Gastric cancer: rethinking patient selection after D2 gastrectomy

  • Shin K & al.
  • BMC Cancer
  • 18 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • The ratio of positive to total lymph nodes examined (LNR) may outperform N stage in selecting patients with gastric cancer who could benefit from XELOX (oral capecitabine plus intravenous oxaliplatin) over S-1 after D2 gastrectomy.

Why this matters

  • LNR may have greater prognostic value than N staging.

Study design

  • 1:1 propensity score-matched analysis (N=220).
  • Funding: Catholic Medical Center Research Foundation.

Key results

  • XELOX was associated with better outcomes than S-1 in patients with LNR >0.25:
    • 5-year DFS: 54% vs 20% (HR, 0.29; P=.004).
    • 5-year OS: 67% vs 26% (HR, 0.28; P=.020).
  • XELOX was associated with better outcomes than S-1 in the N3 group:
    • 5-year DFS: 66% vs 38% (HR, 0.40; P=.004).
    • 5-year OS: 71% vs 47% (HR, 0.45; P=.019).
  • XELOX was associated with better outcomes than S-1 in the stage IIIC group:           
    • 5-year DFS: 57% vs 22% (HR, 0.32; P=.004).
    • 5-year OS: 68% vs 27% (HR, 0.32; P=.009).
  • XELOX was associated with better outcomes than S-1 in patients who were N3 with LNR >0.25:
    • 5-year DFS: 55% vs 21% (P=.0023).
    • 5-year OS: 68% vs 27% (P=.013).

Limitations

  • Retrospective analysis.
  • Population all Asian ethnicity (Korea).