Abstract
Purpose
Whether adjuvant chemotherapy (AC) has a survival benefit for all patients with pathological stage pT1N1M0 (Stage IB) gastric cancer (GC) remains controversial.
Methods
All patients with surgically resected, histologically confirmed pT1N1M0 GC between January 2011 and December 2017 at the National Cancer Center, China, were retrospectively reviewed.
Results
A total of 179 patients with pT1N1M0 were identified. Survival analysis showed that both overall survival (OS) and cause-specific survival (CSS) were significantly different between patients treated with and without AC (p < 0.01). Independent risk factors for reduced OS identified in the Cox regression analysis in patients with pT1N1M0 cancer were sex (male sex, hazard ratio [HR] 2.470, 95% confidence interval [CI] 1.294–4.718), examined lymph nodes (EN) (EN ≤ 15, HR 2.402; 95% CI 1.329–4.341), and AC (treated without AC, HR 2.554; 95% CI 1.393–4.681), which were also independent risk factors for reduced CSS. We divided patients with pT1N1M0 into three risk categories (high, moderate, and low) according to two significant prognostic factors (sex and EN) and found that both OS and CSS were significantly different between the three risk groups (p < 0.05).
Conclusion
An additional survival benefit related to AC is expected for selected pT1N1M0 patients. Male patients with EN ≤ 15 may be particularly appropriate candidates for AC.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Some or all data are available from the corresponding author by request.
Code availability (software application or custom code)
SPSS 22.0 and Graphpad Prism 7.0 are used for statistical analysis and figures drawing.
References
Amin MB et al (2017) The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more personalized approach to cancer staging. Cancer J Clin 67:93–99. https://doi.org/10.3322/caac.21388
Aoyama T et al (2014) Prognostic factors in stage IB gastric cancer. World J Gastroenterol 20:6580–6585. https://doi.org/10.3748/wjg.v20.i21.6580
Aznab M, Maleksabet D, Khazaei S, Khazaei M, Rezaei M (2019) The role of human epidermal growth factor receptor (HER2/neu) in the prognosis of patients with gastric cancer. Asian Pacific J Cancer Prevent 20:1989–1994. https://doi.org/10.31557/APJCP.2019.20.7.1989
Bang YJ et al (2012) Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 379:315–321. https://doi.org/10.1016/S0140-6736(11)61873-4
Boku N et al (2009) Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol 10:1063–1069. https://doi.org/10.1016/S1470-2045(09)70259-1
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492
Folli S et al (2001) Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jpn J Clin Oncol 31:495–499. https://doi.org/10.1093/jjco/hye107
Gold JS et al (2013) Population-based outcome of stage IA–IIA resected gastric adenocarcinoma: who should get adjuvant treatment? Ann Surg Oncol 20:2304–2310. https://doi.org/10.1245/s10434-012-2852-y
Guideline Committee of the Korean Gastric Cancer Association DWG, Review P (2019) Korean practice guideline for gastric cancer 2018: an evidence-based multi-disciplinary approach. J Gastric Cancer 19:1–48. https://doi.org/10.5230/jgc.2019.19.e8
Hsu JT et al (2013) Prognostic significance of the number of examined lymph nodes in node-negative gastric adenocarcinoma. Eur J Surg Oncol 39:1287–1293. https://doi.org/10.1016/j.ejso.2013.07.183
Information Committee of Korean Gastric Cancer A (2016) Korean gastric cancer association nationwide survey on gastric cancer in 2014. J Gastric Cancer 16:131–140. https://doi.org/10.5230/jgc.2016.16.3.131
Jabo B et al (2018) Comparison of perioperative chemotherapy with adjuvant chemoradiotherapy for resectable gastric cancer: findings from a population-based study. J Gastrointest Oncol 9:35–45. https://doi.org/10.21037/jgo.2017.10.13
Japanese Gastric Cancer A (2020) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. https://doi.org/10.1007/s10120-020-01042-y
Katai H et al (2018) Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer 21:144–154. https://doi.org/10.1007/s10120-017-0716-7
Kunisaki C et al (2010) Impact of lymphovascular invasion in patients with stage I gastric cancer. Surgery 147:204–211. https://doi.org/10.1016/j.surg.2009.08.012
Kwon OK et al (2016) Validation of the 7th AJCC/UICC staging system for gastric cancer and a proposal for a new TNM system based on a prognostic score: a retrospective multicenter study. Ann Surg Treat Res 91:295–302. https://doi.org/10.4174/astr.2016.91.6.295
Lee HJ, Kim YH, Kim WH, Lee KU, Choe KJ, Kim JP, Yang HK (2003) Clinicopathological analysis for recurrence of early gastric cancer. Jpn J Clin Oncol 33:209–214. https://doi.org/10.1093/jjco/hyg042
Li H, Wang C, Wei Z, Chen W, Guo Z, He Y, Zhang C (2019a) Differences in the prognosis of gastric cancer patients of different sexes and races and the molecular mechanisms involved. Int J Oncol 55:1049–1068. https://doi.org/10.3892/ijo.2019.4885
Li H, Wei Z, Wang C, Chen W, He Y, Zhang C (2019b) Gender differences in gastric cancer survival: 99,922 cases based on the SEER database. J Gastrointest Surg. https://doi.org/10.1007/s11605-019-04304-y
Lu J et al (2018) Significance of preoperative systemic immune score for stage I gastric cancer patients. Gastroenterol Res Prac 2018:3249436. https://doi.org/10.1155/2018/3249436
Macdonald JS et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. New Engl J Med 345:725–730. https://doi.org/10.1056/NEJMoa010187
Noh SH et al (2014) Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol 15:1389–1396. https://doi.org/10.1016/S1470-2045(14)70473-5
Ryu ES et al (2019) Sex-specific differences in risk factors of lymph node metastasis in patients with early gastric cancer. PLoS ONE 14:e0224019. https://doi.org/10.1371/journal.pone.0224019
Sakuramoto S et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. New Engl J Med 357:1810–1820. https://doi.org/10.1056/NEJMoa072252
Sasako M et al (2011) Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 29:4387–4393. https://doi.org/10.1200/JCO.2011.36.5908
Shiozawa N, Kodama M, Chida T, Arakawa A, Tur GE, Koyama K (1994) Recurrent death among early gastric cancer patients: 20-years' experience. Hepato-gastroenterol 41:244–247
Wang FH et al (2019a) The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer. Cancer Commun 39:10. https://doi.org/10.1186/s40880-019-0349-9
Wang Y et al (2019b) Implication of lymph node staging in migration and different treatment strategies for stage T2N0M0 and T1N1M0 resected gastric cancer: a SEER population analysis. Clin Trans Oncol 21:1499–1509. https://doi.org/10.1007/s12094-019-02078-y
Yura M, Yoshikawa T, Otsuki S, Yamagata Y, Morita S, Katai H, Nishida T (2020) Is surgery alone sufficient for treating T1 gastric cancer with extensive lymph node metastases? Gastric Cancer 23:349–355. https://doi.org/10.1007/s10120-019-01006-x
Zheng WF, Ji TT, Lin Y, Li RZ (2016) The prognostic value of lymph nodes count on survival of patients with node-negative gastric cancer. Oncotarget 7:43680–43688. https://doi.org/10.18632/oncotarget.9845
Acknowledgements
The authors declare that they have no competing interests. The research was sponsored by National Natural Science Foundation of China, No. 81772642; Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022; Wu Jieping Medical Foundation, No. 320.6750.15276; Beijing Hope Run Special Fund of Cancer Foundation of China, No. LC2019L05. We would like to thank Editage (www.editage.cn) for English language editing.
Funding
The research was sponsored by National Natural Science Foundation of China, No. 81772642; Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022; Wu Jieping Medical Foundation, No. 320.6750.15276; Beijing Hope Run Special Fund of Cancer Foundation of China, No. LC2019L05.
Author information
Authors and Affiliations
Contributions
PJ and XJ contributed equally to this work. PJ was involved in study concept, data analysis, and interpretation, and production of tables and figures, wrote the first draft, and revised it critically in light of comments from other authors and reviewers; XJ was involved in production of high resolution figures and manuscript revision. YT was involved in study conception and design, data interpretation, manuscript revision, and discussion; SM, YL, WK, HL, and FM were involved in data acquisition and literature review; HH, WL and XJ were involved in the manuscript revision and discussion.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Ethics approval
This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Consent to participate
Written informed consent was obtained from all patients before their treatment. The data were anonymously analyzed.
Consent for publication
All authors approved the final version submitted.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jin, P., Ji, X., Ma, S. et al. Indications for adjuvant chemotherapy in patients with pT1N1M0 gastric cancer: a single-center experience. J Cancer Res Clin Oncol 147, 561–568 (2021). https://doi.org/10.1007/s00432-020-03355-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-020-03355-y