BACKGROUND: Adjuvant chemotherapy with or without radiation in patients with completely resected gastric and gastroesophageal (GE) junction cancer has been associated with better outcomes. In practice, however, there are often delays in commencing adjuvant therapy. The study aims to determine the prognostic importance of timing of adjuvant therapy in such patients. METHODS: A cohort of patients with early stage (IB-IVM0) gastric and GE junction cancer diagnosed between 2002 and 2007 in the province of Saskatchewan was assessed. Cox proportional hazard analysis was used to identify various clinic-pathological factors that correlate with disease-free survival (DFS). RESULTS: One hundred seventy-four eligible patients with a median age of 71 years (range 36-93) and M/F ratio of 113:61 were identified. Of 174 patients, 60 (35%) received adjuvant therapy. Median follow-up was 18 months (interquartile range 9-37). Twenty-eight percent received adjuvant therapy within 56 days. Median DFS of patients who received adjuvant therapy within 56 days was 37 months (95% CI 6.6-67.3) versus 33 months (95% CI 18.3-47.7) if adjuvant therapy was administered beyond 56 days (p = 0.67). On multivariate analysis, state III-IVM0 disease, hazard ratio (HR) 2.4 (95% CI 1.6-3.5), and age ≥65 years, HR 2.2 (95% CI 1.4-3.5), were significantly correlated with inferior disease-free survival. CONCLUSIONS: Only about one third of patients who received adjuvant therapy were treated within 56 days of surgery. Although stages III and IVM0 and older age were associated with inferior outcome, delay in adjuvant therapy was not associated with inferior survival.
BACKGROUND: Adjuvant chemotherapy with or without radiation in patients with completely resected gastric and gastroesophageal (GE) junction cancer has been associated with better outcomes. In practice, however, there are often delays in commencing adjuvant therapy. The study aims to determine the prognostic importance of timing of adjuvant therapy in such patients. METHODS: A cohort of patients with early stage (IB-IVM0) gastric and GE junction cancer diagnosed between 2002 and 2007 in the province of Saskatchewan was assessed. Cox proportional hazard analysis was used to identify various clinic-pathological factors that correlate with disease-free survival (DFS). RESULTS: One hundred seventy-four eligible patients with a median age of 71 years (range 36-93) and M/F ratio of 113:61 were identified. Of 174 patients, 60 (35%) received adjuvant therapy. Median follow-up was 18 months (interquartile range 9-37). Twenty-eight percent received adjuvant therapy within 56 days. Median DFS of patients who received adjuvant therapy within 56 days was 37 months (95% CI 6.6-67.3) versus 33 months (95% CI 18.3-47.7) if adjuvant therapy was administered beyond 56 days (p = 0.67). On multivariate analysis, state III-IVM0 disease, hazard ratio (HR) 2.4 (95% CI 1.6-3.5), and age ≥65 years, HR 2.2 (95% CI 1.4-3.5), were significantly correlated with inferior disease-free survival. CONCLUSIONS: Only about one third of patients who received adjuvant therapy were treated within 56 days of surgery. Although stages III and IVM0 and older age were associated with inferior outcome, delay in adjuvant therapy was not associated with inferior survival.
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