Patterns of regional recurrence after curative D2 resection for stage III (N3) gastric cancer: Implications for postoperative radiotherapy

Abstract Background The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy. Methods This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined. Results There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1−/3−/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1−/3−/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357–0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322–0.811, P = 0.004) in stage III patients. Conclusions This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

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Impact of the Number of Dissected Lymph Nodes on Survival for Gastric Cancer after Distal Subtotal Gastrectomy

Gastroenterology Research and Practice ◽

10.1155/2011/476014 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Chang-Ming Huang ◽

Jian-Xian Lin ◽

Chao-Hui Zheng ◽

Ping Li ◽

Jian-Wei Xie ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Lymph Nodes ◽

Distal Gastrectomy ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Prognostic Impact ◽

Term Survival

Objectives. To investigate the prognostic impact of the number of dissected lymph nodes (LNs) in gastric cancer after curative distal gastrectomy.Methods. The survival of 634 patients who underwent curative distal gastrectomy from 1995 to 2004 was retrieved. Long-term surgical outcomes and associations between the number of dissected LNs and the 5-year survival rate were investigated.Results. The number of dissected LNs was one of the most important prognostic indicators. Among patients with comparable T category, the larger the number of dissected LNs was, the better the survival would be (). The linear regression showed that a significant survival improvement based on increasing retrieved LNs for stage II, III and IV (). A cut-point analysis yields the greatest variance of survival rate difference at the levels of 15 LNs (stage I), 25 LNs (stage II) and 30 LNs (stage III).Conclusion. The number of dissected LNs is an independent prognostic factor for gastric cancer. To improve the long-term survival of patients with gastric cancer, removing at least 15 LNs for stage I, 25 LNs for stage II, and 30 LNs for stage III patients during curative distal gastrectomy is recommended.

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Adjuvant chemotherapy in stage III gastric cancer: Preliminary results

European Journal of Cancer ◽

10.1016/0959-8049(93)91170-p ◽

1993 ◽

Vol 29 ◽

pp. S102

Author(s):

L. Cirera ◽

T. Cardona ◽

E. Batiste ◽

A. Arcusa ◽

I. Tusquets ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Stage Iii ◽

Preliminary Results

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Prognostic significance of the metastatic lymph node ratio compared to the TNM classification in stage III gastric cancer

Nigerian Journal of Clinical Practice ◽

10.4103/njcp.njcp_345_20 ◽

2021 ◽

Vol 24 (11) ◽

pp. 1602

Author(s):

S Gulmez ◽

AS Senger ◽

O Uzun ◽

S Omeroglu ◽

C Ofluoglu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Ratio ◽

Metastatic Lymph Node ◽

Tnm Classification ◽

Prognostic Significance ◽

Stage Iii ◽

Metastatic Lymph ◽

Node Ratio

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Neoadjuvant chemoradiotherapy plus postoperative adjuvant XELOX chemotherapy versus postoperative adjuvant chemotherapy with XELOX regimen for local advanced gastric cancer-A randomized, controlled study

British Journal of Radiology ◽

10.1259/bjr.20201088 ◽

2021 ◽

pp. 20201088

Author(s):

Fuli Wang ◽

Aizhong Qu ◽

Yinping Sun ◽

Jifeng Zhang ◽

Benzun Wei ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Postoperative Complications ◽

Advanced Gastric Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Regional Recurrence ◽

R0 Resection ◽

Resection Rate ◽

Postoperative Adjuvant Chemotherapy ◽

Local Advanced

Objective: The aim of this study was to compare the clinical efficacy of neoadjuvant chemoradiotherapy (NACRT) combined with postoperative adjuvant XELOX (Oxaliplatin +Capecitabine) chemotherapy and postoperative adjuvant chemotherapy (ACT) with XELOX for local advanced gastric cancer (LAGC). Methods: In this prospectively randomized trial, we investigated the effect of NACRT combined with postoperative ACT for LAGC. 60 patients were randomly divided into NACRT group and ACT group, with 30 patients in each group. Patients in NACRT group were given three-dimensional conformal radiotherapy (45 Gy/1.8 Gy/f) accompanied by synchronous XELOX of two cycles, followed by surgery, and then postoperative adjuvant XELOX chemotherapy of four cycles was performed. Patients in ACT group received surgery in advance, and then XELOX chemotherapy of six cycles was given. Results: The objective response rate of NACRT was 76.7%. The overall incidence of postoperative complications in NACRT group was not significantly different from that in ACT group (23.1% vs 30.0%, p = 0.560). The 1 year, 2 years, and 3 years progression-free survival (PFS）and overall survival (OS) in NACRT and ACT groups were 80.0% vs 56.7%, 73.3% vs 46.7%, 60.0% vs 33.3%, and 86.7% vs 80.0%, 76.7% vs 66.7%, 63.3% vs 50.0%, respectively. Patients in NACRT group showed a significantly higher R0 resection rate (84.6% vs 56.7%, p = 0.029),lower loco-regional recurrence rate (36.7% vs 11.5%, p = 0.039), longer PFS (p = 0.019) and freedom from locoregional progression(FFLP) (p = 0.004) than patients in ACT group, while there was no difference in OS (p = 0.215) and in toxicity incidence (p > 0.05). Conclusions: NACRT combined with postoperative adjuvant XELOX chemotherapy can improve R0 resection rate, reduce loco-regional recurrence, prolong PFS and FFLP without increasing the incidence of postoperative complications in patients with LAGC. Advances in knowledge: Compared with postoperative adjuvant chemotherapy, locally advanced gastric cancer patients may benefit from neoadjuvant chemoradiotherapy, and toxicity associated with chemoradiotherapy was tolerant and manageable.

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