Brian Badgwell1, Mariela Blum2, Jeannelyn Estrella3, Yi-Ju Chiang4, Prajnan Das5, Aurelio Matamoros6, Keith Fournier4, Paul Mansfield4, Jaffer Ajani2. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: bbadgwell@mdanderson.org. 2. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX. 4. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 6. Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND: The purpose of this study was to determine the overall survival (OS) of patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. STUDY DESIGN: The medical records of patients with gastric adenocarcinoma presenting to our institution (January 1995 to August 2012) were reviewed to identify patients who underwent diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy. Associations between various clinicopathologic factors and OS were examined with Cox proportional hazards models. RESULTS: Of 192 patients who met inclusion criteria, 103 (54%) required total gastrectomy. One hundred sixty-eight patients (88%) had an extended lymph node dissection, 26 (14%) had resection of adjacent organs, and 178 (93%) had an R0 resection. Median follow-up time for surviving patients was 4.2 years. Median OS for all patients was 5.8 years, and 5-year OS rate was 56%. Multivariable Cox regression model results identified variables associated with diminished OS including age ≥ 65 years (hazard ratio [HR] 1.62; 95% CI 1.05 to 2.51), male sex (HR 1.76; 95% CI 1.13 to 2.74), adjacent organ resection (HR 1.97; 95% CI 1.16 to 3.35), R1 status (HR 2.29; 95% CI 1.17 to 4.48), pathologic N1 stage (HR 1.92; 95% CI 1.24 to 2.98), N2 stage (HR 2.58; 95% CI 1.01 to 6.58), and N3 stage (HR 6.54; 95% CI 2.69 to 15.93). Five-year OS rates for patients with pathologic N0, N1, N2, and N3 disease were 67%, 42%, 43%, and 0%, respectively. CONCLUSIONS: Patients with gastric cancer who undergo diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy have a high frequency of obtaining an R0 resection and excellent OS rates. Nodal status after surgery remains an important determinant of OS.
BACKGROUND: The purpose of this study was to determine the overall survival (OS) of patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. STUDY DESIGN: The medical records of patients with gastric adenocarcinoma presenting to our institution (January 1995 to August 2012) were reviewed to identify patients who underwent diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy. Associations between various clinicopathologic factors and OS were examined with Cox proportional hazards models. RESULTS: Of 192 patients who met inclusion criteria, 103 (54%) required total gastrectomy. One hundred sixty-eight patients (88%) had an extended lymph node dissection, 26 (14%) had resection of adjacent organs, and 178 (93%) had an R0 resection. Median follow-up time for surviving patients was 4.2 years. Median OS for all patients was 5.8 years, and 5-year OS rate was 56%. Multivariable Cox regression model results identified variables associated with diminished OS including age ≥ 65 years (hazard ratio [HR] 1.62; 95% CI 1.05 to 2.51), male sex (HR 1.76; 95% CI 1.13 to 2.74), adjacent organ resection (HR 1.97; 95% CI 1.16 to 3.35), R1 status (HR 2.29; 95% CI 1.17 to 4.48), pathologic N1 stage (HR 1.92; 95% CI 1.24 to 2.98), N2 stage (HR 2.58; 95% CI 1.01 to 6.58), and N3 stage (HR 6.54; 95% CI 2.69 to 15.93). Five-year OS rates for patients with pathologic N0, N1, N2, and N3 disease were 67%, 42%, 43%, and 0%, respectively. CONCLUSIONS:Patients with gastric cancer who undergo diagnostic laparoscopy, preoperative chemoradiation, and gastrectomy have a high frequency of obtaining an R0 resection and excellent OS rates. Nodal status after surgery remains an important determinant of OS.
Authors: Naruhiko Ikoma; Jeannelyn S Estrella; Wayne L Hofstetter; Jaffer A Ajani; Keith F Fournier; Paul F Mansfield; John M Skibber; Brian D Badgwell Journal: J Gastrointest Surg Date: 2018-07-27 Impact factor: 3.452
Authors: Milan Vošmik; Jan Laco; Igor Sirák; Josef Dvořák; Petr Lochman; Miroslav Hodek; Petra Malá; Stanislav Rejchrt; Rudolf Repák; Michal Leško; Alexander Ferko; Aleš Ryška; Bohuslav Melichar; Jiří Petera Journal: Pathol Oncol Res Date: 2017-05-27 Impact factor: 3.201
Authors: Naruhiko Ikoma; Mariela Blum; Jeannelyn S Estrella; Prajnan Das; Wayne L Hofstetter; Keith F Fournier; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: Gastric Cancer Date: 2017-06-22 Impact factor: 7.370
Authors: Alexander P Stark; Mariela M Blum; Yi-Ju Chiang; Prajnan Das; Bruce D Minsky; Jeannelyn S Estrella; Jaffer A Ajani; Brian D Badgwell; Paul Mansfield; Naruhiko Ikoma Journal: J Gastric Cancer Date: 2020-09-17 Impact factor: 3.720
Authors: Naruhiko Ikoma; Jeannelyn S Estrella; Mariela Blum Murphy; Prajnan Das; Bruce D Minsky; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: J Gastrointest Surg Date: 2020-06-15 Impact factor: 3.452
Authors: Patricia Martin-Romano; Jose J Sola; Juan A Diaz-Gonzalez; Ana Chopitea; Yohana Iragorri; Fernando Martínez-Regueira; Mariano Ponz-Sarvise; Leire Arbea; Jose C Subtil; David Cano; Lucia Ceniceros; Jairo Legaspi; Jose Luis Hernandez; Javier Rodríguez Journal: Br J Cancer Date: 2016-08-18 Impact factor: 7.640