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Open Access 07-11-2024 | Gastric Cancer | Gastrointestinal Oncology

Is Adjuvant Therapy Necessary for Stage IB Gastric Cancer: A Retrospective Cohort Study

Authors: Mingyu Gu, MS, Binghe Zhao, MS, Changda Sui, MS, Minghai Wen, MS, Xinxin Wang, MD

Published in: Annals of Surgical Oncology

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Abstract

Background

The benefit of adjuvant therapy for patients with IB gastric cancer (GC) is a topic of debate. This study aimed to evaluate the benefit of adjuvant therapy for patients with IB GC.

Methods

Overall, the study selected 510 IB GC patients after gastrectomy at the First Medical Center of the Chinese PLA General Hospital, Beijing, China between 2005 and 2018. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and the log-rank test. Cox regression analyses were used to confirm the independent prognostic factors.

Results

Patients who received postoperative adjuvant therapy had a longer 5-year OS (92.9 %) than those who received surgery alone (86.7 %; P < 0.05), but the 5-year DFS did not differ significantly between the two groups (92.6 vs. 95.0 %; P > 0.05). Moreover, DFS did not differ between monotherapy, and combination therapy. Uni- and multivariate analyses showed that older age was a significant risk factor for tumor recurrence. Subgroup analyses also failed to identify suitable candidates for chemotherapy.

Conclusions

Because adjuvant therapy did not demonstrate any benefits in terms of tumor recurrence or DFS, these treatment strategies may be unnecessary for IB GC patients after gastrectomy. Further studies are required to identify subgroups of IB GC patients who may benefit from adjuvant treatments.
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Literature
1.
go back to reference Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11:e197–206.CrossRefPubMed Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11:e197–206.CrossRefPubMed
2.
go back to reference Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRefPubMed Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRefPubMed
3.
go back to reference Saka M, Katai H, Fukagawa T, Nijjar R, Sano T. Recurrence in early gastric cancer with lymph node metastasis. Gastric Cancer. 2008;11:214–8.CrossRefPubMed Saka M, Katai H, Fukagawa T, Nijjar R, Sano T. Recurrence in early gastric cancer with lymph node metastasis. Gastric Cancer. 2008;11:214–8.CrossRefPubMed
4.
go back to reference Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.
5.
go back to reference Ahn HS, Lee H-J, Hahn S, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116:5592–8.CrossRefPubMed Ahn HS, Lee H-J, Hahn S, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116:5592–8.CrossRefPubMed
6.
go back to reference Katai H, Ishikawa T, Akazawa K, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. 2018;21:144–54.CrossRefPubMed Katai H, Ishikawa T, Akazawa K, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. 2018;21:144–54.CrossRefPubMed
7.
go back to reference Boku N, Yamamoto S, Fukuda H, et al. Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol. 2009;10:1063–9.CrossRefPubMed Boku N, Yamamoto S, Fukuda H, et al. Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol. 2009;10:1063–9.CrossRefPubMed
8.
go back to reference Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.CrossRefPubMed Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.CrossRefPubMed
9.
go back to reference Noh SH, Park SR, Yang H-K, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15:1389–96.CrossRefPubMed Noh SH, Park SR, Yang H-K, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15:1389–96.CrossRefPubMed
10.
go back to reference Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric cancer, version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Comp Cancer Ntwk. 2022 2022;20:167–92. Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric cancer, version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Comp Cancer Ntwk. 2022 2022;20:167–92.
11.
go back to reference Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38–49.CrossRefPubMed Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38–49.CrossRefPubMed
12.
go back to reference Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2018 (5th ed). Gastric Cancer. 2021;24:1–21. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2018 (5th ed). Gastric Cancer. 2021;24:1–21.
13.
go back to reference Korean Practice Guideline for Gastric Cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer. 2019;19. Korean Practice Guideline for Gastric Cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer. 2019;19.
14.
go back to reference Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76:182–8.CrossRefPubMed Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76:182–8.CrossRefPubMed
15.
go back to reference Xie Y, Du D, Song X, Li X, Ni Z, Huang H. The role of chemotherapy in patients with stage IB gastric adenocarcinoma: a real-world competing risk analysis. World J Surg Oncol. 2022;20:123.CrossRefPubMedPubMedCentral Xie Y, Du D, Song X, Li X, Ni Z, Huang H. The role of chemotherapy in patients with stage IB gastric adenocarcinoma: a real-world competing risk analysis. World J Surg Oncol. 2022;20:123.CrossRefPubMedPubMedCentral
16.
go back to reference Pan S, Yin S, Zhu Z, Liu F, Xu H. Decision-making of adjuvant therapy in pT1N1M0 gastric cancer: should radiotherapy be added to chemotherapy? A propensity score-matched analysis J Cancer. 2021;12:1179–89.PubMed Pan S, Yin S, Zhu Z, Liu F, Xu H. Decision-making of adjuvant therapy in pT1N1M0 gastric cancer: should radiotherapy be added to chemotherapy? A propensity score-matched analysis J Cancer. 2021;12:1179–89.PubMed
17.
go back to reference In H, Kantor O, Sharpe SM, Baker MS, Talamonti MS, Posner MC. Adjuvant therapy improves survival for T2N0 gastric cancer patients with sub-optimal lymphadenectomy. Ann Surg Oncol. 2016;23:1956–62.CrossRefPubMed In H, Kantor O, Sharpe SM, Baker MS, Talamonti MS, Posner MC. Adjuvant therapy improves survival for T2N0 gastric cancer patients with sub-optimal lymphadenectomy. Ann Surg Oncol. 2016;23:1956–62.CrossRefPubMed
18.
go back to reference Wang Y, Zhang J, Guo S, et al. Implication of lymph node staging in migration and different treatment strategies for stage T2N0M0 and T1N1M0 resected gastric cancer: a SEER population analysis. Clin Transl Oncol. 2019;21:1499–509.CrossRefPubMed Wang Y, Zhang J, Guo S, et al. Implication of lymph node staging in migration and different treatment strategies for stage T2N0M0 and T1N1M0 resected gastric cancer: a SEER population analysis. Clin Transl Oncol. 2019;21:1499–509.CrossRefPubMed
19.
go back to reference Datta J, McMillan MT, Ruffolo L, et al. Multimodality therapy improves survival in resected early stage gastric cancer in the United States. Ann Surg Oncol. 2016;23:2936–45.CrossRefPubMed Datta J, McMillan MT, Ruffolo L, et al. Multimodality therapy improves survival in resected early stage gastric cancer in the United States. Ann Surg Oncol. 2016;23:2936–45.CrossRefPubMed
20.
go back to reference Kim SM, An JY, Lee J, Sohn TS, Kim S. Adjuvant chemotherapy versus chemoradiotherapy versus surgery alone for early gastric cancer with one or two lymph node metastasis. Ann Surg Oncol. 2018;25:1616–24.CrossRefPubMed Kim SM, An JY, Lee J, Sohn TS, Kim S. Adjuvant chemotherapy versus chemoradiotherapy versus surgery alone for early gastric cancer with one or two lymph node metastasis. Ann Surg Oncol. 2018;25:1616–24.CrossRefPubMed
21.
go back to reference Gao X, Li G, Deng J, et al. Association of survival with adjuvant chemotherapy in patients with stage IB gastric cancer: a multicentre, observational, cohort study. Lancet Reg Health West Pac. 2024;45:101031.PubMedPubMedCentral Gao X, Li G, Deng J, et al. Association of survival with adjuvant chemotherapy in patients with stage IB gastric cancer: a multicentre, observational, cohort study. Lancet Reg Health West Pac. 2024;45:101031.PubMedPubMedCentral
22.
go back to reference Japanese Gastric Cancer Treatment Guidelines 2021 (6th ed). Gastric Cancer. 2023;26. Japanese Gastric Cancer Treatment Guidelines 2021 (6th ed). Gastric Cancer. 2023;26.
23.
go back to reference Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.CrossRefPubMedPubMedCentral Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.CrossRefPubMedPubMedCentral
24.
go back to reference Hartgrink HH, van de Velde CJH, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.CrossRefPubMed Hartgrink HH, van de Velde CJH, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.CrossRefPubMed
25.
go back to reference Songun I, Putter H, Kranenbarg EM-K, Sasako M, van de Velde CJH. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRefPubMed Songun I, Putter H, Kranenbarg EM-K, Sasako M, van de Velde CJH. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRefPubMed
26.
go back to reference Wang Z, Yan J, Hu W, Zhang J, Huo B. Adjuvant chemotherapy provided survival benefit for stage T2N0 gastric cancer with high-risk factors. Neoplasma. 2018;65:592–8.CrossRefPubMed Wang Z, Yan J, Hu W, Zhang J, Huo B. Adjuvant chemotherapy provided survival benefit for stage T2N0 gastric cancer with high-risk factors. Neoplasma. 2018;65:592–8.CrossRefPubMed
27.
go back to reference Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US population database. J Clin Oncol. 2005;23:7114–24.CrossRefPubMed Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US population database. J Clin Oncol. 2005;23:7114–24.CrossRefPubMed
28.
go back to reference Yoshikawa T, Terashima M, Mizusawa J, et al. Four courses versus eight courses of adjuvant S-1 for patients with stage II gastric cancer (JCOG1104 [OPAS-1]): an open-label, phase 3, non-inferiority, randomised trial. Lancet Gastroenterol Hepatol. 2019;4:208–16.CrossRefPubMed Yoshikawa T, Terashima M, Mizusawa J, et al. Four courses versus eight courses of adjuvant S-1 for patients with stage II gastric cancer (JCOG1104 [OPAS-1]): an open-label, phase 3, non-inferiority, randomised trial. Lancet Gastroenterol Hepatol. 2019;4:208–16.CrossRefPubMed
29.
go back to reference Kakeji Y, Yoshida K, Kodera Y, et al. Three-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 plus docetaxel versus S-1 alone in stage III gastric cancer: JACCRO GC-07. Gastric Cancer. 2022;25:188–96.CrossRefPubMed Kakeji Y, Yoshida K, Kodera Y, et al. Three-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 plus docetaxel versus S-1 alone in stage III gastric cancer: JACCRO GC-07. Gastric Cancer. 2022;25:188–96.CrossRefPubMed
30.
go back to reference Yoshida K, Kodera Y, Kochi M, et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol. 2019;37:1296–304.CrossRefPubMedPubMedCentral Yoshida K, Kodera Y, Kochi M, et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol. 2019;37:1296–304.CrossRefPubMedPubMedCentral
31.
go back to reference Yoshikawa T, Terashima M, Mizusawa J. Reply to letter to the editor: 5-year follow-up results of a JCOG1104 (OPAS-1) phase III noninferiority trial to compare 4 courses and 8 courses of S-1 adjuvant chemotherapy for pathological stage II gastric cancer. Gastric Cancer. 2024;27:1155–6.CrossRefPubMed Yoshikawa T, Terashima M, Mizusawa J. Reply to letter to the editor: 5-year follow-up results of a JCOG1104 (OPAS-1) phase III noninferiority trial to compare 4 courses and 8 courses of S-1 adjuvant chemotherapy for pathological stage II gastric cancer. Gastric Cancer. 2024;27:1155–6.CrossRefPubMed
32.
go back to reference Vos EL, Nakauchi M, Gönen M, et al. Risk of lymph node metastasis in T1b gastric cancer: an international comprehensive analysis from the Global Gastric Group (G3) Alliance. Ann Surg. 2023;277:e339–45.CrossRefPubMed Vos EL, Nakauchi M, Gönen M, et al. Risk of lymph node metastasis in T1b gastric cancer: an international comprehensive analysis from the Global Gastric Group (G3) Alliance. Ann Surg. 2023;277:e339–45.CrossRefPubMed
33.
go back to reference Choi S, Song JH, Lee S, et al. Lymphovascular invasion: traditional but vital and sensible prognostic factor in early gastric cancer. Ann Surg Oncol. 2021;28:8928–35.CrossRefPubMed Choi S, Song JH, Lee S, et al. Lymphovascular invasion: traditional but vital and sensible prognostic factor in early gastric cancer. Ann Surg Oncol. 2021;28:8928–35.CrossRefPubMed
34.
go back to reference Park JH, Ryu M-H, Kim HJ, et al. Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer. Gastric Cancer. 2016;19:226–33.CrossRefPubMed Park JH, Ryu M-H, Kim HJ, et al. Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer. Gastric Cancer. 2016;19:226–33.CrossRefPubMed
Metadata
Title
Is Adjuvant Therapy Necessary for Stage IB Gastric Cancer: A Retrospective Cohort Study
Authors
Mingyu Gu, MS
Binghe Zhao, MS
Changda Sui, MS
Minghai Wen, MS
Xinxin Wang, MD
Publication date
07-11-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-16444-w
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