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. 2016 Jun 16;5(1):728.
doi: 10.1186/s40064-016-2552-3. eCollection 2016.

The role of adjuvant chemotherapy for patients with stage II and stage III gastric adenocarcinoma after surgery plus D2 lymph node dissection: a real-world observation

Chang-Fang Chiu  1 , Horng-Ren Yang  2 , Mei-Due Yang  2 , Long-Bin Jeng  2 , Aaron M Sargeant  3 , Su-Peng Yeh  4 , Li-Yuan Bai  4
Affiliations

The role of adjuvant chemotherapy for patients with stage II and stage III gastric adenocarcinoma after surgery plus D2 lymph node dissection: a real-world observation

Chang-Fang Chiu et al. Springerplus. .

Abstract

Background: The influence of adjuvant chemotherapy on the survival of gastric adenocarcinoma patients in a stage-specific manner is controversial.

Methods: To further explore this topic, we retrospectively analyzed the impact of adjuvant chemotherapy on the clinical outcomes of 77 stage II and 117 stage III patients diagnosed between January 2008 and December 2012.

Results: All 194 patients underwent radical operation plus D2 dissection, and were followed a median time of 23.3 (range 0.4-80.2) months. Median patient age was 67.7 (range 33.9-97.5) years. Adjuvant chemotherapy prolonged the relapse-free survival [22.9 (95 % confidence interval 9.4-36.4) vs. 14.2 (95 % CI 8.6-19.8) months, P = 0.009] and overall survival [32.3 (95 % CI 22.6-42.0) vs. 13.4 (95 % CI 9.5-17.2) months, P < 0.001] for patients with stage III, but not stage II, disease. Higher overall survival from adjuvant chemotherapy in stage II patients with node involvement did not reach the level of statistical significance (P = 0.102). To reduce the selection bias, 142 patients aged <75 years were included in a subgroup analysis in which the benefit of adjuvant chemotherapy on relapse-free survival and overall survival were demonstrated for patients with stage III disease.

Conclusions: Adjuvant chemotherapy prolongs relapse-free and overall survival for patients with stage III gastric cancer in a real-world situation. Tailoring therapy based on different characteristics for patients with stage II gastric cancer may produce better outcomes.

Keywords: Adjuvant chemotherapy; D2 dissection; Gastrectomy; Gastric cancer; Overall survival; Relapse-free survival.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curve of relapse-free survival and overall survival. a, b All patients (n = 194). c, d The survival curves are stratified by stage
Fig. 2
Fig. 2
Kaplan–Meier curve of relapse-free survival and overall survival according to adjuvant chemotherapy. a, b All patients (n = 194). c, d Patients with stage II gastric cancer (n = 77). e, f Patients with stage III gastric cancer (n = 117)
Fig. 3
Fig. 3
Kaplan–Meier overall survival curve of patients with stage II gastric cancer according to adjuvant chemotherapy. a Patients without lymph node involvement. b Patients with lymph node involvement
Fig. 4
Fig. 4
Kaplan–Meier curve of relapse-free survival and overall survival of patients aged <75 years according to adjuvant chemotherapy. a, b Patients with stage II gastric cancer (n = 51). c, d Patients with stage III gastric cancer (n = 91)
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