Naruhiko Ikoma1,2, Prajnan Das3, Wayne Hofstetter4, Jaffer A Ajani5, Jeannelyn S Estrella6, Hsiang-Chun Chen7, Xuemei Wang7, Rashida A Callender2, Cong Zhu2, Christina L Roland1, Keith F Fournier1, Janice N Cormier1, Paul Mansfield1, Brian D Badgwell8. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Fct17.6010, Houston, TX, 77030, USA. 2. Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Cardiac and Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 8. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Fct17.6010, Houston, TX, 77030, USA. bbadgwell@mdanderson.org.
Abstract
BACKGROUND: The benefit of preoperative chemoradiation (CXRT) over preoperative chemotherapy alone ("chemotherapy" hereafter) is unknown. By analyzing the National Cancer Database (NCDB), we investigated whether preoperative CXRT improves the incidence of primary tumor pathologic complete response (ypT0) and overall survival (OS) compared with preoperative chemotherapy in patients with gastric cancer. METHODS: Patients with non-metastatic gastric adenocarcinoma who underwent CXRT or chemotherapy followed by gastrectomy were included. Propensity score matching with a ratio of 1:1 was implemented to reduce selection bias. A conditional logistic regression model was used to compare incidences of ypT0 between groups, and Cox proportional hazards model was used to compare OS. RESULTS: We identified 8464 patients. Median patient age was 63 years; 76% were male and 79% were white. ypT0 was observed in 16.1% of patients in the CXRT group and 6.6% in the chemotherapy group (p < 0.001). After propensity score matching, a total of 2408 patients were matched. CXRT was associated with a higher incidence of ypT0 (OR 2.28, 95% CI 1.76-2.95; p < 0.0001) and higher frequency of R0 resection (92 vs. 86%; p < 0.001). However, CXRT was not associated with longer OS (HR 1.03, 95% CI 0.92-1.15; p = 0.63). Safety profiles (30-day mortality, 30-day readmission, and length of hospital stay) were equivalent between groups. CONCLUSIONS: In this study of gastric cancer patients from the NCDB, CXRT was associated with a higher incidence of ypT0 and R0 resection compared with chemotherapy, although it was not associated with a longer OS.
BACKGROUND: The benefit of preoperative chemoradiation (CXRT) over preoperative chemotherapy alone ("chemotherapy" hereafter) is unknown. By analyzing the National Cancer Database (NCDB), we investigated whether preoperative CXRT improves the incidence of primary tumor pathologic complete response (ypT0) and overall survival (OS) compared with preoperative chemotherapy in patients with gastric cancer. METHODS:Patients with non-metastatic gastric adenocarcinoma who underwent CXRT or chemotherapy followed by gastrectomy were included. Propensity score matching with a ratio of 1:1 was implemented to reduce selection bias. A conditional logistic regression model was used to compare incidences of ypT0 between groups, and Cox proportional hazards model was used to compare OS. RESULTS: We identified 8464 patients. Median patient age was 63 years; 76% were male and 79% were white. ypT0 was observed in 16.1% of patients in the CXRT group and 6.6% in the chemotherapy group (p < 0.001). After propensity score matching, a total of 2408 patients were matched. CXRT was associated with a higher incidence of ypT0 (OR 2.28, 95% CI 1.76-2.95; p < 0.0001) and higher frequency of R0 resection (92 vs. 86%; p < 0.001). However, CXRT was not associated with longer OS (HR 1.03, 95% CI 0.92-1.15; p = 0.63). Safety profiles (30-day mortality, 30-day readmission, and length of hospital stay) were equivalent between groups. CONCLUSIONS: In this study of gastric cancerpatients from the NCDB, CXRT was associated with a higher incidence of ypT0 and R0 resection compared with chemotherapy, although it was not associated with a longer OS.
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