Predictors of Survival in Patients with Resectable Gastric Cancer Treated with Preoperative Chemoradiation Therapy and Gastrectomy - 19/06/15

Doi : 10.1016/j.jamcollsurg.2015.04.004

Brian Badgwell, MD, MS, FACS ^a,^⁎ , Mariela Blum, MD ^b, Jeannelyn Estrella, MD ^c, Yi-Ju Chiang, MSPH ^a, Prajnan Das, MD ^d, Aurelio Matamoros, MD ^e, Keith Fournier, MD ^a, Paul Mansfield, MD, FACS ^a, Jaffer Ajani, MD ^b
^a Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
^b Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
^c Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
^d Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
^e Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX

^∗Correspondence address: Brian Badgwell, MD, MS, FACS, Department of Surgical Oncology, Unit 1484, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.

Abstract

Background

The purpose of this study was to determine the overall survival (OS) of patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy.

Study Design

The medical records of patients with gastric adenocarcinoma presenting to our institution (January 1995 to August 2012) were reviewed to identify patients who underwent diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy. Associations between various clinicopathologic factors and OS were examined with Cox proportional hazards models.

Results

Of 192 patients who met inclusion criteria, 103 (54%) required total gastrectomy. One hundred sixty-eight patients (88%) had an extended lymph node dissection, 26 (14%) had resection of adjacent organs, and 178 (93%) had an R0 resection. Median follow-up time for surviving patients was 4.2 years. Median OS for all patients was 5.8 years, and 5-year OS rate was 56%. Multivariable Cox regression model results identified variables associated with diminished OS including age ≥ 65 years (hazard ratio [HR] 1.62; 95% CI 1.05 to 2.51), male sex (HR 1.76; 95% CI 1.13 to 2.74), adjacent organ resection (HR 1.97; 95% CI 1.16 to 3.35), R1 status (HR 2.29; 95% CI 1.17 to 4.48), pathologic N1 stage (HR 1.92; 95% CI 1.24 to 2.98), N2 stage (HR 2.58; 95% CI 1.01 to 6.58), and N3 stage (HR 6.54; 95% CI 2.69 to 15.93). Five-year OS rates for patients with pathologic N0, N1, N2, and N3 disease were 67%, 42%, 43%, and 0%, respectively.

Conclusions

Patients with gastric cancer who undergo diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy have a high frequency of obtaining an R0 resection and excellent OS rates. Nodal status after surgery remains an important determinant of OS.

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Abbreviations and Acronyms : AJCC, HR, OS