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Return to Intended Oncologic Treatment (RIOT) in Resected Gastric Cancer Patients

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Postoperative chemotherapy (CMT) or chemoradiotherapy (CRT) is commonly recommended for gastric cancer (GC) patients in order to improve survival. However, some factors that prevent patients from return to intended oncologic treatment (RIOT) may increase the risk of recurrence and decrease the survival benefits achieved with curative resection. The aim of this study was to determine the frequency and factors associated with inability to RIOT and their impact on survival.

Methods

This retrospective study included stage II/III GC patients treated with potentially curative gastrectomy. Patients who could return to intended oncologic treatment (RIOT group) and those who could not (inability to RIOT group) were analyzed.

Results

Of the 313 eligible GC patients, 89 (28.4%) and 85 (27.2%) patients receive CRT and CMT, respectively, representing a RIOT rate of 55.6%. The main reason was attributed to general poor performance status (30.2%), followed by surgical postoperative complications (POC) (20.1%). Older age, higher ASA, D1 lymphadenectomy, and major POC were related to inability to RIOT. Older age, neutrophil-lymphocyte ratio (NLR), and major POC were independent risk factors for inability to RIOT. Five-year DFS and OS were worse for the inability to RIOT group than for the RIOT group (p = 0.008 and p = 0.004, respectively). In multivariate analyses, absence of neoadjuvant therapy, total gastrectomy, pT3/T4, pN+, and inability to RIOT were associated with worse DFS. Type of gastrectomy, lymphadenectomy, pN status, Rx resection, and RIOT group were associated with OS.

Conclusion

Older age, high NLR, and major POC were risk factors for inability to RIOT. RIOT was an independent predictor of survival.

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Authors and Affiliations

  1. Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil

    Marcus Fernando Kodama Pertille Ramos, Tiago Biachi de Castria, Marina Alessandra Pereira, Andre Roncon Dias, Fernanda Fronzoni Antonacio, Bruno Zilberstein, Paulo Marcelo Gehm Hoff, Ulysses Ribeiro Jr & Ivan Cecconello

Authors
  1. Marcus Fernando Kodama Pertille Ramos
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  2. Tiago Biachi de Castria
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  3. Marina Alessandra Pereira
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  4. Andre Roncon Dias
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  5. Fernanda Fronzoni Antonacio
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  6. Bruno Zilberstein
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  7. Paulo Marcelo Gehm Hoff
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  8. Ulysses Ribeiro Jr
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  9. Ivan Cecconello
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Contributions

Marcus F.K.P. Ramos, Tiago B. de Castria, Marina A. Pereira: study design, data retrieval, statistical analysis, draft of the manuscript.

Andre R. Dias, Fernanda F Antonacio: data retrieval, review of the manuscript.

Bruno Zilberstein, Paulo M.G. Hoff, Ulysses Ribeiro Jr, Ivan Cecconello: critical analysis, review of the manuscript.

Corresponding author

Correspondence to Marcus Fernando Kodama Pertille Ramos.

Ethics declarations

The study was approved by the hospital ethics committee (NP993/16) and registered online (www.plataformabrasil.org.br). Informed consent of patients was waived because of the retrospective nature of the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Oral presentation at Digestive Disease Week - Plenary Session, 2019, San Diego, USA

Electronic Supplementary Material

Supplementary Table 1

Postoperative complications for RIOT and inability to RIOT groups according to Clavien-Dindo classification. (DOCX 16 kb)

Supplementary Table 2

Adjuvant treatment trials and RIOT. (DOCX 13 kb)

Supplementary Table 3

Perioperative treatment trials and RIOT. (DOCX 14 kb)

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Ramos, M.F.K.P., de Castria, T.B., Pereira, M.A. et al. Return to Intended Oncologic Treatment (RIOT) in Resected Gastric Cancer Patients. J Gastrointest Surg 24, 19–27 (2020). https://doi.org/10.1007/s11605-019-04462-z

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  • DOI: https://doi.org/10.1007/s11605-019-04462-z

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