GAC: adjuvant chemotherapy, CRT boost OS in pT1N1 disease

  • Hester CA & al.
  • Ann Surg Oncol
  • 12 Nov 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A  Western study shows a survival benefit for adjuvant chemotherapy (ACT) and adjuvant chemoradiation therapy (CRT) in patients with pT1N1 gastric adenocarcinoma (GAC), after studies in South Korea showed no apparent benefit.

Why this matters

  • Eastern and Western populations are known to have significant disparities in gastric cancer outcomes.

Study design

  • Retrospective comparison between 4516 patients with pT1N0 GAC and 696 patients with pT1N1 GAC identified from the National Cancer Database (2004-2012).
  • Funding: University of Texas Southwestern Medical Center.

Key results

  • Patients with pT1N0 GAC were more likely to undergo observation than those with pT1N1 disease (98.1% vs 47.4%; P<.001>
  • pT1N1 GAC was more commonly treated with ACT (ACT, 11.1% vs 0.9%), adjuvant radiation therapy (ART: 9.8% vs 0.4%), and adjuvant CRT (31.8% vs 0.6%; P<.001 for all>
  • ACT and adjuvant CRT were independently associated with improved OS in pT1N1 disease after adjustment for other clinicopathological factors:
    • ACT: HR, 0.37 (95% CI, 0.22-0.65).
    • ACRT: HR, 0.40 (95% CI, 0.28-0.57).
  • No survival benefit was observed for ART in pT1N1 disease.

Limitations

  • Study was observational and retrospective.

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