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Stage-Specific Effect of Adjuvant Therapy Following Gastric Cancer Resection: a Population-based Analysis of 4,041 Patients

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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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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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Natalie G. Coburn MD, MPH, Anand Govindarajan MD, MSc, Calvin H. L. Law MD, MPH, Ulrich Guller MD, MHS, Carol J. Swallow MD, PhD & Nancy N. Baxter MD, PhD

  2. Department of Research Design and Biostatistics, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Alex Kiss PhD

  3. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada

    Jolie Ringash MD

Authors
  1. Natalie G. Coburn MD, MPH
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  2. Anand Govindarajan MD, MSc
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  3. Calvin H. L. Law MD, MPH
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  4. Ulrich Guller MD, MHS
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  5. Alex Kiss PhD
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  6. Jolie Ringash MD
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  7. Carol J. Swallow MD, PhD
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  8. Nancy N. Baxter MD, PhD
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Corresponding author

Correspondence to Natalie G. Coburn MD, MPH.

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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

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