BACKGROUND AND OBJECTIVES: Various adjuvant chemotherapy regimens have been proposed for patients with advanced gastric cancer; however, the majority of these trials failed to show a clear survival benefit over surgery alone. In this study, the feasibility and efficacy of a strategy of extended surgery combined with individualized adjuvant chemotherapy for advanced gastric cancer with serosal invasion and nodal involvement was examined. PATIENTS AND METHODS: Sixty-four patients with advanced gastric cancer underwent gastrectomy with extended lymph node dissection. After surgery, a chemosensitivity test by MTT assay, using highly purified tumor cells, was performed, and the patients received individualized adjuvant chemotherapy on the basis of the results of this chemosensitivity test. RESULTS: Overall survival in the chemosensitivity-guided chemotherapy (CSC) group was significantly better than the standard chemotherapy (SC) and the no-chemotherapy (NC) group (p<0.05). In patients with stage IV disease, the 5-year survival rate was 38.1% in the CSC group and 0% in the SC + NC group, respectively, with a significant difference being observed in the two survival curves (p<0.01). In patients with paraaortic node involvement, survival in the CSC group was significantly better than that in the SC + NC group (p<0.01). On the other hand, in patients without paraaortic node involvement, no survival difference was observed between the two groups. CONCLUSION: The strategy of extended surgery combined with individualized adjuvant chemotherapy offers a favorable survival outcome for advanced gastric cancer patients with serosal invasion and nodal involvement.
BACKGROUND AND OBJECTIVES: Various adjuvant chemotherapy regimens have been proposed for patients with advanced gastric cancer; however, the majority of these trials failed to show a clear survival benefit over surgery alone. In this study, the feasibility and efficacy of a strategy of extended surgery combined with individualized adjuvant chemotherapy for advanced gastric cancer with serosal invasion and nodal involvement was examined. PATIENTS AND METHODS: Sixty-four patients with advanced gastric cancer underwent gastrectomy with extended lymph node dissection. After surgery, a chemosensitivity test by MTT assay, using highly purified tumor cells, was performed, and the patients received individualized adjuvant chemotherapy on the basis of the results of this chemosensitivity test. RESULTS: Overall survival in the chemosensitivity-guided chemotherapy (CSC) group was significantly better than the standard chemotherapy (SC) and the no-chemotherapy (NC) group (p<0.05). In patients with stage IV disease, the 5-year survival rate was 38.1% in the CSC group and 0% in the SC + NC group, respectively, with a significant difference being observed in the two survival curves (p<0.01). In patients with paraaortic node involvement, survival in the CSC group was significantly better than that in the SC + NC group (p<0.01). On the other hand, in patients without paraaortic node involvement, no survival difference was observed between the two groups. CONCLUSION: The strategy of extended surgery combined with individualized adjuvant chemotherapy offers a favorable survival outcome for advanced gastric cancerpatients with serosal invasion and nodal involvement.