Adjuvant Chemotherapy vs. Surgery Alone for pT3N0M0 Gastric Cancer
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Adjuvant Chemotherapy vs. Surgery Alone for pT3N0M0 Gastric Cancer Minseo Kang, MD1, Ho Geun Youn, MD2, Ji Yeong An, MD, PhD1, Min-Gew Choi, MD, PhD1, Jun Ho Lee, MD, PhD1, Tae Sung Sohn, MD, PhD1, Jae Moon Bae, MD, PhD1, and Sung Kim, MD, PhD1 1 2
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, VHS Medical Center, Seoul, Korea
ABSTRACT Background. As both the role and clinical application of adjuvant chemotherapy (CTx) for pT3N0M0 gastric cancer after curative gastrectomy have fluctuated chronologically, the oncological benefit of adjuvant CTx in patients should be elucidated. Methods. Between 2000 and 2018, 1083 patients underwent radical gastrectomy for pT3N0M0 gastric cancer and were subsequently divided into two groups: the surgeryalone group (n = 471) and the adjuvant CTx group (n = 612). Chronological changes in adjuvant CTx and various chemotherapeutic regimens were evaluated and disease-free survival was compared between the two groups. Risk factors for tumor recurrence were also analyzed. Results. The proportion of patients in the surgery-alone group was more than 60% until 2001, whereas in the CTx group this increased to over 80%, especially after publication of the American Joint Committee on Cancer (AJCC) 7th edition staging manual. The main chemotherapeutic agents were tegafur-uracil (UFT) and 5-fluorouracil with leucovorin until 2008, whereas tegafur/gimeracil/oteracil (TS-1) has been the main agent since 2009. The 5-year disease-free survival was 89.2% in the surgery-alone group
Minseo Kang and Ho Geun Youn have contributed equally to this work as first authors. Ó Society of Surgical Oncology 2020 First Received: 17 May 2020 Accepted: 8 August 2020 J. Y. An, MD, PhD e-mail: [email protected]
and 89.9% in the CTx group, which was not significantly different (p = 0.694). In multivariate analysis, larger tumor size (C 4.5 cm) and venous invasion were significant risk factors for tumor recurrence. In addition, adjuvant CTx did not improve the oncological outcome, even in the large tumor size group (p = 0.760) and the venous invasion group (p = 0.753). Conclusions. As adjuvant CTx did not show any oncological benefit in pT3N0M0 gastric cancer in this largescale study, it might be unnecessary for these patients after curative gastrectomy.
Recently, two large randomized trials conducted in Asia demonstrated a significant oncologic advantage of adjuvant chemotherapy (CTx) after radical gastrectomy with D2 lymph node dissection over surgery alone in patients with resectable advanced gastric cancer.1,2 Adjuvant CTx with tegafur/gimeracil/oteracil (TS-1; ACTS-GC trial) and capecitabine/oxaliplatin (CLASSIC trial) following D2 gastrectomy improved the overall survival (OS) in patients with advanced gastric cancer, especially stage II and III cancer. These two trials offered evidence supporting the adoption of adjuvant CTx after curative gastrectomy. However, in these trials, stage II
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