Abstract
Background
Adjuvant chemoradiotherapy improved survival in patients with resected gastric adenocarcinoma in the Southwest Oncology Group/Intergroup 0116 trial. Our objective was to examine the impact of adjuvant treatment on overall survival (OS) in the general population.
Methods
Patients 18–85 years old who had undergone resection of non-metastatic gastric adenocarcinoma between May 2000 and December 2003, were identified from the Surveillance Epidemiology and End Results (SEER) database. Patients who had received pre-operative irradiation, had unknown stage or radiation status, or had a survival of 3 months or less from the date of diagnosis were excluded. Survival of those who received post-operative irradiation was compared with those who did not; Kaplan-Meier methods and Cox proportional hazards models were used.
Results
Of 4,041 patients, there was improved survival for those receiving adjuvant irradiation for stages III and IVM0, with a median OS of 31 versus 24 months (P = 0.005) and 20 versus 15 months (P < 0.001), respectively, and a trend for improved survival in univariate analysis of stage II (P = 0.0535). In final adjusted analysis, adjuvant irradiation significantly improved OS in stages III (HR: 0.71, P = 0.0007) and IVM0 (HR: 0.66, P < 0.0001). Adjusted analysis using a propensity score suggested that the benefit of adjuvant irradiation was similar in stage-II and -III patients. However, there was no statistical improvement in survival for stage-Ib and -II patients who had received adjuvant irradiation.
Conclusions
In this population-based analysis, adjuvant radiotherapy for stage-III and IVM0 gastric cancer significantly improved OS. Analysis of stage-Ib and -II patients is limited by small numbers, but there may not be the same benefit.
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REFERENCES
Surveillance Epidemiology and End Results Program Website. 1973-2003 Public-Use Data. http://www.seer.cancer.gov/publicdata. National Cancer Institute. 8-17-2006. Ref Type: Electronic Citation
Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer 2000;88:921–32
Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Jr., Winchester D, Osteen R. Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg 1993;218:583–92
Earle CC, Maroun JA. Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials. Eur J Cancer 1999;35:1059–64
Hallissey MT, Dunn JA, Ward LC, Allum WH. The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up. Lancet 1994;343:1309–12
Hermans J, Bonenkamp JJ, Boon MC, Bunt A, Ohyama S, Sasako M, et al. Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol 1993;11:1441–7
Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–30
Mari E, Floriani I, Tinazzi A, et al. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente). Ann Oncol 2000;11:837–43
Moertel CG, Childs DS, O’Fallon JR, Holbrook MA, Schutt AJ, Reitemeier RJ. Combined 5-fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol 1984;2:1249–54
Cancer Care Ontario: Gastrointestinal Cancer Evidence-based Series and Practice Guidelines. Neoadjuvant or Adjuvant Therapy for Resectable Cancer. http://www.cancercare.on.ca/index_gastrointestinalCancerguidelines.htm. Cancer Care Ontario. 12-9-2006. Ref Type: Electronic Citation
NCCN Clinical Practice Guidelines in Oncology. http://www.nccn.org/patients/patient_gls.asp. National Comprehensive Cancer Network Website. 2006. Ref Type: Electronic Citation
Ajani JA, Dat JM, National Comprehensive Cancer Network-Clinical Practice Guidelines in Oncology. http://www.nccn.org. Gastric Cancer. National Comprehensive Cancer Network. 2006. Ref Type: Electronic Citation
Kassam Z, Lockwood G, O’Brien C, et al. Conformal radiotherapy in the adjuvant treatment of gastric cancer: Review of 82 cases. Int J Radiat Oncol Biol Phys 2006;65:713–9
Hughes B, Yip D, Chao M, Gibbs P, Carroll S, Goldstein D, et al. Audit of postoperative chemoradiotherapy as adjuvant therapy for resected gastroesophageal adenocarcinoma: an Australian multicentre experience. ANZ J Surg 2004;74:951–6
Kelsen DP. Postoperative adjuvant chemoradiation therapy for patients with resected gastric cancer: intergroup 116. J Clin Oncol 2000;18:32S–34S
Macdonald J, Smalley S, Benedetti J et al. Postoperative combined radiation and chemotherapy improves disease-free survival (DFS) and overall survival (OS) in resected adenocarcinoma of the stomach and gastroesophageal junction: Update of the results of Intergroup Study INT-0116 (SWOG 9008). [Abstract]. 2004 Gastrointestinal Cancers Symposium 2007
American Joint Committee on Cancer Staging Manual. JB. Lippincott, Philadelphia, 1997
Kasakura Y, Ajani JA, Mochizuki F, Morishita Y, Fujii M, Takayama T. Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer. J Surg Oncol 2002;80:181–5
So JB, Yam A, Cheah WK, Kum CK, Goh PM. Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy. Br J Surg 2000;87:1702–7
Brennan M. Current status of surgery for gastric cancer: a review. Gastric Cancer 2005;8:64–70
Hundahl S. Eliminating and suppressing local-regional disease in gastric cancer. J Surg Oncol 2005;90:171–3
Lordick F, Siewert J. Recent advances in multimodal treatment for gastric cancer: a review. Gastric Cancer 2005;8:78–85
Harrell Jr. F. Regression modelling strategies with applications to linear models, logistic regression, and survival analysis (Springer Series in Statistics). Springer-Verlag, New York, 2002
Coburn NG, Guller U, Baxter NN, Kiss A, Ringash J, Swallow C, Law CHL. Adjuvant Therapy for Resected Gastric Cancer—Rapid, yet Variable Adoption Following the Results of the Intergroup 0116 Trial. 2007. Ref Type: Unpublished Work
Rosenbaum P, Rubin D. Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc 1984;79:516–24
de Gara C, Hanson J, Hamilton S. A population-based study of tumor-node relationship, resection margins, and surgeon volume on gastric cancer survival. Am J Surg 2003;186:23–7
Chemotherapy and radiation therapy after surgery in treating patients with stomach or esophageal cancer. ClinicalTrials.gov Identifier NCT00052910. National Cancer Institute. 2007. Ref Type: Electronic Citation
Coburn NG, Swallow CJ, Kiss A, Law C. Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer 2006;107:2143–51
Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11–20
ACKNOWLEDGEMENTS
Dr. Calvin Law is a Career Scientist of the Ontario Ministry of Health and Long Term Care and is supported through a Health Research Personnel Development–Career Scientist Award.
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Coburn, N.G., Govindarajan, A., Law, C.H.L. et al. Stage-Specific Effect of Adjuvant Therapy Following Gastric Cancer Resection: a Population-based Analysis of 4,041 Patients. Ann Surg Oncol 15, 500–507 (2008). https://doi.org/10.1245/s10434-007-9640-0
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DOI: https://doi.org/10.1245/s10434-007-9640-0