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Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Perioperative chemotherapy in gastric cancer is increasingly used since the “MAGIC” trial, while clinical practice data outside of trials remain limited. We sought to evaluate the predictors and prognostic implications of perioperative chemotherapy completion in patients undergoing curative-intent gastrectomy across multiple US institutions.

Methods

Patients who underwent curative-intent resection of gastric adenocarcinoma between 2000 and 2012 in eight institutions of the US Gastric Cancer Collaborative were identified. Patients who received preoperative chemotherapy were included, while those who died within 90 days or with unknown adjuvant chemotherapy status were excluded. Predictors of chemotherapy completion and survival were identified using multivariable logistic regression and Cox proportional hazards.

Results

One hundred sixty three patients were included (median age 63.3, 36.8% female). The postoperative component of perioperative chemotherapy was administered in 112 (68.7%) patients. Factors independently associated with receipt of adjuvant chemotherapy were younger age (odds ratio (OR) 2.73, P = 0.03), T3 tumors (OR 14.3, P = 0.04), lymph node metastasis (OR 5.82, P = 0.03), and D2 lymphadenectomy (OR 4.12, P = 0.007), and, inversely, postoperative complications (OR 0.25, P = 0.008). Median overall survival (OS) was 25.1 months and 5-year OS was 36.5%. Predictors of OS were preexisting cardiac disease (hazard ratio (HR) 2.7, 95% CI 1.13–6.46), concurrent splenectomy (HR 4.11, 95% CI 1.68–10.0), tumor stage (reference stage I; stage II HR 2.62; 95% CI 0.99–6.94; stage III HR 4.86, 95% CI 1.81–13.02), and D2 lymphadenectomy (HR 0.43, 95% CI 0.19–0.95). After accounting for these factors, adjuvant chemotherapy administration was associated with improved OS (HR 0.33, 95% CI 0.14–0.82).

Conclusion

Completion of perioperative chemotherapy was successful in two thirds of patients with gastric cancer and was independently associated with improved survival.

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Authors and Affiliations

  1. Department of Surgery, New York University, New York, NY, USA

    Georgios Karagkounis, Marcovalerio Melis, Antonio Masi, Russell Berman, H. Leon Pachter, Elliot Newman & Ioannis Hatzaras

  2. Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Malcolm Hart Squires III, Charles A. Staley & Shishir K. Maithel

  3. Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA

    George A. Poultsides & David Worhunsky

  4. Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, MO, USA

    Linda X. Jin & Ryan C. Fields

  5. Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Gaya Spolverato

  6. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik, Carl Schmidt & Mark Bloomston

  7. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos & Edward A. Levine

  8. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Clifford S. Cho & Sharon Weber

  9. Department of Surgery, NYU School of Medicine, 462 First Ave, NBV 15 N1, New York, NY, 10016, USA

    Ioannis Hatzaras

Authors
  1. Georgios Karagkounis
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  2. Malcolm Hart Squires III
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  3. Marcovalerio Melis
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  4. George A. Poultsides
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  5. David Worhunsky
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  6. Linda X. Jin
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  7. Ryan C. Fields
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  8. Gaya Spolverato
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  9. Timothy M. Pawlik
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  10. Konstantinos I. Votanopoulos
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  11. Edward A. Levine
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  12. Carl Schmidt
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  13. Mark Bloomston
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  14. Clifford S. Cho
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  15. Sharon Weber
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  16. Antonio Masi
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  17. Russell Berman
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  18. H. Leon Pachter
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  19. Charles A. Staley
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  20. Elliot Newman
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  21. Shishir K. Maithel
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  22. Ioannis Hatzaras
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Contributions

Study conception and design: Karagkounis, Squires, Melis, Poultsides, Worhunsky, Jin, Fields, Spolverato, Pawlik, Votanopoulos, Levine, Schmidt, Bloomston, Cho, Weber, Berman, Pachter, Newman, Staley, Maithel, Hatzaras.

Acquisition of data: Karagkounis, Squires, Melis, Poultsides, Worhunsky, Jin, Fields, Spolverato, Pawlik, Votanopoulos, Levine, Schmidt, Bloomston, Cho, Weber, Berman, Pachter, Newman, Staley, Maithel, Hatzaras.

Analysis and interpretation of data: Karagkounis, Maithel, Hatzaras.

Manuscript drafting and critical revision: Karagkounis, Squires, Melis, Poultsides, Worhunsky, Jin, Fields, Spolverato, Pawlik, Votanopoulos, Levine, Schmidt, Bloomston, Cho, Weber, Masi, Berman, Pachter, Staley, Newman, Maithel, Hatzaras.

Final approval of the manuscript: Karagkounis, Squires, Melis, Poultsides, Worhunsky, Jin, Fields, Spolverato, Pawlik, Votanopoulos, Levine, Schmidt, Bloomston, Cho, Weber, Masi, Berman, Pachter, Staley, Newman, Maithel, Hatzaras.

Corresponding author

Correspondence to Ioannis Hatzaras.

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Karagkounis, G., Squires, M.H., Melis, M. et al. Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer. J Gastrointest Surg 21, 1984–1992 (2017). https://doi.org/10.1007/s11605-017-3594-8

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  • DOI: https://doi.org/10.1007/s11605-017-3594-8

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