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01-12-2017 | Original Article

Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer

Authors: Georgios Karagkounis, Malcolm Hart Squires III, Marcovalerio Melis, George A. Poultsides, David Worhunsky, Linda X. Jin, Ryan C. Fields, Gaya Spolverato, Timothy M. Pawlik, Konstantinos I. Votanopoulos, Edward A. Levine, Carl Schmidt, Mark Bloomston, Clifford S. Cho, Sharon Weber, Antonio Masi, Russell Berman, H. Leon Pachter, Charles A. Staley, Elliot Newman, Shishir K. Maithel, Ioannis Hatzaras

Published in: Journal of Gastrointestinal Surgery | Issue 12/2017

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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Title: Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer
Authors: Georgios Karagkounis
Malcolm Hart Squires III
Marcovalerio Melis
George A. Poultsides
David Worhunsky
Linda X. Jin
Ryan C. Fields
Gaya Spolverato
Timothy M. Pawlik
Konstantinos I. Votanopoulos
Edward A. Levine
Carl Schmidt
Mark Bloomston
Clifford S. Cho
Sharon Weber
Antonio Masi
Russell Berman
H. Leon Pachter
Charles A. Staley
Elliot Newman
Shishir K. Maithel
Ioannis Hatzaras
Publication date: 01-12-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3594-8

At a glance: The STEP trials

Springer Medicine

Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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