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



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.


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.


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.


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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4



lymph node


upper gastrointestinal endoscopy


contrast-enhanced computed tomography


American Joint Committee on Cancer




modified FOLFOX 4


docetaxel, cisplatin, 5-fluorouracil


external beam radiation therapy


three-dimensional conformal radiotherapy


intensity-modulated radiotherapy


volumetric modulated arc therapy


planning target volume


Common Terminology Criteria for Adverse Events


overall survival


disease-free survival


local control


hazard ratio


confidence interval




S-1 plus oxaliplatin


  1. 1.

    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    Article  Google Scholar 

  2. 2.

    Gunderson LL, Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 1982;8(1):1–11.

    CAS  Article  Google Scholar 

  3. 3.

    Landry J, Tepper JE, Wood WC, Moulton EO, Koerner F, Sullinger J. Patterns of failure following curative resection of gastric carcinoma. Int J Radiat Oncol Biol Phys. 1990;19(6):1357–62.

    CAS  Article  Google Scholar 

  4. 4.

    Ringash J, Khaksart SJ, Oza A, et al. Post-operative radiochemotherapy for gastric cancer: adoption and adaptation. Clin Oncol (R Coll Radiol). 2005;17(2):91–5.

    CAS  Article  Google Scholar 

  5. 5.

    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  6. 6.

    Tepper JE, Gunderson LL. Radiation treatment parameters in the adjuvant postoperative therapy of gastric cancer. Semin Radiat Oncol. 2002;12(2):187–95 Review.

    Article  Google Scholar 

  7. 7.

    Smalley SR, Gunderson L, Tepper J, Martenson JA Jr, Minsky B, Willett C, et al. Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implementation. Int J Radiat Oncol Biol Phys. 2002;52(2):283–93.

    Article  Google Scholar 

  8. 8.

    Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38–49.

    CAS  Article  Google Scholar 

  9. 9.

    Horn RC Jr. Carcinoma of the stomach; autopsy findings in untreated cases. Gastroenterology. 1955;29(4):515–23 discussion, 523–5.

    Article  Google Scholar 

  10. 10.

    Gunderson LL. Gastric cancer—patterns of relapse after surgical resection. Semin Radiat Oncol. 2002;12(2):150–61 Review.

    Article  Google Scholar 

  11. 11.

    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(8909):1309–12.

    CAS  Article  Google Scholar 

  12. 12.

    Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001 Sep 6;345(10):725–30.

    CAS  Article  Google Scholar 

  13. 13.

    Smalley SR, Benedetti JK, Haller DG, Hundahl SA, Estes NC, Ajani JA, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012;30(19):2327–33.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.

    Article  PubMed  Google Scholar 

  15. 15.

    Lam S, Tan E, Menezes A, Martin D, Gallagher J, Storey D, et al. A comparison of the operative outcomes of D1 and D2 gastrectomy performed at a single Western center with multiple surgeons: a retrospective analysis with propensity score matching. World J Surg Oncol. 2018;16(1):136.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Basaran H, Koca T, Cerkesli AK, Arslan D, Karaca S. Treatment outcomes and survival study of gastric cancer patients: a retrospective analysis in an endemic region. Asian Pac J Cancer Prev. 2015;16(5):2055–60.

    Article  Google Scholar 

  17. 17.

    Lee J, Lim DH, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012;30(3):268–73.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Park SH, Sohn TS, Lee J, Lim DH, Hong ME, Kim KM, et al. Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol. 2015;33(28):3130–6.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Cunningham D, Allum WH, Stenning SP, Thompson JN, van de Velde C, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.

    CAS  Article  Google Scholar 

  20. 20.

    Dikken JL, van Sandick JW, Maurits Swellengrebel HA, Lind PA, Putter H, Jansen EPM, et al. Neo-adjuvant chemotherapy followed by surgery and chemotherapy or by surgery and chemoradiotherapy for patients with resectable gastric cancer (CRITICS). BMC Cancer. 2011;11:329.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Park SH, Zang DY, Han B, et al. ARTIST 2: interim results of a phase III trial involving adjuvant chemotherapy and/or chemoradiotherapy after D2-gastrectomy in stage II/III gastric cancer (GC). J Clin Oncol. 2019;37(15_suppl):4001.

    Article  Google Scholar 

Download references

Author information




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.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation


  • Gastric carcinoma
  • Adjuvant radiation
  • Chemotherapy
  • Treatment outcomes