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Gastric Cancer

, Volume 21, Issue 6, pp 1004–1013 | Cite as

Preoperative chemoradiation therapy induces primary-tumor complete response more frequently than chemotherapy alone in gastric cancer: analyses of the National Cancer Database 2006–2014 using propensity score matching

  • Naruhiko Ikoma
  • Prajnan Das
  • Wayne Hofstetter
  • Jaffer A. Ajani
  • Jeannelyn S. Estrella
  • Hsiang-Chun Chen
  • Xuemei Wang
  • Rashida A. Callender
  • Cong Zhu
  • Christina L. Roland
  • Keith F. Fournier
  • Janice N. Cormier
  • Paul Mansfield
  • Brian D. Badgwell
Original Article
  • 314 Downloads

Abstract

Background

The benefit of preoperative chemoradiation (CXRT) over preoperative chemotherapy alone (“chemotherapy” hereafter) is unknown. By analyzing the National Cancer Database (NCDB), we investigated whether preoperative CXRT improves the incidence of primary tumor pathologic complete response (ypT0) and overall survival (OS) compared with preoperative chemotherapy in patients with gastric cancer.

Methods

Patients with non-metastatic gastric adenocarcinoma who underwent CXRT or chemotherapy followed by gastrectomy were included. Propensity score matching with a ratio of 1:1 was implemented to reduce selection bias. A conditional logistic regression model was used to compare incidences of ypT0 between groups, and Cox proportional hazards model was used to compare OS.

Results

We identified 8464 patients. Median patient age was 63 years; 76% were male and 79% were white. ypT0 was observed in 16.1% of patients in the CXRT group and 6.6% in the chemotherapy group (p < 0.001). After propensity score matching, a total of 2408 patients were matched. CXRT was associated with a higher incidence of ypT0 (OR 2.28, 95% CI 1.76–2.95; p < 0.0001) and higher frequency of R0 resection (92 vs. 86%; p < 0.001). However, CXRT was not associated with longer OS (HR 1.03, 95% CI 0.92–1.15; p = 0.63). Safety profiles (30-day mortality, 30-day readmission, and length of hospital stay) were equivalent between groups.

Conclusions

In this study of gastric cancer patients from the NCDB, CXRT was associated with a higher incidence of ypT0 and R0 resection compared with chemotherapy, although it was not associated with a longer OS.

Keywords

Gastric cancer Preoperative chemoradiation therapy Complete response Surgery Survival 

Notes

Funding

Supported in part by the National Institutes of Health under Award number P30CA016672 and used the Clinical Trials Support Resource.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Human/animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Naruhiko Ikoma
    • 1
    • 7
  • Prajnan Das
    • 2
  • Wayne Hofstetter
    • 3
  • Jaffer A. Ajani
    • 4
  • Jeannelyn S. Estrella
    • 5
  • Hsiang-Chun Chen
    • 6
  • Xuemei Wang
    • 6
  • Rashida A. Callender
    • 7
  • Cong Zhu
    • 7
  • Christina L. Roland
    • 1
  • Keith F. Fournier
    • 1
  • Janice N. Cormier
    • 1
  • Paul Mansfield
    • 1
  • Brian D. Badgwell
    • 1
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Cardiac and Thoracic SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  6. 6.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  7. 7.Department of Biostatistics, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonUSA

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