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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2022

07-07-2022 | Gastrectomy | Gastrointestinal Oncology

Indications for Adjuvant Chemotherapy in Stage II Gastric Cancer After D2 Gastrectomy–A Chinese Multicenter Study

Authors: Zi-Jian Deng, MD, Jun Lu, MD, Run-Cong Nie, MD, PhD, Jia-Ming Fang, MD, Xi-Jie Chen, MD, Jun-Jie Liu, MD, Xian-Zhe Li, MD, Ying-Bo Chen, MD, Chang-Ming Huang, MD, Lei Lian, MD, PhD, Jun-Sheng Peng, MD, Shi Chen, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2022

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Abstract

Background

The benefit of adjuvant chemotherapy (AC) for patients with stage II gastric cancer remains controversial. This study aimed to explore the indications for adjuvant chemotherapy in patients with stage II gastric cancer by constructing an individual prediction model.

Patients and Methods

In this Chinese multicenter study, a total of 1012 patients with stage II gastric cancer after D2 radical gastrectomy were retrospectively analyzed. All patients were randomly assigned to a training cohort (n = 674) or a validation cohort (n = 338). A nomogram was constructed according to the training cohort. Concordance index (C-index), the area under the receiver operating characteristic (ROC) curves (AUC), calibration curves, and decision curve analysis (DCA) were applied to evaluate the performance of the nomogram. ROC curves and stratified survival were used to determine the patients’ cutoff score for a benefit from adjuvant chemotherapy. An additional 338 patients were used as a validation cohort to validate the feasibility of using this nomogram to guide individualized therapy for patients with stage II gastric cancer.

Results

Univariate and multivariate analyses illustrated that age, sex, tumor location, size, carcinoembryonic antigen (CEA), hemoglobin (HB), and T stage were independent prognostic factors for overall survival (OS), and they were used to establish a nomogram. The cutoff value was determined by ROC curve analysis, and patients were divided into a high-risk group (< 239 points) and a low-risk group (≥ 239 points). There was no significant difference in the OS of low-risk patients in either the training cohort or the validation cohort. However, the OS of high-risk patients in the AC group was better than that of patients in the surgery-only group.

Conclusions

This prediction model can be applied to guide treatment of patients with stage II gastric cancer. High-risk patients (< 239 points) are likely to benefit from AC after D2 radical gastrectomy.
Appendix
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Metadata
Title
Indications for Adjuvant Chemotherapy in Stage II Gastric Cancer After D2 Gastrectomy–A Chinese Multicenter Study
Authors
Zi-Jian Deng, MD
Jun Lu, MD
Run-Cong Nie, MD, PhD
Jia-Ming Fang, MD
Xi-Jie Chen, MD
Jun-Jie Liu, MD
Xian-Zhe Li, MD
Ying-Bo Chen, MD
Chang-Ming Huang, MD
Lei Lian, MD, PhD
Jun-Sheng Peng, MD
Shi Chen, MD, PhD
Publication date
07-07-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12108-9

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