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Does Adjuvant Chemoradiotherapy Improve the Prognosis of Gastric Cancer After an R1 Resection? Results from a Dutch Cohort Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to investigate the impact of adjuvant chemoradiotherapy (CRT) on survival of non-metastatic gastric cancer patients who had undergone an R1 resection.

Methods

We compared the survival of patients after an R1 gastric cancer resection from the population-based Netherlands Cancer Registry who did not receive adjuvant CRT (no-CRT group) with the survival of resected patients who had been treated with adjuvant CRT (CRT group) at our institute. Patients who had a resection between 2002 and 2011 were included. CRT consisted of radiotherapy (45 Gy) combined with concurrent cisplatin- or 5-fluorouracil-based chemotherapy. The impact of CRT treatment on overall survival was assessed using multivariable Cox regression and stratified propensity score analysis.

Results

A series of 409 gastric cancer patients who had undergone an R1 resection were studied (no-CRT, N = 369; CRT, N = 40). In the no-CRT group, median age was higher (70 vs. 57 years; p < 0.001) and the percentage of patients with diffuse-type tumors was lower (43 vs. 80 %; p < 0.001). There were no significant differences in pathological T- and N-classification. There was a significant difference in median overall survival between the no-CRT and CRT group (13 vs. 24 months; p = 0.003). In a multivariable analysis, adjuvant CRT was an independent prognostic factor for improved overall survival (hazard ratio 0.54; 95 % confidence interval 0.35–0.84). This effect of CRT was further supported by propensity score analysis.

Conclusions

Adjuvant CRT was associated with an improved survival in patients who had undergone an R1 resection for gastric cancer.

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Acknowledgment

This study was supported by Stichting Cornelis Vrolijk Development Fund.

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Authors and Affiliations

  1. Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Jurriën Stiekema MD & Johanna W. van Sandick MD, PhD

  2. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Anouk K. Trip MD, Edwin P. M. Jansen MD, PhD & Marcel Verheij MD, PhD

  3. Comprehensive Cancer Center the Netherlands, Eindhoven, The Netherlands

    Mieke J. Aarts PhD

  4. Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Henk Boot MD, PhD & Annemieke Cats MD, PhD

  5. Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Olga Balague Ponz MD, PhD

  6. Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Patrycja L. Gradowska PhD

Authors
  1. Jurriën Stiekema MD
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  2. Anouk K. Trip MD
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  3. Edwin P. M. Jansen MD, PhD
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  4. Mieke J. Aarts PhD
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  5. Henk Boot MD, PhD
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  6. Annemieke Cats MD, PhD
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  7. Olga Balague Ponz MD, PhD
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  8. Patrycja L. Gradowska PhD
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  9. Marcel Verheij MD, PhD
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  10. Johanna W. van Sandick MD, PhD
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Corresponding author

Correspondence to Johanna W. van Sandick MD, PhD.

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Stiekema, J., Trip, A.K., Jansen, E.P.M. et al. Does Adjuvant Chemoradiotherapy Improve the Prognosis of Gastric Cancer After an R1 Resection? Results from a Dutch Cohort Study. Ann Surg Oncol 22, 581–588 (2015). https://doi.org/10.1245/s10434-014-4032-8

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  • DOI: https://doi.org/10.1245/s10434-014-4032-8

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