Clinical Outcomes and Prognostic Factors in Gastric Carcinoma Patients with Curative Surgery Followed by Adjuvant Treatment: Real-World Scenario

Abstract

Background

A wide range of adjuvant treatment regimens exist in gastric carcinoma patients which include chemotherapy, radiotherapy, and/or both either sequential or concurrent. The study aimed to assess the benefit of adjuvant sequential chemotherapy followed by radiotherapy for operable gastric cancers and evaluate the prognostic factors associated with clinical outcomes.

Methods

Patients of stage IB-III gastric carcinoma who underwent radical surgery followed by adjuvant treatment from January 2013 to December 2016 were analyzed retrospectively. Survival was computed using Kaplan-Meier method and prognostic factors were analyzed in multivariate analysis using Cox progression hazard model. A P value < 0.05 was taken as statistically significant.

Results

A total of 108 patients were identified with a median follow-up of 31.7 months (range: 6–96). Seventy-two percent of the patients received adjuvant sequential chemoradiation (N = 77) and 28% of patients received chemotherapy alone. The median survival was 26 months (95% CI: 23.09–28.90). Overall survival (OS) rates for 1, 2, 3, 4, and 5 years were 88.9%, 57.4%, 40.7%, 28.8%, and 20.4%, respectively. Five-year OS for stage-IB, II, and III was 75%, 45%, and 8.3%, respectively (p = 0.023). Surgical margin positivity (9.5% vs. 26.9%, p = 0.042), signet-ring cell histology (6.5% vs. 25.8%, p = 0.00), and adjuvant sequential chemoradiation (p = 0.002) showed a significant impact on survival outcomes and proved as independent prognostic factors.

Conclusion

The present study demonstrated that survival in gastric carcinoma is influenced by the stage of disease and surgical margins. In locally advanced patients, radical surgery followed by sequential chemoradiation based on a doublet/triplet regimen was an independent prognostic factor for survival.

Mini Abstract

Majority of patients in our set-up presented in locally advanced stage, curative resection followed by adjuvant sequential chemoradiation was an independent prognostic factor for survival.

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Abbreviations

LN:

lymph node

UGIE:

upper gastrointestinal endoscopy

CECT:

contrast-enhanced computed tomography

AJCC:

American Joint Committee on Cancer

5FU:

5-fluorouracil

mFOLFOX 4:

modified FOLFOX 4

DCF:

docetaxel, cisplatin, 5-fluorouracil

EBRT:

external beam radiation therapy

3DCRT:

three-dimensional conformal radiotherapy

IMRT:

intensity-modulated radiotherapy

VMAT:

volumetric modulated arc therapy

PTV:

planning target volume

CTCAE:

Common Terminology Criteria for Adverse Events

OS:

overall survival

DFS:

disease-free survival

LC:

local control

HR:

hazard ratio

CI:

confidence interval

CRT:

chemoradiation

S1OX:

S-1 plus oxaliplatin

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Affiliations

Authors

Contributions

All the authors had contributed to the conception and study design, data acquisition and interpretation, and drafting the article. All authors critically reviewed the manuscript for its content, contributed to the interpretation and presentation of the review, and approved the final version of the same before submission.

Specific contributions by the authors individually have been highlighted below:

1. Dr. Rakesh Kapoor—study concepts and design, manuscript preparation, manuscript editing

2. Dr. Chinna Babu Dracham—conceptualization, the guarantor of integrity of the entire study, experimental studies/data analysis, statistical analysis, manuscript preparation, and editing

3. Dr. Srinivasa GY—literature research, supervision

4. Dr. Divya Khosla—literature research, study concepts, and design, manuscript preparation, manuscript editing, supervision

5. Dr. Treshita dey—literature research, manuscript preparation, manuscript editing

6. Dr. Arun Elangovan—literature research, clinical studies, experimental studies/data analysis, supervision

7. Dr. Renu Madan—conceptualization, manuscript preparation, manuscript editing

8. Dr. Budhi S Yadav—literature research

9. Dr. Narendra Kumar—clinical studies

Corresponding author

Correspondence to Chinna Babu Dracham.

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Kapoor, R., Dracham, C.B., G Y, S. et al. Clinical Outcomes and Prognostic Factors in Gastric Carcinoma Patients with Curative Surgery Followed by Adjuvant Treatment: Real-World Scenario. J Gastrointest Canc (2020). https://doi.org/10.1007/s12029-020-00440-w

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Keywords

  • Gastric carcinoma
  • Adjuvant radiation
  • Chemotherapy
  • Treatment outcomes