disease-specific survival rate (DSS) remain controversial. This study aims to explore the ideal indications.MethodsPatients in the Surveillance, Epidemiology, and End Results (SEER) database with T3–4Nx or TxN+ GA from January 1988 to December 2012 were included and divided into a postoperative chemoradiotherapy group (Group R) and a postoperative chemotherapy group (Group C). We established a nomogram to predict DSS and then divided entire patient cohort into low-risk and high-risk groups based on the DSS predicted by the nomogram.ResultsThe Cox multiple regression analysis demonstrated that various risk factors affected DSS for Group R. Based on these risk factors, a nomogram for predicting DSS was established. The decision curve indicated that the best clinical effect could be obtained when the threshold probability was 0–58%. The patients were then divided into low-risk (< 69 points) and high-risk (≥ 69 points) groups according to the five-year DSS predicted. DSS was significantly better for Group R than for Group C for high-risk patients (P < 0.001) but was similar for low-risk patients (P = 0.732).ConclusionAt present, the National Comprehensive Cancer Network (NCCN) guidelines may include an overly broad range of indications for postoperative radiotherapy for patients with GA. For intestinal GA patients with a postoperative pathologic stage of T1 N1 who are younger than 65 years, have had more than 15 lymph nodes dissected, and have received postoperative chemotherapy, postoperative radiotherapy should not be recommended.
Highlights
The types of patients with gastric adenocarcinoma (GA) for whom postoperative radiotherapy can improve the disease-specific survival rate (DSS) remain controversial
The National Comprehensive Cancer Network (NCCN) guidelines for GA that exhibits mitosis [13] clearly suggest that a postoperative pathological stage of T3–4Nx or TxN+ indicates the feasibility of adjuvant chemoradiotherapy after surgery, which means that postoperative radiotherapy is based on postoperative chemotherapy, a portion of patients who undergo radiotherapy experience severe postoperative complications [14,15,16], and the curative effects of radiotherapy are influenced by various pathological factors
The purpose of this study was to use the Surveillance, Epidemiology, and End Results (SEER) database to explore risk factors for prognosis for patients who undergo postoperative radiotherapy; perform stratified analyses of the effects of radiotherapy on postoperative disease-specific survival rate (DSS) for patients with GA; construct a nomogram to filter out patients who are unsuitable for postoperative radiotherapy; and provide a reference for the reasonable implementation of postoperative radiotherapy
Summary
The types of patients with gastric adenocarcinoma (GA) for whom postoperative radiotherapy can improve the disease-specific survival rate (DSS) remain controversial. The NCCN guidelines for GA that exhibits mitosis [13] clearly suggest that a postoperative pathological stage of T3–4Nx or TxN+ indicates the feasibility of adjuvant chemoradiotherapy after surgery, which means that postoperative radiotherapy is based on postoperative chemotherapy, a portion of patients who undergo radiotherapy experience severe postoperative complications [14,15,16], and the curative effects of radiotherapy are influenced by various pathological factors. The purpose of this study was to use the Surveillance, Epidemiology, and End Results (SEER) database to explore risk factors for prognosis for patients who undergo postoperative radiotherapy; perform stratified analyses of the effects of radiotherapy on postoperative disease-specific survival rate (DSS) for patients with GA; construct a nomogram to filter out patients who are unsuitable for postoperative radiotherapy; and provide a reference for the reasonable implementation of postoperative radiotherapy
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