Abstract
ObjectiveThe benefit of adjuvant chemotherapy is still controversial for stage II gastric cancer patients. This study aims to identify prognostic factors to guide individualized treatment for stage II gastric cancer patients.MethodsWe retrospectively reviewed 1121 stage II gastric cancer patients who underwent D2 radical gastrectomy from 2007 to 2017 in the Sixth Affiliated Hospital of Sun Yat-sen University, FuJian Medical School Affiliated Union Hospital and Sun Yat-sen University Cancer Center. Propensity score matching was used to ensure that the baseline data were balanced between the adjuvant chemotherapy group and surgery-only group. Kaplan–Meier survival and multivariate Cox regression analyses were carried out to identify independent prognostic factors.ResultsIn univariate analysis, after propensity score matching, age, tumor location, tumor size, CEA, T stage and N stage were associated with overall survival (OS). Multivariate analysis illustrated that age ≥ 60 years old, linitis plastica and T4 were independent risk factors for OS, but lower location and adjuvant chemotherapy were protective factors.ConclusionStage II gastric cancer patients with adverse prognostic factors (age ≥ 60, linitis plastica and T4) have poor prognosis. Adjuvant chemotherapy may be more beneficial for these patients.
Highlights
Despite the rapid advances that continue to improve comprehensive therapy and screening methods, gastric cancer is still the fourth most common malignant tumor in the world (989,600 new cases per year) and the second leading cause of death among all malignant tumors (738,000 deaths annually) [1]
Choi et al confirmed that stage II or III gastric cancer patients with high microsatellite instability might not benefit from adjuvant chemotherapy [9]
Discussion the incidence of gastric cancer is declining worldwide [10], most gastric cancer patients are diagnosed at an advanced stage in China, so D2 radical gastrectomy and adjuvant chemotherapy still play a critical role in gastric cancer treatment [4]
Summary
Despite the rapid advances that continue to improve comprehensive therapy and screening methods, gastric cancer is still the fourth most common malignant tumor in the world (989,600 new cases per year) and the second leading cause of death among all malignant tumors (738,000 deaths annually) [1]. Adjuvant chemotherapy has been widely used for stage II and III gastric cancer patients to improve the 5-year overall survival rate. The ACTS-GC study, a randomized phase III trial, showed that the overall survival rate at 5 years was 71.7% in the adjuvant group and 61.1% in the surgery-only group (HR [95%CI], 0.669 [0.540–0.828]) [5]. Deng et al BMC Gastroenterol (2021) 21:363 and oxaliplatin for 6 months after a median follow-up of 62.4 months [6] These results from randomized controlled trials provided hard evidence of the survival benefits associated with adjuvant chemotherapy. The subgroup analysis of 3-year disease-free survival in the CLASSIC study demonstrated that the improvement in the adjuvant chemotherapy group for stage II disease was not as evident as that for stage IIIa or IIIb disease. Some researchers have tried to use biomarkers to determine the necessity of chemotherapy, but all of these studies were retrospective, and the results were unsatisfactory
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