Abstract
PurposeThe purpose of this study was to explore the differences between stage T2N0M0 and stage T1N1M0 gastric cancer (GC) and to identify the necessity of adjuvant treatment (AT) for these stages.MethodsBetween years 2004 and 2015, 1971 stage IB GC patients who underwent radical surgery were recruited using the Surveillance, Epidemiology and End Results database. We conducted univariate/multivariate analyses, the propensity score matching and evaluated gastric cancer-specific survival (GCSS) and overall survival (OS) with the log-rank test.ResultsT1N1M0 had a significantly worse survival than T2N0M0 in both GCSS and OS before and after the propensity score matching. Examined lymph nodes (ELN) ≤ 15 and T1N1M0 were independent risk factors for worse GCSS and OS in stage IB GC. The absence of adjuvant chemotherapy (CT) was an independent risk factor for worse GCSS and OS in T1N1M0 but not in T2N0M0. AT demonstrated similar GCSS and OS with surgery alone (SA) for T2N0M0 but better survival for T1N1M0. Compared to CT and adjuvant chemoradiotherapy (CRT) group, SA demonstrated significantly worse GCSS and OS for T1N1M0. There was no significant difference between CT and CRT in both T2N0M0 and T1N1M0 stages. T2N0M0 had a better survival than T1N1M0 in ELN ≤ 15 subgroup. However, similar survival was demonstrated in ELN > 15 subgroup.ConclusionsT2N0M0 GC has a better survival rate than T1N1M0 GC when ELN are ≤ 15. Moreover, T2N0M0 GC may not benefit from AT. T1N1M0 GC requires CT but not adjuvant radiotherapy.
Highlights
Gastric cancer (GC) is the fourth leading cause of cancer-related death worldwide [1]
We sought to seek evidence to explore the differences between T2N0M0 and T1N1M0 GC, both classified as stage IB GC, using the SEER database
The larger tumors were widely distributed in T2N0M0 group, while the smaller tumors were mainly aggregated in T1N1M0 group
Summary
Gastric cancer (GC) is the fourth leading cause of cancer-related death worldwide [1]. According to the National Comprehensive Cancer Network (NCCN), adjuvant chemotherapy (CT) is recommended for stage T1N1M0 (invading the mucosa or submucosa, having 1 or 2 positive lymph nodes and no distant metastasis) GC after the curative resection [3]. While CT is not recommended for all stage T2N0M0 (invading the muscularis propria and having no positive lymph node and no distant metastasis) patients, it is recommended for high-risk patients with poorly differentiated or higher-grade cancer, lymphatic and/or blood vessel invasion, perineural invasion, or who are under 50 years of age. According to the Japanese Gastric Cancer Treatment Guidelines, observation alone is recommended without any adjuvant treatment (AT) after curative resection for both T1N1M0 and T2N0M0 GC [4].
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