Abstract
75 Background: The benefit of adjuvant treatment in gastric adenocarcinoma was demonstrated by randomized controlled studies that predominantly enrolled patients with locally advanced tumors. Thus its role for stage IIB – IIIC disease is widely accepted. Our aim was to identify patients with stage IA – IIA gastric adenocarcinoma who have a poor prognosis and therefore may benefit from adjuvant treatment. Methods: Patients with local or local-regional gastric adenocarcinoma who underwent surgical resection with pathological evaluation of ≥15 lymph nodes and had available disease-specific survival (DSS) data were identified from the Surveillance Epidemiology and End Results Registry. AJCC 7th edition gastric cancer staging was used. Kaplan-Meier survival was estimated. Survival differences were evaluated with the logrank test and Cox multivariate analysis. Results: TN grouping strongly predicted DSS (p<0.001, n=8515 patients). Stage IA (T1N0) (n=887) tumors had a distinctly excellent outcome, 91±1.2% DSS at 5 years, and thus were excluded from further analysis. The 5 TN groups of stages IB and IIA (n=1544) had the next best outcomes with DSS ranging from 66±4.6% to 81±2.3% at 5 years. Older age (p<0.001), higher grade (p=0.004), larger size (p<0.001), and proximal tumor location (p<0.001) were independent predictors of worse DSS in stage IB and IIA tumors. Interestingly, T and N stages did not independently predict outcome (p=0.07, p=0.41 respectively). We devised a risk stratification scheme for stage IB and IIA tumors where 1 point was assigned for each of the following variables: age >60 years, tumor size >5 cm, proximal tumor location, and grade other than well differentiated. DSS was 100% at 5 years for patients with no points (n=2); 86±4.3% for those with 1 point (n=92); 76±3.0%, 2 points (n=325); 72±2.8%, 3 points (n=372); and 48±4.9%, 4 points (n=136) (p<0.001). Conclusions: Patients with stage IB and IIA gastric adenocarcinomas with at least 2 adverse features (age >60 years, tumor size >5 cm, proximal tumor location, and grade other than well differentiated) have 5 year DSS ≤76%. Adjuvant therapy may be warranted for these patients.
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